Discuss AHIP AHM-530 Exam Topic 1 Question 60

Grant Pelham is covered by both a workers' compensation program and a group health plan provided by his employer. The Shipwright Health Plan administers both programs. Mr. Grant was injured while on the job and applied for benefits.

Because Mr. Pelham was injured on the job, he is entitled to receive benefits through workers' compensation. Under the terms of the state-mandated exclusive remedy doctrine included in the workers' compensation agreement, Mr. Pelham will most likely be prohibited from

AReceiving workers' compensation benefits unless he can show that the employer was at fault for his injury

BObtaining care from providers who are not members of a workers' compensation network

CSuing his employer for additional benefits

DClaiming benefits from both workers' compensation and his group health plan

Suggested Answer: C

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13 comments · newest first

Edna 12 months ago

I thought he could sue if the employer was negligent?

Galen 1 year ago

B is misleading, he can see non-network providers sometimes.

Augustine 1 year ago

Wait, can he really not claim both benefits?

Kristofer 1 year ago

Totally agree, C is the right choice!

Dorothy 1 year ago

Workers' comp usually means no suing the employer.

Nan 1 year ago

I feel like I might be mixing up the details, but I think the exclusive remedy doctrine prevents suing the employer. So, I guess option C sounds right, but I’m not 100% sure.

Zona 1 year ago

I practiced a similar question about workers' compensation benefits last week. I remember that you can't claim benefits from both the workers' comp and health plan, but I think that was a different context.

Onita 1 year ago

I’m not entirely sure, but I think workers' compensation is supposed to be the only remedy for job-related injuries. That makes me think option C is correct, but I could be wrong.

Gilma 1 year ago

I remember discussing the exclusive remedy doctrine in class, and I think it means you can't sue your employer for additional benefits. So, I’m leaning towards option C.

Glenn 1 year ago

This one seems pretty straightforward. The key is to focus on network performance factors that could impact the client-side application, given the remote location of the database server.

Lenna 1 year ago

I think the key here is to understand how policies are applied in an offline scenario. I'll need to carefully consider the options and think through the implications of each.

Beckie 1 year ago

Okay, let me think this through. I believe the arbiter's role is to direct the shadow controller to begin managing the platform if the controller fails. That sounds like the most logical answer to me.

Chaya 1 year ago

I seem to recall that "delay" isn't really relevant for LDAP queries, so maybe it's not a choice here.

AHIP AHM-530 Exam - Topic 1 Question 60 Discussion