Contents__________________________________
HR Center Series
Workers Compensation
I.
Workers’ Compensation – An Overview by Tina Ott Chiappetta……….2
II.
Changes in Workers’ Compensation Laws During 2001, by Glenn Whittington, Chief,
Branch of Planning Policy and Standards, U.S. Department of Labor, Office of Workers’
Compensation Programs………5
Policies & Programs
III.
State of New Hampshire Program: Frequently Asked Questions, Medical Form and Task
Analysis………...……….……11
IV.
Commonwealth of Kentucky Program………16
V.
Alexandria, Virginia Sanitation Authority……….……….20
VI.
Multnomah County, Oregon………30
i.
Policy for Management Employees……….30
ii.
Policy for Collective Bargaining Employees……….………..34
Workers’ Compensation – Overview
By Tina Ott Chiappetta
Workers’ compensation laws provide benefits to workers who are injured on the job or who contract a work-related illness. States design and administer their own workers’ compensation programs and the federal
government has a program that covers federal employees. Most states adopted workers’ compensation programs early in the twentieth century. It is a strict liability system - workers will recover for work-related injuries or illnesses regardless of who is at fault. Workers benefit because they do not need to go to court to prove that the employer was negligent. In exchange, employers’ liability is limited by the terms set out in the law.
Because each state and the federal government have their own programs, they differ significantly. However, the programs do have some similarities. Most programs are mandatory for all employers except in Texas, where participation is optional. In addition, some state and local government employees may not be covered,
particularly police and fire employees who are covered by other insurance programs. Other groups such as very small private employers and those in agriculture are exempt or participation may be optional. The programs provide a level of wage replacement, less than 100%, for a limited amount of time, medical benefits, and benefits for permanent injuries or death. Many workers can be required to return to a light duty position prior to full recovery or risk losing benefits all together.
In 2000, 126.6 million workers were covered under various workers’ compensation programs and $45.9 billion in benefits were paid.i This was a 6.4% increase over benefits paid in 1999, and is the single largest percentage
increase since 1992. However, for the eighth year in a row, the workers’ compensation benefits and costs declined relative to wages. This is likely due to strong wage rates and fewer reported accidents, according to a report issued by the National Academy of Social Insurance (NASI). ii
Employer costs for 2000 were estimated at $56 billion; relative to total wages this represented a decline of 1.25% from 1999. Costs soared during the 1980’s and early 1990’s but then began to decline. NASI offers a variety of reasons for this including the introduction of managed care in the early 1990s. Among other possible reasons for the decline in costs are: states limiting eligibility of workers for the programs, fewer accidents, improvements in program operation, active management of medical treatment to reduce length of medical care, and a reduction in generosity of benefits.
Cost containment continues to be an issue of concern for many employers, especially in light of rising health care costs. A report of the Workers’ Compensation Research Institute (WCRI), found that jurisdictions have moved away from implementing new cost containment strategies and are instead looking at ways to evaluate the impact of current programs.iii In particular, no new jurisdiction has mandated the use of managed care in treating
workers’ compensation injuries since 1997 and some jurisdictions have actually eliminated the requirement. The most common cost containment method is limiting an employee’s ability to choose or change medical providers. One jurisdiction, the state of Colorado, has developed a repetitive motion injury cost reduction program. Since 1991, repetitive motion injuries, such as carpal tunnel syndrome, tendonitis, chronic back and neck pain, have accounted for approximately 25% of the state’s reported work-related injuries. The state’s Safety and Loss Control Team saw the numbers and realized that they needed to take action. The traditional medical approach of treating the symptoms and then returning employees to work – often in the same position with the same work habits, did nothing to reduce costs.
The three person Safety and Loss Control Team began traveling the state performing ergonomic evaluations. The evaluations analyzed problems and corrected them. In an effort to broaden the program, they instituted the Repetitive Motion Injury Cost Reduction Program or RMICRP. The program has three distinct components:
• A train-the-trainer course allowing the ergonomics program to be spread beyond the three person Safety and Loss Control Team;
• A web-based “Online Repetitive Motion Injury Prevention” course; and
2
• “Trauma Release Techniques” TRT (trademark), an alternative and highly effective, on-site, hands-on, treatment derived from Rolfing, which is a deep tissue manipulation system.
One of the most impressive aspects of the program has been the result. A pilot program showed a significant decrease in cost per case. Sixty nine cases in fiscal year 200 had an average cost per case treated by traditional medicine of $2,622.15, while the average case treated by TRT was a mere $409.50. There was also a drastic decrease in lost work time and claims were closed much faster. For more information on the Colorado program, please read the slide presentation and brochure included in this HR Center Series Packet.
The materials that follow are designed to provide you with information about workers’ compensation programs, provide sample policies and programs, and provide additional resources for further research. IPMA is always updating the HR Center Series and welcomes information about your workers’ compensation program. Please forward materials to: IPMA's Research Department or call (703) 549-7100. Below is a list of additional resources:
• The United States Department of Labor (DOL), Office of Workers’ Compensation Programs, maintains a web site with detailed information on federal workers’ compensation programs as well as a list of state workers’ compensation programs and links to the state’s web site. Almost, if not all, states maintain their
information online.
• The National Academy of Social Insurance (NASI) conducts annual surveys of state workers’
compensation programs. NASI began this research after the U.S. Social Security Administration (SSA) discontinued its research of state workers’ compensation programs in 1995. .
• The Workers’ Compensation Research Institute (WCRI) is an independent, non-profit organization that studies workers’ compensation issues. The WCRI has a benchmarking study that may be of interest to IPMA members.
Monthly Labor Review January 2002 31
Workers' Compensation, 2001
Changes in workers' compensation
laws during 2001
Workers’ compensation coverage was extended
to certain law enforcement and public safety officers,
but excluded from some sports officials, inmates,
musicians, and horse trainers
Glenn Whittington
Glenn Whittington is Chief, Branch of Planning Policy and Standards, Office of Workers’ Compensation Programs, Employment Standards Administration, U.S. Department of Labor. e-mail: [email protected]
T
he issue of coverage under workers’ compensation laws received a great deal of attention in 2001. For example, extending presumptions of coverage for certain dis-eases suffered by law enforcement officers or firefighters, or both, occurred in Arizona, California, Florida, Maryland, and Virginia. On the other hand, sports officials, State prisoners and county inmates in Florida, musicians in Louisiana, horse trainers in Montana, and soccer referees in Oregon were ex-cluded from coverage.In gearing up for the Winter Olympic games, Utah is pro-viding workers’ compensation coverage for law enforcement/ public safety volunteers and paid officers who provide public safety services.
In Idaho, infectious hepatitis and tuberculosis are now con-sidered “occupational diseases” in any occupation involving exposure to human blood or body fluids.
In Nevada, if a person contracts a contagious disease dur-ing the course and scope of his employment that results in a
temporary or permanent disability or death, the disease is deemed to be an occupational disease and compensable if certain conditions are met.
In Georgia, the weekly maximum benefit for temporary total disability increased to $400 and the minimum to $40 (up from $375 and $37.50, respectively). Also in Georgia, the weekly maximum for temporary partial disability was increased to $268 from $250. In Louisiana, the amount of benefits paid to each surviving parent in a no-dependency death claim was increased to $75,000 from $20,000. In Wyo-ming, the amount of permanent total disability and death benefits awarded to dependent children was increased to $150 from $100 per month. Future payments are to be ad-justed annually for inflation.
Maximum burial allowances increased to $3,500 in North Carolina.
The following is a State-by-State summary of significant changes to workers’ compensation laws.
Arizona
Any party to a claim for partial disability and permanent total disability now has 90 days (previously 60 days) from the time the Commission mails a copy of its determina-tion to all parties to request a hearing.
Any disease, infirmity, or impairment of a firefighter’s health that is caused by brain, bladder, rectal or colon cancer, lym-phoma, leukemia, or aden carcinoma or mesothelioma of the respiratory tract that results in disability or death is presumed to be an occupational disease and is deemed to arise out of the employment if certain requirements are met. Among them are that the firefighter must have passed a physical examination before employment and that the examination did not indicate evidence of cancer; the firefighter was
as-signed to hazardous duty for at least 5 years; and that the firefighter was exposed to a known carcinogen as defined by the International Agency for Research on Can-cer, informed the department of this expo-sure, and the carcinogen is reasonably re-lated to the cancer.
Arkansas
Personnel assigned to the Workers’ Com-pensation Fraud Investigation Unit, upon meeting the qualifications established by
32 Monthly Labor Review January 2002 Workers' Compensation, 2001
the Arkansas Commission on Law En-forcement Standards and Training, shall have the powers of specialized law en-forcement officers of the State for the pur-pose of conducting investigations.
The burden of proof connecting em-ployment with an occupational disease is now established by a “preponderance” of evidence rather than “clear and convinc-ing” evidence.
A hospital, physician, or healthcare pro-vider is prohibited from billing or attempt-ing to collect any fee for services rendered to an employee due to a workers’ compensa-tion injury when a claim has been filed and notification of filed claim has been provided. Such provider is also prohibited from re-porting to any credit rere-porting agency the employee’s failure to make the payment. When an injury has been found to be non-compensable, any unpaid portion of a bill may then be pursued.
The schedule for attorneys’ fees was changed from the sliding scale, based on the amount of compensation awarded, to a set 25 percent of compensation for in-demnity benefits payable to the injured employee or dependents of a deceased employee.
California
The presumption that a hernia, heart trouble, or pneumonia arose out of and in the course of employment was extended to members of the California Highway Patrol. For law enforcement officers and fire department employees, the definition of “injury” was extended to include a blood-borne infectious disease.
For active lifeguards employed for more than 3 consecutive months in a calendar year by certain local agencies and the Department of Parks and Recreation, the term “injury” now includes skin cancer that develops or manifests itself during the period of the lifeguard’s employment.
A healthcare provider or licensed healthcare facility can now contract with a contracting agent, employer, or insur-ance carrier for reimbursement rates that are different from the official medical fee schedule.
Whenever an employer or insurer em-ploys an individual or contracts with an en-tity to conduct a review of a billing
submit-ted by a physician or medical provider, the employer or insurer must make available to that individual or entity all documentation submitted together with that billing by the physician or medical provider.
Medical treatment for a work-related injury may be provided by a State-licensed physician assistant or nurse practitioner. This includes the authority to authorize the patient to receive time off from work for a period not to exceed 3 calendar days if that authority is included in a standard-ized procedure or protocol approved by the supervising physician.
Connecticut
The mileage reimbursement rate for the use of a privately owned vehicle necessary for an employee to receive medical attention will now be at the rate equal to the Federal mile-age reimbursement rate.
The State’s Attorney General is now au-thorized to bring action in Superior Court against any employer, carrier, or risk man-agement agency that fails to comply with the Second Injury Fund reporting requirements. An employer- or insurer-sponsored medi-cal plan must contain a list of all pharmacies that will provide services under the plan.
The time limit for appealing a commissioner’s decision was extended to 20 days, up from 10.
Delaware
The time for either party to appeal a notice of award was increased to 30 days from 20. The “cap” on attorneys’ fees that can be awarded by the Industrial Accident Board was changed from $2,250 to a sliding scale based upon the average weekly wage as an-nounced annually by the State’s Secretary of Labor. This presently places the “cap” at $6,744.
An employer or its carrier is to notify the Department and claimant, in writing, of its acceptance or denial of an employee’s claim within 15 days from the date of its receipt of knowledge that the employee sus-tained a work-related injury. Also, all medi-cal expenses are to be paid by the employer or carrier within 30 days of receipt unless notification is provided that the expenses are being contested or further verification is required.
Florida
The definition of “employee” excludes a per-son who performs services as a sports offi-cial for interscholastic sports events, or ama-teur sports events sponsored by nonprofit organizations. The term “employment” ex-cludes services performed by state prison-ers or county inmates, except those perform-ing services for private employers.
For a public employer to be eligible for special premium rates, they must have a workplace safety program. If authorized by the employee, compensation payments may be deposited directly into the employee’s account at a financial institution. Upon written request, the employee is en-titled to one change of physician during the course of treatment for any one accident.
If lost wages from concurrent employ-ment are used in calculating the average weekly wage, the employee is responsible for providing information concerning the loss of earnings from the concurrent employment. A claimant, represented by counsel, may waive all rights to benefits by entering into a settlement agreement releasing the employer and carrier from liability in exchange for a lump-sum payment to the claimant. In such settlements, only the attorney’s fee is sub-ject to approval by the judge of compensa-tion claims. The exempcompensa-tion of workers’ com-pensation claims from creditors does not ex-tend to claims based on an award of child support or alimony.
An injury to a law enforcement officer while on duty or while going to or coming from work in an official law enforcement ve-hicle shall be presumed to be an injury arising out of and in the course of employment un-less the injury occurred during a distinct de-viation for a non-essential personal errand.
Georgia
The weekly maximum for temporary total disability benefits increased to $400 from $375, and the minimum to $40 from $37.50. The weekly maximum for temporary partial disability was increased to $268 from $250. Upon determining that proceedings were brought, prosecuted, or defended without reasonable grounds, the administrative law judge or the board may, in addition to reason-able attorney’s fees, award to the adverse party reasonable litigation expenses against the offending party.
Monthly Labor Review January 2002 33
The list of physicians the employer must maintain who are reasonably acces-sible to employees increased to 6 from 4. All reasonable charges for medical, surgical, hospital, and pharmacy goods and services are payable by the employer or its work-ers’ compensation insurer within 30 days from the date the employer or insurer re-ceives the charges and reports.
Idaho
Infectious hepatitis and tuberculosis are now considered “occupational diseases” in any occupation involving exposure to hu-man blood or body fluids.
Iowa
A limited liability partner may elect to be covered by the workers’ compensation law.
Kansas
“Usual charge” means the amount most commonly charged by healthcare providers for the same or similar services while “cus-tomary charge” means the usual rates or range of fees charged by healthcare provid-ers in a given locale or area.
The average gross weekly wage of a per-son serving on a volunteer basis as a duly authorized law enforcement officer, ambu-lance attendant and driver, or firefighter, who receives no wages for such services, or who receives wages that are substantially less than the usual wages paid for such ser-vices, is now computed on the basis of the dollar amount closest to but not exceeding 112.5 percent of the State average weekly wage. The average weekly wage of any other volunteer who receives no wages for such services, or who receives wages that are substantially less than the usual wages paid for such services by comparable em-ployers to employees who are not volun-teers, are to be computed on the basis of the usual wages paid by the employer for such services to employees who are not volunteers.
Louisiana
The amount of benefits to be paid to each surviving parent in a no-dependency
death claim was increased to $75,000 from $20,000.
If upon release by a physician to re-turn to work, the employee fails a drug test, benefits, with the exception of rea-sonable and necessary medical treatment, may be terminated subject to the terms a n d c o n d i t i o n s e s t a b l i s h e d i n t h e employer ’s promulgated drug testing policy and program.
In calculating an employee’s wage, any amount withheld by the employer to fund any health insurance benefit provided by the employer, and which was elected by the employee in lieu of taxable earnings, is to be included.
Constitutional challenges to the Work-ers’ Compensation Act are now recog-nized if they meet established filing pro-cedures. An award of temporary total disability benefits may be modified by the filing of a motion for modification with the same court that awarded the ben-efits and under the same caption and docket number without the necessity of filing a new dispute and appearing at a mediation conference.
The time limit for filing a claim for disability arising from an occupational disease was increased to 1 year from 6 months.
Musicians and performers who are rendering services pursuant to a perfor-mance contract are exempt from workers’ compensation coverage.
F o r p u r p o s e s o f d e t e r m i n i n g a n employee’s average weekly wage in an oc-cupational disease claim, the date of the “accident” shall be the date of the employee’s last employment with the employer from whom benefits are being claimed or the date of last injurious expo-sure to employment conditions, which-ever date occurs later.
Maine
The amount of medical insurance cover-age required for an agricultural employer to be exempt from workers’ compensa-tion coverage was increased to $5,000 from $1,000.
The Supplemental Benefits Fund was created to provide reimbursement for the payment of workers’ compensation ben-efits in excess of 260 weeks. Previously,
these reimbursements were made from the Employment Rehabilitation Fund.
Maryland
A decision rendered by the Workers’ Com-pensation Commission is to be sent to each party’s attorney of record or, if the party is unrepresented, to the party.
For purposes of workers’ compensa-tion coverage, the definicompensa-tion of “public safety employee” was expanded to in-clude a Prince George’s County deputy sheriff.
If an award of permanent partial dis-ability compensation is reversed or modi-fied by a court of appeal, the payment of any new compensation awarded shall be subject to a credit for compensation pre-viously awarded and paid.
Each employer that self-insures must establish a toll-free telephone number through which an employee or claimant, or a representative of an employee or claimant, may make direct telephone in-quiries during regular business hours.
Michigan
In response to a request that pertains to a specific employer and includes the employer’s address and the date of injury of the claim for which information is re-quested, the bureau may disclose the name and address of the insurer that, according to the records of the bureau, provided cover-age on the date of injury, but shall not dis-close the effective date or expiration date of the policy.
Montana
The Workers’ Compensation Act does not apply to employment of a trainer, assis-tant trainer, exercise person, or pony per-son who is performing services under a li-cense issued by the board of horseracing while on the grounds of a licensed race meet. The waiting period for receiving tem-porary total disability benefits was re-duced from 6 to 5 days, and for shift work from 48 to 40 hours.
A worker requalifies for temporary to-tal disability benefits if a modified or alter-native position is no longer available to the
34 Monthly Labor Review January 2002 Workers' Compensation, 2001
worker for any reason, except for the worker’s incarceration, resignation, or ter-mination for disciplinary reasons caused by a violation of the employer’s policies that provide for termination of employment.
If an employee is intentionally injured by an intentional and deliberate act of the employee’s employer or by the inten-tional and deliberate act of a fellow em-ployee while performing the duties of employment, the employee or, in case of death, the employee’s heirs have a cause of action for damages against the person whose intentional and deliberate act caused the intentional injury.
Nevada
An officer or manager of a quasi-public or private corporation, or a limited liability company who owns the entity, operates it exclusively from his primary residence, and receives pay for services performed, may elect to reject coverage for himself by filing written notice with the insurer.
If a person employed in the State con-tracts a contagious disease during the course and scope of his employment that results in a temporary or permanent disability or death, the disease is deemed to be an occu-pational disease and compensable if certain conditions are met. “Contagious disease” means hepatitis A, B, and C, tuberculosis, the human immunodeficiency virus or ac-quired immune deficiency syndrome.
If a treating physician or chiropractor refers an injured employee to a specialist for treatment, the treating physician or chi-ropractor must provide to the injured em-ployee a list that includes the name of each physician or chiropractor with that spe-cialization who is available pursuant to the terms of the contract with the organization for managed care or with providers of healthcare services. The injured employee may select someone from that list.
New Hampshire
Scheduled permanent impairment awards can now be given for an injury to the brain or from scarring, disfigurement, or other skin impairment resulting from a burn or burns. A mental injury is not compensable un-der the Workers’ Compensation Act if such mental injury results from any disciplinary
action, work evaluation, job transfer, lay-off, demotion, termination or similar action, taken in good faith by the employer.
Any State employee injured in the line of duty by a hostile or overt act that causes hospitalization or renders the employee temporarily unable to perform the duties of his or her position shall remain on active payroll and not be charged annual or sick leave for the time lost due to the injury.
When an insurance carrier, self-insurer, or payor, acting on behalf of such carrier or self-insurer, disputes the causal relation-ship of a medical bill to the claimant’s in-jury, and denies payment of such bill, and is after a hearing ordered to pay or reim-burse the bill by the Commissioner, the employee shall be entitled to reimbursement of reasonable counsel fees and costs as ap-proved by the Commissioner.
North Carolina
Burial expenses were increased to $3,500 from $2,000.
An insurer that covers an employee under a health benefit plan, a disability income plan, or any other health insur-ance plan is not a real party in interest and shall not participate in any proceed-ing or settlement agreement to determine compensability of a claim. The insurer that covers an employee under a health benefit plan or any other health insur-ance plan may seek reimbursement from the employee, employer, or carrier that is liable or responsible for the specific medical charge according to a final adjudi-cation of the claim or an order of the Com-mission approving a settlement.
North Dakota
The bureau may now pay for preventa-tive treatment for significant exposures documented by emergency medical ser-vice providers or employees of licensed facilities, and for exposure to rabies oc-curring in the course of employment.
An employer may not require an em-ployee to use sick or annual leave, or other employer-paid time off work, before ap-plying for or receiving workers’ compen-sation benefits. However, an employer may allow an employee to use sick or annual leave to make up the difference
between the employee’s wage-loss ben-efits and the employee’s regular pay.
For purposes of workers’ compensa-tion, a “preferred worker” means a worker who has incurred a compensable injury that resulted in a disability that poses a sub-stantial obstacle to employment. The bu-reau may provide assistance as deemed ap-propriate to employers who employ a pre-ferred worker, and employers who apply for and are approved as a preferred worker employer may not be assessed premiums on a preferred worker’s salary for 3 years from the date of hiring. Also, the bureau may not charge claims costs incurred as a result of an injury sustained by a preferred worker against the account of the preferred worker’s employer during the first 3 years after the worker is hired.
The award for the amputation of more than one finger on one hand may not exceed an award for the amputation of a hand. The award for the amputation of more than one toe of one foot may not exceed an award for the amputation of a foot.
An employer may not employ any person, or receive the fruits of the labor of any person, in a hazardous employ-ment, without first applying for work-ers’ compensation insurance coverage by notifying the bureau of the intended ployment, the nature of the intended em-ployment, and the estimated payroll ex-penditure for the coming 12-month pe-riod. An employer who willfully misrep-resents the amount of payroll upon which a premium is based, or who willfully fails to secure coverage for employees, is li-able to the State in the amount of $2,000 plus three times the difference between the premium paid and the amount of pre-mium the employer should have paid.
Oklahoma
The name of State Insurance Fund was changed to “CompSource Oklahoma.”
Oregon
A person serving as a referee or assistant referee in a youth or adult recreational soc-cer match whose services are retained on a match-by-match basis is exempt from work-ers’ compensation coverage. Firefighters and police employees of any city having a
popu-Monthly Labor Review January 2002 35
lation of more than 200,000 that provides a disability and retirement system by law are also exempt from coverage.
“Preexisting condition” means, for all occupational disease claims, any injury, disease, congenital abnormality, person-ality disorder or similar condition that contributes to disability or need for treat-ment and that precedes the onset of the claimed occupational disease.
For purposes of determining entitle-ment to temporary disability or perma-nent total disability benefits, “worker” does not include a person who has with-drawn from the workforce during the pe-riod for which such benefits are sought.
The maximum for temporary total dis-ability was increased to 133 percent of the State’s average weekly wage, up from 100 percent. For workers employed in more than one job at the time of injury, all the worker’s earnings will be considered in determining the temporary total dis-ability compensation rate. For the per-manent loss of use or function of an in-jured member of the body, benefits for each degree of disability was increased to $511.29 from $454. Beginning January 1, 2002, through December 31, 2004, the worker will receive $559 for each degree of disability.
An offer of modified employment may be refused by a worker, without the ter-mination of temporary total benefits, if the offer does not meet an established set of requirements.
An injured worker may pursue a civil negligence action for a work-related in-jury that has been determined to be not compensable because the worker has failed to establish that a work-related in-cident was the major contributing cause of the worker’s injury—only after an or-der determining that the claim is not com-pensable has become final. Such action must occur within the later of (1) 2 years from the date of injury or (2) 180 days from the date the order affirming that the claim is not compensable on such grounds becomes final.
Rhode Island
Any person who is appointed a corpo-rate officer between January 1, 1999 and December 31, 2001, and was not
previ-ously an employee of the corporation, will not be considered an employee un-less a notice is filed to elect coverage by the workers’ compensation provisions.
The penalty for an employer failing to post a summary of the workers’ compen-sation act provisions was increased to $250 from $100. The payment of medi-cal services required by the employer shall not include hearing aids or other am-plification devices.
An injured employee who accepts suitable alternative employment will re-ceive a weekly compensation equal to 66 2/3 percent of the difference between the employee’s average weekly wage, earn-ings or salary before the injury and his/ her weekly wages, earnings, or salary from the suitable alternative employment. For total occupational deafness in one ear, 75 weeks of compensation will be paid; for total occupational deafness of both ears, 244 weeks of compensation will be paid (previously 17 and 100 weeks, respectively).
South Dakota
No local prisoner, State inmate, or Fed-eral inmate providing services to the State or any of its political subdivisions may be considered a volunteer worker for workers’ compensation purposes.
Tennessee
In cases where an injury occurs as the re-sult of gradual or cumulative events or trauma, the injured employee, or represen-tative, needs to provide notice to the em-ployer of the injury within 30 days after the employee knows or reasonably should know that he/she has suffered a work-re-lated injury resulting in permanent physi-cal impairment, or is rendered unable to continue to perform his/her normal work activities as the result of the work-related injury, and the employee knows or reason-ably should know that the injury was caused by work-related activities.
Before any proposed settlement is con-sidered final in cases involving benefits from the second injury fund, it must have the written approval of the Commissioner of Labor and Workforce Development.
If an injury or illness requires the treatment of a physician or surgeon who practices orthopedic or neuroscience medicine, the employer may appoint a panel of physicians or surgeons practic-ing orthopedic or neuroscience medicine for the employee to choose. The injured employee is entitled to have a second opinion on the issue of surgery, impair-ment, and a diagnosis from that same panel of physicians.
The representative of the employee, employer, or employer’s insurer attend-ing a benefit review conference must have authority to settle any disputes. Failure to provide such a person at the confer-ence, without good cause, by the em-ployer or insurer, shall subject them to a penalty of not less than $50 nor more than $5,000.
Texas
T h e r e q u i r e m e n t s f o r b e i n g o n t h e Commission’s approved list of doctors licensed in the State who are approved to provide healthcare services were signifi-cantly revised. Regional Health Care De-livery Networks may now be established by the Commission, as fee-for-service networks designed to improve the qual-ity and reduce the cost of healthcare. An insurance carrier or a self-insurer, certi-fied to provide workers’ compensation coverage in the State, may elect to par-ticipate or not parpar-ticipate, by contract, in a regional network. A public employer, with certain exceptions, are required to participate in a regional network.
An employer shall notify an em-ployee, treating doctor, and insurance carrier of the existence or absence of op-portunities for modified duty or a modi-fied duty return-to-work program avail-able through the employer. An insurance carrier shall, with the agreement of a par-ticipating employer, provide the em-ployer with return-to-work coordination services as necessary to facilitate an employee’s return to employment.
The Texas Workers’ Compensation In-surance Fund was changed to a domestic mutual insurance company and now op-erates as the Texas Mutual Insurance Company.
36 Monthly Labor Review January 2002 Workers' Compensation, 2001
Utah
Law enforcement and public safety volun-teers and paid officers who provide public safety services during the Olympic Winter Games of 2002 and the Paralympic Winter Games of 2002 are covered under workers’ compensation. For purposes of comput-ing compensation, the average weekly wage rate of a public safety volunteer is consid-ered to be $400.
Virginia
The presumption as to disability or death from respiratory disease, hypertension or heart disease was extended to special agents of the Department of Alcoholic Beverage Control.
Premium discounts insurers provide to employers for drug-free workplace pro-grams are no longer limited to 4 years.
Wyoming
For purposes of workers’ compensation coverage, the definition of “State em-ployee” was clarified.
The amount of permanent total disability and death benefits awarded to dependent chil-dren was increased to $150 per month, up from $100, for payments made after July 1, 2001. In the future such payments are to be adjusted annually for inflation.
Fax-on-demand
Users of data from the Bureau of Labor Statistics can request a fax of news releases, historical data, and technical information 24 hours a day, 7 days a week, from the Bureau’s fax-on-demand system.
Users can receive news releases of major economic indicators (see schedule on back cover) at 8:45 a.m. on the morning the data are released. The number to obtain data from the national office is:
(202) 691–6325
Use a touch-tone telephone and follow the voice instructions for entering document codes and your fax telephone number. The fax-on-demand catalog, containing a list of available documents and codes, can be obtained by entering code 1000. You may request up to four documents with each call. Faxes are sent immediately following the request. If your fax line is busy, the system attempts to send the requested material four times before disconnecting.
State of New Hampshire
Kathryn J. Barger
Director, Workers’ Compensation Division
State of New Hampshire
Workers’ Compensation Division
NH Department of Labor
95 Pleasant Street
Concord, NH 03301
Phone: (603) 271-3176
Frequently Asked Questions
Workers’ Compensation
The following information is general in nature. There may be exceptions to each. In order to inquire about a particular law or rule please contact the New Hampshire Department of Labor at (603) 271-3176 or 1-800-272-4353 or via our web site contact form.
1. How soon does workers' compensation start? 2. How do they figure my workers' compensation rate? 3. Can I see my own doctor?
4. Who pays for my prescriptions? 5. Do I need an attorney?
6. Can my employer fire me?
7. What type of light duty job can my employer offer me?
8. If I return to light duty, can my employer reduce my rate of pay? 9. How long is my claim open?
10. Is workers' compensation taxable? 11. What are my rights and responsibilities?
Q. How soon does workers' compensation start?
Workers' compensation starts on the fourth day of disability (subject to a three day period). The waiting period is waived if the disability continues for 14 days or longer or if an employee returns to temporary alternative
employment within five days.
Q. How do they figure my workers' compensation rate?
Weekly compensation is based on 60% of your average weekly wage. To determine average weekly wage, gross wages are added together for 26 weeks up to 52 weeks preceding injury, then divided by the number of weeks. If less than 26 weeks, they may use rate of hire.
Q. Can I see my own doctor?
This depends on whether or not your carrier is using a managed care program. If they are, you must choose a doctor within the network. If you are not subject to managed care, the choice is yours.
Q. Who pays for my prescriptions?
The insurance carrier will reimburse you for any prescriptions relating to your injury. They have 30 days from receipt of the request.
Q. Do I need an attorney?
Whether you choose to use an attorney is a personal choice. Individuals may seek legal counsel or represent themselves.
Q. Can my employer fire me?
It depends on your case and circumstances. There are no job security laws in New Hampshire, but the employer may be required to reinstate you if you are released by your treating physician within 18 months of the date of injury. See RSA 281-A:25a or New Hampshire Administrative Rule Chapter Lab 504.05 Reinstatement of Employee Sustaining Compensable Injuries.
Q. What type of light duty job can my employer offer me?
The position offered to you under light duty must be meaningful employment within the restrictions set by your physician.
Q. If I return to light duty, can my employer reduce my rate of pay?
Yes, but you may be entitled to receive a partial benefit from the insurance carrier in addition to your reduced wages.
Q. How long is my claim open?
Medical bills related to your injury remain the responsibility of the carrier as long as treatment is required. There are certain time limits for indemnity benefits depending on the circumstances of the case. See RSA 281-A:31.
Q. Is workers' compensation taxable?
No, but any questions pertaining to reporting, etc., should be directed to the IRS.
Q. What are my rights and responsibilities?
The following is a list of benefits to which an injured worker may be entitled under workers' compensation. Not all injured workers are entitled to all of the listed benefits, as the benefits received depend on the type of the injury and the specific circumstances of the case. Check out our Timeframe for Filing a Claim page for more
information on filing your paperwork with the Department of Labor.
Weekly Indemnity Benefits
• Temporary Partial Disability Benefits
• Death Benefits
• Payment of related medical bills including mileage to doctors' visits and prescription reimbursement.
• Permanent Impairment Award
• Temporary Alternative Duty
• Reinstatement of Employee Sustaining Compensable Injuries
• Cost of Living Adjustment
• Vocational Rehabilitation
Employee can No Restrictions Frequently Occasionally Unable to bend kneel squat climb stand walk sit reach drive do fine motor
No Wrist Elbow Shoulder Ankle
repetitive Right
motions Left
ALL MEDICAL NOTES MUST BE ATTACHED TO BILL
I certify that the narrative descriptions of the principal and secondary diagnosis and the major procedures performed are accurate and complete to the best of my knowledge.
Employee can lift/carry maximally ______ lbs. Employee can lift/carry frequently ______ lbs.
Employee can work a maximum of #___ hours/day, #___days /wk. What special accommodations are required? _______________
___________________________________________________
Other _______________________________________________ Has employee reached maximum medical improvement?
Yes No
Has injury caused permanent impairment?
Yes No Undetermined
______________________________ _______________________________ _______________________________
Provider ’s signature Provider’s Printed name Provider ’s telephone#
__________________________________ ___________________________________
Federal ID# Date of visit
MEDICAL AUTHORIZATION: The act of the worker in applying for workers’ compensation benefits constitutes authorization to any physician, hospital, chiropractor, or other medical vendor to supply all relevant medical information regarding the worker’s occupational injury or illness to the insurer, the worker’s employer, the worker ’s representative, and the department. Medical information relevant to a claim includes a past history of complaints of, or treatment of, a condition similar to that presented in the claim. [281-A:23 V(a)]
75 WCA-1 (06/94) White - Insurer/Managed Care Yellow - Provider Pink - Employee/Employer
NEW HAMPSHIRE WORKERS’ COMPENSATION MEDICAL FORM
This form must be completed at each health professional visit (MD, DO, DC or DDS) and must be filed with the worker’s compensation insurance carrier within 10 days of the treatment (first aid excluded). Failure to comply and complete this form shall result in the provider not being reimbursed for services rendered and may result in a civil penalty of up to $2,500.
In compliance with RSA 281-A:23-b, the employer with 5 or more employees must provide temporary alternative/transitional work opportunities to all employees temporarily disabled by a work related injury or illness.
Employee _________________________________________ Employer _________________________________________
SS # _____________________________________________ Work telephone # ___________________________________
Occupation ________________________________________ Employer contact ___________________________________
Date last worked ___________________________________ Employer address __________________________________
W.C. insurer _______________________________________ ___________________________________
HEALTH PROFESSIONAL TO COMPLETE
Initial visit Follow-up visit Date of injury __________________________ Time _____________
Worker’s statement of the incident _________________________________________________________________________________ Worker’s complaints _____________________________________________________________________________________________ Diagnosis/Prognosis _____________________________________________________________________________________________ Treatment plan _________________________________________________________________________________________________
In your opinion is this injury and disability as a result of injury described above? Yes No Unclear
EMPLOYEE WORK CAPABILITY
Continue Working Can return to work: Yes Date _________________ No
N.H. WORKERS’ COMPENSATION TASK ANALYSIS
In compliance with RSA 281-A:23-b, the employer with 5 or more employees must provide temporary alternative/ transitional work opportunities to all employees temporarily disabled by a work-related injury or illness.
Task is defined as one of the distinct activities that constitute logical and necessary steps in the performance of a job. A task analysis, for the purpose of this section, is the evaluation of the physical requirements of each task of a particular job or work assignment.
Employer ______________________________________ Employee _____________________________________ Telephone # ___________________________________ W.C. Insurer ___________________________________ Employer Address _________________________________________________________________________________ Complete the following information to describe the employee’s job at the time of injury:
Job Title ___________________ Usual Job? Yes ___ No ____ General Description/Purpose ______________ ________________________________________________________________________________________________ Department ____________________________________ Supervisor _____________________________________ Description of Tasks (use additional page as needed):
1. _______________________________________________________________________________________________ 2. _______________________________________________________________________________________________ 3. _______________________________________________________________________________________________ 4. _______________________________________________________________________________________________ 5. _______________________________________________________________________________________________ Tools & Equipment _________________________________________________________________________________ Describe Special Demands __________________________________________________________________________ ________________________________________________________________________________________________
PHYSICAL DEMANDS
Complete the following to show the maximum physical demand for all of the tasks listed above. For example, if Tasks 1 through 4 require no bending but Task #5 requires “occasional” bending, the overall job must be rated as requiring occasional bending. JOB REQUIRES: maximum lifting/carrying of ______ lbs. frequent lifting/carry of _________ lbs. WORK SCHEDULE: Number of hours/day _______________ Number of days/week ______________
Does job require Repetitive Motions? (check if applicable)
wrist elbow shoulder ankle
Right Left
ATTACH JOB DESCRIPTION IF AVAILABLE
____________________________________ ____________________________________ __________________
Completed by Title Date
JOB REQUIRES: Continuous Frequent Occasional
part of day 100%-67% 66%-34% 33%-1% bending kneeling squatting climbing standing walking sitting reaching driving
WORKERS' COMPENSATION PROGRAM
State of Kentucky
Worker's Compensation Branch
200 Fair Oaks Lane
Suite 511
Frankfort, Kentucky 40601
Phone: (502) 564-6846
Toll Free: (888)-860-0302
The Worker’s Compensation Law (KRS 342) is designated to compensate employees for loss of earnings power due to work-related injuries or diseases arising out of and in the course of their employment.
On July 1, 1979, the Commonwealth of Kentucky established a Workers’ Compensation Self-Insurance Program to be administered by the Personnel Cabinet, Division of Employee Benefits. Claims are processed and reviewed by the State Workers’ Compensation Branch Manager along with their Third Party Administrator.
WORKERS' COMPENSATION PROGRAM BENEFITS
The Workers’ Compensation Program provides state government employees many benefits at the event of an on the job injury. Each benefit is briefly described in the following paragraphs. Also, you will find a description of the Workers’ Compensation Forms as well as printable access to each.
MEDICAL
An employee who sustains a compensable injury or disease is entitled to immediate and continuing medical treatment at the expense of the employer. An employee should never use their health insurance when they are seeking treatment under workers’ compensation. The employer shall pay for the cure and relief from the effects of an injury or occupational disease as may reasonably be required at the time of the injury and thereafter during disability. Requiring employees to make co-payments for treatment of work-related injuries is unlawful. Likewise, medical providers may not engage in “balance billing” by charging employees separately for amounts in excess of those set forth in the medical fee schedule.
TEMPORARY TOTAL DISABILITY BENEFITS (TTD)
TTD Benefits are paid during the period in which the worker is recovering from an injury or disease and is unable to return to some type of work. TTD is not payable unless the employee is unable to work for more than seven (7) calendar days. Once an employee misses eight (8) calendar days from work due to a work-related injury, the
employee is entitled to benefits for each additional day he or she is unable to work. If the employee misses a total of fifteen (15) calendar days from work benefits for the first seven days will be paid. Kentucky law makes no allowance for temporary partial disability benefits.
WORKERS’ COMPENSATION TEMPORARY TOTAL DISABILITY BENEFITS
As a benefit to employees (KAR 2:100 Section 2 (12), state government allows its employees to continue to receive 100% of their pay while utilizing their accumulated leave. The Workers’ Compensation check shall then be used to restore the leave time used. Under no circumstances should an employee receive more pay than his/her normal salary. The employer must have employee sign the Sick Leave Workers’ Compensation Form indicating how they wish to utilize their Workers’ Compensation benefits.
PERMANENT PARTIAL DISABILITY
An employee who has recovered as much as he or she will from an occupational injury or disease, but still has some permanent impairment which results in a permanent but partial loss of wages or wage earning capacity, may be entitled to PERMANENT PARTIAL DISABILITY.
PERMANENT TOTAL DISABILITY
An employee who has reached maximum medical improvement but still has permanent impairment and restrictions, which prevent him or her from performing regular employment of the type he or she was doing before his or her injury may be entitled to Permanent Total Disability.
DEATH AND BURIAL BENEFITS
If death of employee occurs within four (4) years from date of injury as a direct result of the injury, $54,089.28 lump sum payment to estate will be made, from which burial expenses are to be paid.
FORMS
FIRST REPORT OF INJURY OR ILLNESS (IA-1)
For Workers’ Compensation benefits, there is only one requirement of the employee and that is to “notify his/her supervisor as soon as practicable after happening thereof” (KRS 342-185). When a supervisor has knowledge of a work-related injury or illness to one of his employees, it is his responsibility to obtain all pertinent information and complete a First Report of Injury (IA-1) form.
Effective August 9,1995 the Workers’ Compensation Branch began a new procedure for processing the First Report of Injury (IA-1). Once all pertinent information is obtained, the supervisor must immediately telephone the Workers’ Compensation Branch to report the injury. The reporting time is Monday through Friday from 8:30 AM to 4:30 PM EST at either (502) 564-2226 or (502) 564-2307 or toll free 1-888-860-0302. Any questions regarding status of a Workers’ Compensation claim should be addressed at (502) 564-6846. If the injury occurs during the evening hours or on the weekend the injury must be reported at the beginning of the next working day. Copies of the IA-1 will be sent to your agency for documentation in your records.
Even if the employee does not plan to visit a doctor, it is still important to report a First Report of Injury (IA-1). This must be completed “within three (3) working days”, (KRS 342.038), after the injury due to the time
requirement on making the first payment to the employee. This requirement cannot be met if the injury report is not received promptly. Failure to comply with this statute can result in a fine being levied of up to $1,000.00 for each occurrence. The First Report of Injury (IA-1) must be completed and called in by the supervisor
immediately after notification of injury. The First Report of Injury (IA-1) must be complete and thorough. Give specifics: i.e., right arm or left arm, upper back or lower back, etc. Each question must be answered completely, accurately.
It is unlawful to knowingly make a misrepresentation of a material fact to obtain workers’ compensation benefits. Likewise, it is unlawful to misrepresent important facts to avoid responsibility under the law. Through its
Insurance Fraud Unit, the Department of Insurance actively investigates and prosecutes workers’ compensation fraud. Violations may result in civil fines and criminal procedures.
LOSS OF TIME AND RETURN TO WORK FORM
Form WCF-1 must be completed by the supervisor and submitted immediately when one of the following occurs in order for employees to receive their lost time benefits in a timely manner.
• When an injured employee loses time from work due to a work-related injury.
• When an injured employee returns to work.
• At the time of death of an injured employee.
SICK LEAVE – WORKERS’ COMPENSATION FORM
According to 101 KAR 2:100 Section 2 (12), the employee’s absence due to illness or injury for which Workers’ Compensation benefits are received for lost time, sick leave may be utilized to the extent of the difference between such benefits and the employee’s regular salary. To use sick leave for a Workers’ Compensation injury, the employee must assign his/her Workers’ Compensation check to the agency by completing a Sick Leave – Workers’ Compensation Form prior to receiving sick leave. This form must be signed by the employee, witnessed, and forwarded to the payroll officer for their records.
REPORT OF MEDICAL STATUS FORM
The Report of Medical Status Form (WCF-5) was adopted by the Workers’ Compensation Office in October 1994 and should be issued at the time the First Report of Injury (IA-1) is completed or as soon as practicable, if the employee intends to seek medical treatment. This form must be issued to the employee prior to their first doctor’s appointment. The employer is responsible for completing the first section of the form titled. “To Be Completed By Employer”. The physician will then complete the remaining section of the form and return it to the employee. Once the physician has completed the form, the employee should return the completed form to their employer. The employer will then mail the completed form to the Workers’ Compensation Office. It is imperative that each injured employee receives this form before they go to the doctor’s office. With the proper completion of this form, this office can better monitor the treatment of each injured employee.
Alexandria Sanitation Authority
1500 Eisenhower Avenue
Alexandria, VA 22314
Phone: (703) 549-3381
Fax: (703) 549-9671
ALEXANDRIA SANITATION AUTHORITY
Supercedes: D-6, 04-01-96 Policy Title:
Number: D-6
Worker's Compensation Insurance Effective: 11-01-98
1. POLICY
1. It is the policy of the Alexandria Sanitation Authority to provide Worker's Compensation Insurance as an employee benefit to cover losses arising out of occupational injury or illness. Benefits from such insurance include the payment of medical expenses as well as partial compensation for lost income and/or temporary or permanent disability.
2. All Authority employees must report all injuries/illnesses immediately to their immediate supervisor. Failure to do so can jeopardize the employee's rights under the Worker's Compensation Law. All work injuries/illnesses must be reported in writing within twenty-four (24) hours.
3. Worker's compensation status is considered as a medical leave of absence (non-pay, not actively at work status) and subject to the provisions outlined in the Leave Benefits, D-2 and FMLA, D-4 policies, as applicable.
2. RESPONSIBILITY 1. Employee
1. Any injury or illness arising out of work for the Authority must be reported immediately by employee.
2. Employees must follow the Authority's instructions in seeking medical care for an on-the-job injury/illness by going to Inova Occupational Health Services/Inova Alexandria Hospital Emergency Room, if first-aid treatment is not sufficient (see section IV).
3. Employees must follow the authorized physician's instructions and restrictions.
4. Employees out on worker's compensation status have a responsibility to continually keep their supervisor and the Personnel Department informed of their condition and likely date of return to work or requirement to apply for VRS disability or service retirement.
5. Employees must share in the responsibility for their own safety and the safety of fellow employees.
Employees have a responsibility to read, understand and comply with established rules and practices. Employees' failure to comply may be grounds for discipline, including termination. a. Supervision
i. All Directors/Department Heads shall establish for their division/department a reporting system through supervisory personnel, for prompt reporting of job related employee injuries/illnesses. This reporting system must be accessible to all employees, including those employees whose hours of work differ from normal business hours. All supervisors and employees must be made aware of the reporting system, in order to comply with procedures established herein.
ii. Injuries/illnesses must be promptly reported by the employee's supervisor. The supervisor will investigate the injury/illness and obtain details from the employee as well as other witnesses to the injury/illness. This information is to be provided on the Quick-Fax Report form (see section V of this policy for enclosures that must be furnished to Inova Occupational Health Center along with Quick-Fax Report Form), which must then be forwarded immediately to the Personnel Department.
iii. The Personnel Department will send all claims to the Authority insurance carrier. The claims handler will review and investigate each claim for determination of compensability.
Employees and supervisors are expected to respond and cooperate fully during the investigation process.
ii. Physicians Used by the Authority
i. The physician used by the Authority is responsible for examining and treating injured or ill employees, completing "Section D-Medical Provider" on the Quick Fax Report (this form must be returned with the employee), offering a prognosis on length of disability, and certifying the date and condition, if any, for a return to work.
ii. The employee must use one of the doctors listed on the Authority's Panel of Physicians. If an employee uses a doctor not listed on the Authority's Panel of Physicians, which is posted on each bulletin board, (except in an emergency with written permission from the Authority's insurance carrier) the Authority's insurance carrier will not consider payment of the doctor's bill and it will be at the employees' personal expense. The employee will bring the completed Quick-Fax Report to the Personnel Department.
iii. To avoid such personal expense, use only approved doctors and facilities. It should be clearly understood that other physicians or medical facilities may not be used without first securing approval from the Personnel Department or the Authority insurance carrier. Exception to this rule may be made in case of a bona fide emergency that occurs outside of normal working hours.
iii. Personnel Department
i. The Personnel Department will coordinate with supervision the treatment of any injured/ill employee, as well as his/her return to work.
ii. The Personnel Department will investigate and analyze injury/illness reports or forms. This decision concerning whether or not an employee injury/illness is legitimate is the responsibility of the Safety Manager in conjunction with the Authority insurance carrier. iii. The Personnel Department will maintain records and statistics on injuries/illnesses and
lost time.
iv. Personnel will coordinate the general administration of the program to establish procedures and guidelines for divisions/departments to follow when reporting actual or potential worker's compensation claims.
iv. Virginia Workers' Compensation Commission
The Virginia Workers' Compensation Commission has responsibility for the overall administration of worker's compensation.
A. REGULATIONS a. Effect of Coverage
All employees of the Authority are covered by worker's compensation insurance during the scope of their employment.
b. Benefits for Compensable Injuries or Occupational Diseases
i. Medical treatment is administered by a licensed physician, including the necessary medicines, supplies and hospital services.
ii. Income Indemnity - Currently, two thirds of gross income or (66 and 2/3 percent) during total disability start with the eighth (8) day. If disability exceeds twenty one (21) calendar days, the first seven (7) days are also indemnified. If sick leave has been used by the employee and paid by the Authority for the first seven (7) calendar days, then an additional reimbursement of two thirds of gross income for the period of sick leave as mentioned above will be paid to the employee by the insurance carrier. The employee may retain this extra payment that he/she receives from the insurance carrier.
B. PROCEDURES a. Treatment of Injured/Ill Employees
i. When first aid treatment is not sufficient, the supervisor should arrange for the injured/ill employee to receive professional medical attention from Inova Occupational Health Center from 8:00 a.m. to 5:00 p.m. weekdays. After 5:00 p.m. until 8:00 a.m. weekdays, and on weekends and holidays, injuries/illnesses are handled by the Inova Alexandria Hospital Emergency Room. (See Policy E-4, EMERGENCIES, for handling "emergency treatment"/"emergency care" injuries/illnesses.) The employee should take with him/her the Quick-Fax Report, (with appropriate enclosures) which provides for the physician's initial report. Addresses and phone numbers are furnished as follows:
Inova Occupational Health Center Inova Alexandria Hospital 225 Reinekers Lane 4320 Seminary Road
Alexandria, Virginia Alexandria, Virginia
(703) 838-5530 Emergency Room
(703) 504-3000
ii. The supervisor or his/her designated lead person will see that an employee's time card is punched out upon the employee leaving the plant premises to go to one of the above, if the employee is unable to punch his/her own card.
iii. A leave request form must be prepared for the remainder of the shift on the day of the injury/illness. The employee will be paid administrative leave with pay for the remainder of that shift if the physician determines that he/she is not to return to work. (If the
physician determines that the employee is to return to work for the remainder of the shift, the employee will punch back in on his/her time card and the supervisor will fill out a leave request form granting administrative leave with pay for the period that medical treatment was received.)
iv. If, per the authorized physician's instructions, the employee will be considered off duty for additional time after the day of the injury/illness, a leave request form must be completed in the employee's absence using primarily sick leave and secondarily annual leave; or leave without pay (excused) in the event of a zero leave balance.
v. If the additional time exceeds seven (7) calendar days, the employee will be eligible for worker's compensation benefits and no more leave benefits will apply. If the disability exceeds twenty-one (21) calendar days, the first seven (7) days of leave benefits are indemnified by the insurance carrier and the employee retains the extra payment. b. Recurrence Reporting
i. An employee who sustains recurrence of medical problems, due to a prior job-related injury or illness, must obtain authorization for medical treatment from the Safety Manager or the Authority's insurance carrier. Once authorization is given, the Safety Manager will call Inova Occupational Health Center for an appointment.
ii. Any lost time, due to recurrence, shall be charged to employee's sick or annual leave balances until eligibility for worker's compensation benefits is determined. If the claim is accepted as compensable, sick and/or annual leave used will be restored. If the employee does not have any sick or annual leave he/she will be placed on administrative leave with pay. If the claim is denied, the employee will be placed on administrative leave without pay.
c. Return to Work from Injury/Illness
i. An injured/ill employee who returns to work after treatment or examination must immediately furnish his/her supervisor with medical certification, completed by his/her authorized treating physician, before being permitted to resume any type of work. Supervisors will not permit employees to return to work without a medical release completed prior to the return date indicated by the authorized physician. A copy of the medical release is to be forwarded promptly to the Personnel Department.
ii. An injured/ill employee who goes for job related medical treatment during scheduled work hours and is advised by an authorized physician on the same day/night of the injury not to return to work that day/night will receive administrative leave with pay for the remainder of that scheduled shift only.
d. Light Duty
i. Light duty assignment may be made for an employee who is temporarily disabled for return to full duty, but not an employee whose treating physician has indicated the employee is totally incapable of return to work, even with a reasonable accommodation, or is a "direct threat" to the health or safety of the employee or others. (See Reasonable Accommodation policy, B-3.)
ii. Every effort will be made to return the employee to his or her division/department when restricted temporarily to light duty due to a job-related injury/illness. Directors/Department Heads and the Authority insurance carrier will coordinate efforts to place the employee in a light duty assignment that accommodates the restrictions set by the treating physician. iii. If a light duty assignment is not available within the employee's division/department,
attempts may be made to temporarily place the employee in another division/department. Such assignment will not be implemented without the approval of the treating physician and the concurrence of appropriate division/department and the Director of Personnel Services. The light duty status of an employee will be monitored by consultation with the Director/Department Head, treating physician and employee.
e. Doctor Appointments
i. When employees are on duty and have a doctor's appointment with an approved Authority's physician related to an on-the-job injury/illness, the supervisor will fill out a leave request form placing the employee
on administrative leave with pay.
f. False Claims
i.
Any employee who falsifies an injury/illness claim or collaborates or corroborates in making a false claim is committing a misdemeanor and shall be subject to the full penalties provided by law, as well as disciplinary action, including termination from employment.
f. Reporting to Safety Manager Off-Plant Accident or Injuries
i. When an injury results from a vehicular accident or the negligence of someone other than the injured employee, including a work-related injury resulting from a malfunction or failure of tools or equipment, the Safety Manager must be notified immediately by the employee. A police officer must be requested at the scene of any vehicular accident and a police report provided to the Safety Manager.
ii. Any legal claim or lawsuit by an employee against a third party, due to a work-related injury/illness, must be reported to the Safety Manager by the employee. The Safety Manager must immediately report any such legal claims or lawsuits to the Director of Personnel Services who will contact the Authority's legal counsel.
iii. Any permanently disabling illness or fatal accident must be reported immediately to the Safety Manager by the supervisor.
h. Not Covered by Worker's Compensation
i. Worker's Compensation benefits do not cover injuries/illnesses resulting from traveling and/or walking to or from work, unpaid lunch periods and breaks, sports, dance or any other activities not authorized or required by the employees actual position or work assignment.
ii. Request for worker's compensation coverage for special activities or programs during which employee injuries/illnesses might occur must be made in writing to the Safety Manager prior to implementation of such activities or programs. The Safety Manager will then check with and seek approval from the Authority's insurance carrier.
i. Reinstatement/Termination/Benefits
i. Position reinstatement, termination, and benefits in relation to worker's compensation status are as applicable to the provisions outlined in either section XVI (Leave of
Absence covered under Disability Insurance, but not the FMLA) of Leave Benefits policy D-2, or Leave under the Family and Medical Leave Act (FMLA), D-4.
ii. Under current Virginia law, an employee must be out on worker's compensation for a period of over 6-months before they can be terminated for lack of a suitable position at the time of return from a worker's compensation leave of absence.
iii. An employee not actively at work in an "unpaid status" (e.g., LWOP, worker's
compensation insurance, other disability insurance, and other types of leave of absence except for extended military duty) may be involuntarily terminated if in such status for over 185 consecutive calendar days, or reach a cumulative total of over 185 days in such status within a consecutive 12-month period.
iv. A former employee who continues to be covered under worker's compensation, or other Authority provided disability insurance, after being involuntarily terminated from the Authority may again seek employment with the Authority (on an equal basis with other applicants) once he/she is deemed capable of performing some type of work by a certified medical authority and is no longer receiving disability insurance compensation.
C. ENCLOSURES THAT ARE TO BE FURNISHED TO INOVA MEDICAL SERVICES ALONG WITH QUICK-FAX FORM.
1. Employee’s Job Description;
2. Job Interpretation Report (Physical Requirements for Employee’s position);
3. Inova Occupational Health Center Authorization of Services form, which includes instructions where medicals bills for work-related illnesses/injuries are sent; and
4. Material Safety Data sheet (MSDS), for chemical employee was exposed to, if chemical exposure was cause of work-related illness/injury.
VI FORMS
C Quick-Fax Report Form Instructions C Quick-Fax Report Form (2 pages)
C Employer's First Report of Accident Form C Leave Request Form
C Sick Certificate (Example)
C Inova Return to Work Status Form
C Referral Physician Return to Work Form for work-related illnesses/injuries C Inova Authorization of Services Form
C Instructions for Dealing with Injured Employees C Material Safety Data Sheet (MSDS) (Example) C Job Interpretation Report (Example)
C Job Description (Example)
