Week 2
The CODES "R", "A", and "X" on SCDB
What is Disability Insurance, Unemployment Insurance, and Paid Family Leave
The 12-month period which ended five months or two quarters prior to the CED
What is the base period?
What is 7 days?
The six factors influencing the CED
What is last day worked, care and treatment, late file, recovery home, drug free facility, and not disabled
Clmt's last name on SDIO is off by one letter from SCDB because the system misread the paper 01A. Determine the identifier to assign the clmt.
What is the SSN?
Protects SDI rate payers, SDI field office staff, and SDI claimant
What is Program Integrity?
A tool to cause the system to create and send a reminder of a necessary action to be taken or to verify the receipt of a pending response
What is a suspense work item?
Information the system needs for you to update the RPU tab besides the dates and amount received?
What is the R&C (Normal hours worked per week prior to becoming disabled and hourly rate)?
Requested CED 01/15/2021
Clmt DDB 12/10/2020
determine the comp year
What 0?
The claim fails for possible VP liability. You find the ER on VPDB. Name the group the work item will be forwarded to.
what is (Voluntary Plan Group) VPG?
What screen of SCDB gives you the DI claim payment history inquiry?
D0306
The first 7 days of a claim, which are non-compensable
What is the waiting period?
conflicts with DI benefits when paid for the same body part
What is WC PD?
Identify the type of spell using the following information. Clmt had an initial claim CED 12/05/2020 due to vomiting during pregnancy. clmt released to go back to work on 12/26/2020 prior to delivery. Clmt now back on disability for normal pregnancy with CED 02/14/2021.
A new claim with CED of 12/11/2020 is submitted for back spasm. Determine the spell of the new claim.
What is same spell?
slide 12 of S/S module
The tab in SDIO to update pregnancy information
What is duration management?
A claim that has no money in the Base Period upon which the benefits can be computed and therefore has no benefit dollars associated with it
What is an Invalid Claim?
Reason needed when qualifying dates within the original WP after a CED change
What is CED?
A private alternative that an employer may offer to their California employees, as a legal alternative to the SDI and PFL programs
What is a Voluntary Plan?
To establish medical eligibility, the claim must have an ICD or CPT code and a diagnosis. The criteria for a diagnosis is met with what information.
What is ICD/CPT code?
The suffix that means pain.
What is -algia?
Give the base period used for a claim with a CED of 06/01/2020
What is 2019-4, 2019-3, 2019-2, and 2019-1?
The only taxable UDA code
What is UDA 7?
The DQ's (including dates) and adjusted CED for a claim with the following information. CED requested 11/19/20 LDW 11/19/20 C&T 12/23/20 DDB 12/23/20 PX 02/23/21 P/P and clmt signed 01/13/21
New CED 12/16/2020
DQ 1716 (11/19/2020 to 11/25/2020)
DQ 1717 (11/19/2020 to 11/19/2020)
DQ 1718 (11/19/2020 to 12/15/2020)
Find the WBA for claim with CED 12/01/2020. The base period is
19-3 19-4 20-1 20-2
21,111 20,111 21,500 21,000
**2020 rate is 17,225 and 23.3% of SAWW is $309
What is $993?
BPHQW is 21,500, which is more than 929. When multiplied by 3, is more than 17,225.Therefore, we use 60%