EMPLOYEE HANDBOOK
FOR
WORKERS’ COMPENSATION
MARSHALL PUBLIC SCHOOLS
MISSOURI
Dear Employee:
The District School Board of Marshall Public Schools goal is to provide you a safe working environment. We realize that occasionally an accident occurs at work; therefore, we have teamed up with Missouri United School Insurance Council (M.U.S.I.C.) and Gallagher Bassett Services to provide you quality medical services if you are involved in a work-related accident that results in the need for medical treatment. The following workers’ compensation material will provide you with information regarding your claim for benefits and answer questions that you may have.
Your Responsibilities
1. Immediately report all work-related accidents to your supervisor.
2. If your work-related accident results in the need for medical treatment, and is not an emergency, you must immediately report the injury to your supervisor before seeking medical treatment.
If your accident is serious and requires immediate medical treatment, go to the nearest hospital for treatment or call 911. After treatment, have your supervisor, or a representative from the facility call the districts Workers’ Compensation Designee (660)886-7414.
3. Contact your supervisor to complete a notice of injury report, and obtain a workers compensation treatment authorization for medical services from Central Office. You are required to seek medical treatment at an authorized workers’ compensation network provider.
The Missouri Valley Physicians Clinic- Dr. Timothy Ryan is the District’s authorized network facility and doctor. In the event that Dr. Ryan has a full schedule, or is out of office, Missouri Valley Physicians is staffed with full-time physicians who are able to provide medical treatment for work-related injuries. Dr. Ryan, or one of these physicians will become your primary care provider for your work-related injury and in partnership with Gallagher Bassett Services will coordinate all medical care, including referral to specialists or other medical providers.
4. Pick up the Workers’ Compensation Treatment Authorization from Central Office prior to your first scheduled appointment, and return it after your appointment is complete.
5. For your convenience, workers’ compensation wall cards are posted at your work site with outlined procedures and network provider information.
6. Obtain all medical services from a provider within the District’s authorized workers’ compensation provider network. If your treating physician approves treatment by another physician you must obtain authorization from Gallagher Bassett Services, before any scheduling may be made.
7. Follow your physician’s and/or Adjuster’s instructions concerning your treatment and ask questions if you do not understand or need an explanation.
8. Provide your treating physician with complete information on your medical history and current medical problem as related to your employment.
9. Keep all scheduled appointments and be on time for all medical treatments and evaluations. You are encouraged to schedule appointments before or after your normal work schedule if possible.
10. If you choose to cancel or do not keep your scheduled appointment(s), you may be considered in non-compliance which may affect your eligibility for certain workers’ compensation benefits. Contact the nurse case manager or adjuster assigned to your case before canceling or rescheduling an approved appointment.
11. Return to work as soon as your treating physician releases you.
12. Only request medical treatment for injuries or illnesses related to your work environment.
13. Cooperate and respond to all requests from Gallagher Bassett Services regarding your work-related injury.
Workers’ Compensation Employee Bill of Rights
WHEN YOU HAVE BEEN INJURED ON THE JOB, WHAT CAN YOU EXPECT?
Your school district is a member of a self-insurance pool, Missouri United School Insurance Council, which provides
Workers’ Compensation coverage within the state of Missouri. The claims are administered by Gallagher Bassett Services
on behalf of your school district. Workers’ Compensation is basically no fault insurance for injuries that are sustained while you are within the course and scope of your employment, subject to applicable Missouri law. Benefits for injuries that are found to be compensable include payment for medical treatment, payments for lost wages, and if applicable, payments for permanent handicaps. These benefits will be explained in more detail below.
MEDICAL TREATMENT
You are required to report an injury to your employer/supervisor immediately. Your employer will then complete and file the necessary reports with the claims administrator. Your employer will arrange for your initial medical treatment and has the right to choose the treating physician. The employer is not responsible for payment of any unauthorized medical treatment. Should you receive any bills for your medical treatment at home, please forward these to your school district
administrative office or Gallagher Bassett Services immediately.
PAYMENT FOR LOST WAGES
Some injuries may keep you from working temporarily, and you will receive "temporary disability" payments until the authorized treating physician indicates you are able to return to work. Temporary disability is paid at 2/3 of your average weekly wage. Benefits do not begin until you are off work the fourth scheduled working day.
ADDITIONAL BENEFITS
If there is a permanent handicap involved with your injury – such as the loss of a finger or an eye – the treating physician will advise that you have sustained a permanent partial (referring to a portion of the body) disability relative to your injury and provide the claims administrator with his/her opinion of the amount of disability sustained. Your claim would then be set by the Division of Workers’ Compensation and a lump sum settlement made based upon the information provided by the treating physician.
WHAT IF THERE IS A PROBLEM?
If there is a problem with payment of medical bills, lost time benefits, etc., contact your employer or the claims administrator, Gallagher Bassett. Many questions can be cleared up with a phone call. If the problem still cannot be resolved, you can file a "Claim" with the Division of Workers’ Compensation. You may contact the Division at (573)751-4231 or write them at Missouri Division of Workers’ Compensation, P.O. Box 58, Jefferson City, Missouri 65102. You may file a claim yourself or consult an attorney about filing the claim. Attorneys do receive a percentage (usually 25%) of any settlement made on your behalf.
We wish you a speedy recovery. If you should have any questions relative to your medical treatment or benefits, please contact your employer immediately, or contact the representative handling your claim at the appropriate office.
Seeking Medical Treatment
If you are involved in a work-related accident that requires medical treatment, you will be sent to an approved authorized workers’ compensation provider for initial treatment. If you require a referral to a specialist, the referring doctor must contact Gallagher Bassett Services for the proper referral.
Accessing Medical Treatment After Normal Business Hours
If you are involved in a work-related accident that occurs after normal business hours and require immediate medical treatment, go to the nearest hospital emergency room or call 911.
Examples of when you should use an urgent care facility or hospital emergency room as initial treatment for a work-related injury or illness:
1. The injury or illness is life threatening.
2. You are involved in an accident at the end of the day and the injury is serious enough that you cannot wait until the next business day to seek medical treatment.
3. The work-related injury or illness occurs after normal business hours or when all District administrative offices are closed, and is serious enough for immediate medical attention.
After receiving treatment at a hospital emergency room, you must follow up with an authorized workers’ compensation network provider before returning to work. Within 24 hours of emergency treatment, call the districts Workers’ Compensation Designee (660)886-7414, to coordinate all follow-up medical treatment.
Workers’ Compensation Employee Medical Care Issues
The District School Board of Marshall Public Schools desires that each employee involved in a work-related accident receive medical benefits with high quality care and courteous customer service.
You have the right to report any problem you may have with the level of medical care you receive. You may report problems to Gallagher Bassett Services at (800)333-6137, where you may request to speak with your adjuster. Concerns will be handled telephonically with your Gallagher Bassett adjuster.
If you have any questions concerning this program or need assistance, please contact your Gallagher Bassett Services claims adjuster.
Fraud Statement
Workers’ compensation fraud occurs when any person knowingly, and with intent to injure, defraud, or deceive, any employer or employee, insurance company, or self-insured program, files false or misleading information. Workers’ Compensation fraud is a third degree felony that can result in fines, civil liability, and jail time.
SUGGESTIONS FOR MAKING YOUR CLAIM GO MORE SMOOTHLY
Communicating with Your Supervisor or the Employee Benefits, Assistance and Risk Management Department:
Communicate frequently with your supervisor and Central Office.
Notify your supervisor and Central Office of your return-to-work status, work restrictions and medical treatment plan after each doctor visit.
If you are off work, tell your supervisor and Central Office when the doctor anticipates you will be able to return to work.
If you receive restrictions for returning to work from your doctor (for example, “light duty”), ask your supervisor if they will accommodate those restrictions and allow you to return to work.
When you return to work, try to schedule your doctor’s appointments so you take minimal time away from your job. The District is not required to pay for your time out of the workday to attend doctor or therapy appointments. Let the Employee Benefits, Assistance and Risk Management Department at the district’s Central Office know if you
are having difficulty obtaining authorization for medical treatment from your claims adjuster.
Communicating with Your Adjuster:
Communicate in a positive manner. Let the adjuster know your goal is to recover and return to work. Keep the adjuster aware of any address/phone changes.
If you change or cancel a doctor’s appointment, notify Central Office immediately. The doctor’s office may not notify the adjuster or nurse case manager of your change in appointment or failure to keep an appointment.
Suggestions for Successful Physician or Health Care Provider Visits:
Be on time for your appointments.
Give your physician or health care provider as much advance notice as possible if you need to cancel your appointment. You should contact your adjuster or nurse case manager before cancelling any appointment. Have the carrier and adjuster’s name, address, telephone and fax numbers and your claim number available. Take
these with you to all your appointments.
It is very important to provide a complete description of how your injury occurred and all of your body parts affected. An incomplete record can affect your claim and benefits later. Let your doctor know your symptoms are improving, worsening or are the same.
Be thorough. Give your complete medical history, status and list of current medications for your related and non-work-related conditions.
Be prepared. Have a list of any questions or concerns you would like to discuss with your doctor.
Ask how long it will take to recover from your injury and when you can return to work, both with and without restrictions.
Ask about alternative or less invasive treatment options. Follow your doctor’s treatment plan.
Keep copies of all your medical records including lab and x-ray results, and keep copies of your CT scans and MRI’s. If you see a new physician, take your medical records with you. While some offices will forward these to your new physicians, it is better to be prepared so you are not unnecessarily going to an appointment where they cannot assist you due to incomplete information.
Procedures to report injuries to Gallagher Bassett Services is separate from your regular group health insurance. Notify your supervisor of your work-related injury immediately when possible, or within 24 hours of injury.
Workers’ Compensation Contacts
District School Board of Marshall Public Schools860 West Vest Street Marshall, MO 65340 Phone: (660)886-7414
Gallagher Bassett Services 1630 Des Peres Road – Suite 200
01.08.15
01.08.15
