DENVER OFFICE OF RISK MANAGEMENT OF THE DEPARTMENT OF FINANCE

Transcription

1 DENVER OFFICE OF RISK MANAGEMENT OF THE DEPARTMENT OF FINANCE Rules Governing Benefits to Firefighters for Certain Cardiac Illnesses for Compliance with Colorado Revised Statutes , et. seq. A. PURPOSE/BACKGOUND: On June 5, 2014 Governor Hickenlooper signed SB into law which provides specified payments to eligible firefighters who sustain identified heart and circulatory malfunctions within 48 hours of a defined work event. The law was annotated into CRS , et. seq. Under the authority of Denver's Charter sections 2.5.3(h) and 2.5.3(1), these rules are established to comply with the statutes. Consistent with CRS any payments due under these Rules is subject to the Colorado State Legislature appropriating sufficient funding in any given year. B. FIREFIGIITERS COVERED: Sworn members of the Denver Fire Department who have worked at least 1,600 hours in any calendar year for a qualified fire department whose duties are directly involved with fire protection services. C. PAYMENTS AMOUNTS: Subject to requirements as more fully addressed herein, the eligible payments consist of the following: 1. $4,000 lump sum - if a medical examination reveals the firefighter has a heart and circulatory malfunction. 2. $1,500 per week up to a maximum of 7 weeks ($10,500 maximum) - if a firefighter made an emergency room visit and was hospitalized for up to 48 hours for a heart and circulatory malfunction. The number of weeks is based upon the number of weeks the firefighter is unable to return to usual and customary employment. 3. $2,000 per week up to a maximum of 25 weeks ($50,000 maximum) - if a firefighter made an emergency room visit and was hospitalized for more than 48 hours for a heart and circulatory malfunction. The number of weeks is based upon the number of weeks the firefighter is unable to return to usual and customary employment. 4. $2,500 per week up to a maximum of 80 weeks ($200,000 maximum) - if a firefighter has a heart and circulatory malfunction that prohibits the firefighter from returning to a position that the firefighter is trained for or could reasonably could be trained to perform. The number of weeks will be based upon the criteria contained in section H-10, herein. 5. Up to $25,000 for rehabilative employment services relating to heart and circulatory malfunction. 6. $10,000 lump sum payment - if a firefighter incurs cosmetic disfigurement resulting from a heart and circulatory malfunction.

2 7. $25,000 lump sum payment - if the covered heart and circulatory malfunction is diagnosed as terminal, as an accelerated payment towards the benefits due in C Eligible payment amounts will be offset by payments paid under (1) workers compensation, (2) the Colorado Fire and Police Pension Association, (3) benefits of the City and County of Denver, including PTO, sick, vacation, or other paid leave, (4) payments made by Social Security or a retirement plan. D. DEFINITIONS: 1. Heart and circulatory malfunction means a sudden and serious malfunction of the heart and circulatory system as occurs in the diagnosis of coronary thrombosis, cerebral vascular accident, myocardial infarction, or cardiac arrest that meets the requirements of CRS Section (6). Heart and circulatory malfunction does not include hypertension or angina. 2. Work Event means stressful or strenuous activity related to fire suppression, rescue, hazardous material response, emergency medical services, disaster relief, or other emergency response activity, including a training activity that a firefighter engages in while on duty that involves stressful or strenuous activity. 3. Office of Risk Management means Denver's Risk Management Section of the City's Department of Finance, located at 201 West Colfax Ave., Department 1105, Denver, CO Denver Fire Department Official means a managing official of the Denver Fire Department responsible for receiving and transmitting reports of heart and circulatory malfunctions regarding Denver Firefighters. 5. Hearing Officer means a person appointed by the Denver Manager of Finance pursuant to Denver City Charter to hear evidence and decide disputed claims under CRS , et. seq. 6. Heart and Circulatory Malfunction Claim Form means the form developed by the Office of Risk Management to be completed and submitted by any Firefighter who seeks benefits for a Heart and Circulatory Malfunction under the terms of these Rules and CRS , et. seq. E. REQUIRED FACTORS TO SUBMIT A CLAIM 1. Prior to the work event that results in a heart and circulatory malfunction and after the firefighter became employed by Denver, the firefighter had a medical examination that would reasonably have found an illness or injury that could have caused the heart and circulatory malfunction, but no illness or injury was found at the most recent medical examination. 2. The Firefighter must have been employed by Denver or other qualified fire agencies prior to working for Denver for a total of at least five years of continuous, full-time employment.

3 3. The heart and circulatory malfunction occurred during or within 48 hours after a work event. F. THE CLAIMS PROCESS 1. No later than ten days after onset of a heart and circulatory malfunction caused by a work event, a Firefighter seeking benefits shall complete and submit a Heart and Circulatory Malfunction Claim Form to the Office of Risk Management and the Fire Department Official. If the firefighter is hospitalized as a result of the heart and circulatory malfunction, the Claim Form shall be submitted no later than ten days after release from the hospital. 2. Within 15 days of mailing, the Firefighter shall complete, sign, and return authorizations to release medical information directed to: a. All doctors, clinics, hospitals, or other medical care providers who evaluated, diagnosed, or treated the heart and circulatory malfunction. b. All primary care physicians, specialists, or other doctors who performed an examination that would reasonably have found a condition that caused the heart and circulatory malfunction or examined or treated the firefighter for any heart or circulatory malfunction. 3. The Firefighter shall, if applicable, complete, sign, and return authorizations to release employment information directed to any secondary or prior employer the Firefighter had within a six month period of the heart and circulatory malfunction. 4. Within 15 days of receipt of any medical or employment records received pursuant to the authorizations to release medical or employment information, the Office of Risk Management shall mail copies of such records to the Firefighter. 5. The Firefighter shall respond to written questions from the Office of Risk Management regarding his/her medical history, the facts and circumstances leading up to the heart and circulatory malfunction, treatment of the heart and circulatory malfunction, smoking history, and time lost from work. The Firefighter shall respond to the questions in writing within 20 days of mailing the questions. 6. At the written request and expense of the Office of Risk Management, the Firefighter shall attend an independent medical examination to determine medical issues pertinent to the clai~. If scheduled to work when the independent medical examination is scheduled, the Firefighter shall be granted administrative leave to attend the examination. 7. After any examination conducted under this section, the examiner shall prepare a written report giving a description of the examination performed, the written documents or any other materials reviewed, and all findings or conclusions of the examiner. The Firefighter shall be entitled to receive from the examining

4 physician a copy of any report that the physician makes to the City upon the examination, and the copy shall be furnished to the Firefighter at the same time it is furnished to the City. 8. All such examinations shall be recorded in audio in their entirety and retained by the examining physician until requested by any party. Prior to commencing the audio recording, the examining physician shall disclose to the Firefighter the fact that the exam is.being recorded. 9. Upon submittal of a Heart and Circulatory Malfunction Claim form, the Denver Fire Department Official shall provide copies of all reports reflecting the Firefighter's work activities for the 14 day period preceding the onset of the heart and circulatory malfunction. The Fire Department Official will provide these reports to the Firefighter and the Office of Risk Management within 10 days of receipt of the Heart and Circulatory Malfunction Claim Form. 10. The Fire Department Official shall provide the Office of Risk Management with copies of employment records reflecting the amount of time the Firefighter has missed from work due to the Heart and Circulatory Malfunction. 11. Within 45 days of receipt of all medical records, information from the Fire Department, and any reports from an Independent Medical Examiner, the Office of Risk Management will provide a written response to the claim stating: a. Whether the Office of Risk Management accepts the Firefighter' s claim; b. If the claim is. accepted, the amount of benefits that will be provided pursuant to C.R.S (2)(a) and (b). c. If the claim is not accepted due to the need for further information, the written response will include a list of the medical or other information needed to resolve the claim. d. Information regarding appealing the decision pursuant to Section I below. G. SUPPLEMENT AL CLAIMS 1. The receipt of payment pursuant to C.R.S (2)(a) through (e) does not prevent the Firefighter from receiving additional benefits. If a Firefighter seeks additional benefits, under this law,a new Heart and Circulatory Malfunction Claim Form must be submitted to the Fire Department Official and the Office of Risk Management. 2. Upon receipt of a supplemental claim for benefits, the Office of Risk Management may schedule an independent medical examination regarding any medical issue pertinent to the claim pursuant to Section F If the Firefighter seeks rehabilitative employment services pursuant to C.R.S (2)(c), the Office of Risk Management may upon written notice schedule a vocational rehabilitation evaluation. Within 30 days of performing the vocational rehabilitation evaluation, the vocational rehabilitation evaluator must submit a written report to the Office of Risk Management and the

5 Firefighter concerning whether vocational rehabilitation services are reasonable and necessary as a result of a heart and circulatory malfunction and outline the nature, scope, and expected duration of vocational rehabilitation services. 4. Within 45 days of receipt of all medical records, information from the Fire Department, independent medical examination reports, and vocation rehabilitation reports, if applicable, the Office of Risk Management will issue a written response to the claim stating: a. Whether the Office of Risk Management accepts the Firefighter' s claim; b.if the claim is accepted, the amount of benefits that will be provided pursuant to C.R.S (2)(a) through (e). c.if the claim is not accepted due to the need for further information, the written response will include a list of the medical or other information needed to resolve the claim. d.information regarding appealing the decision pursuant to Section I below. H. DETERMINATION OF BENEFITS - Upon determination that a claim is accepted, the Office of Risk Management shall submit the claim to the insurance carrier or pay benefits pursuant to this policy subject to the following conditions: 1. The Medical Director of the Center for Occupational Safety and Health (COSH) will periodically examine the Firefighter and determine if the Firefighter is able to perform his or her usual and customary duties.. 2. If the Firefighter is determined to be able to return to his or her usual and customary duties, the benefits available under this section will stop. 3. If the Medical Director is unable to determine whether the Firefighter was able to perform his or her regular duties due to failure of the Firefighter to attend a scheduled appointment without good cause, the Firefighters right to collect benefits under this section shall be denied until such a determination can be made. Benefits denied for failure to attend a medical appointment without good cause will not be retroactively awarded. 4. The Denver Fire Department or other City agency may offer the Firefighter modified-duty employment approved by the Firefighter's treating physician or the Medical Director of COSH. The offer of modified-duty employment shall be made in writing and shall contain a detailed description of the employment, the salary to be paid, and the physician's approval of the modified-duty position. 5. The Firefighter will be allowed three days from receipt of the written modifiedduty offer to begin work. If the Firefighter fails to begin work at the offered modified-duty employment, the right to seek benefits under this section is denied during the period of such failure.

6 6. If the Firefighter receiving the 7 week benefit begins work at such modifiedduty employment, the Office of Risk Management will pay the difference between $1,500 per week and Firefighter's weekly salary until the Firefighter is released to return to regular employment or until seven weeks elapse, whichever is sooner. 7. If the Firefighter is responsible for suspension or termination from employment while performing modified-duty work, he or she will not receive his or her normal salary and the Office of Risk Management will be responsible for payment of only the difference between the $1,500 per week payment and the Firefighter's weekly salary. 8. If the Firefighter receiving the 25 week benefit begins work at such modifiedduty employment, the Office of Risk Management will pay the difference between $2,000 per week and Firefighter's weekly salary until the Firefighter is released to return to regular employment or until twenty-five weeks elapse, whichever is sooner. 9. If the Firefighter is responsible for suspension or termination from employment while performing modified-duty work, he or she will not receive his or her normal salary and the Office of Risk Management will be responsible for payment of only the difference between the $2,000 per week payment and the Firefighter's weekly salary 10. If the Firefighter has a heart and circulatm:y malfunction that prohibits the firefighter from returning to employment to a position that the firefighter is trained for or reasonably could be trained to perform. The number of weeks of benefits under this subsection up to 80 weeks will be determined as follows: a. Benefits under this section will begin after the Medical Director at COSH has determined Firefighter has completed reasonable and necessary treatment of the heart and circulatory malfunction and the Medical Director at COSH has issued a medical report the imposes permanent work restrictions that will prevent the Firefighter from performing the essential functions of his or her position. b. After the Firefighter has been disqualified from his or her position at the Denver Fire Department, the City may begin the Interactive Process. The Interactive Process may determine that a position exists that is consistent with the Firefighter' s permanent work restrictions and that the Firefighter is trained to perform or can reasonably be trained to perform. c. If the Interactive Process determines that a position described in subsection (b) above exists, the City may offer the position to the Firefighter in writing. d. Benefits under this section will end as of the starting date of the position that the City offers in writing.

7 e. Benefits under this section will also end if the Firefighter fails to cooperate with or complete rehabilitative employment services offered by the City. f. Benefits under this section will also end if the vocational rehabilitation consultant determines the Firefighter is able to perform jobs for which he or she is trained and such jobs are available in the Denver labor market. g. Benefits may also end if the Firefighter otherwise obtains employment to which he is trained or could reasonably be trained to perform. I. CLAIM DISPUTE PROCESS - Commencement of the Dispute Resolution Process: 1. To commence the adjudication process, a party must file an Application for Adjudication which must contain the following information: a. A list of the disputed issues to be determined. b. A list of all witnesses the Firefighter expects to call at the adjudication. c. A list of exhibits that will be introduced into evidence. d. A concise statement of the relief sought. 2. The party requesting the adjudication must send a copy of the Application for Adjudication to the other party, the Office of Risk Management, 201 West Colfax Ave., Dept. 1105, Denver, CO and to the Denver Fire Department Headquarters, 745 West Colfax Ave., Denver, CO Within 21 days of mailing of the Application for Adjudication, the opposing party shall file a Response to Application which shall contain the following information: a. The opposing party's position regarding the issues raised by the Applicant. The opposing party may also raise other issues, including citations to relevant sections of Senate Bill and these Rules. b. A list of witnesses the opposing party expects to call at the adjudication. c. A list of exhibits the opposing party expects to introduce into evidence. The responding party may supplement this list pursuant to Section 5.C.3 below. d. A concise statement of the relief sought. 4. Scheduling the Adjudication~ a. Upon receipt or submittal of an Application for Adjudication, the Office of Risk Management will arrange for the appointment of a Hearing Officer to preside at the adjudication. b. Upon appointment of the hearing officer, the applicant will contact the Hearing Officer to schedule a date for the adjudication not more than 90 days or less than 60 days from the date the response to application for adjudication was filed. c. Upon confirmation of the adjudication date, the Hearing Officer (Office of Risk Management) will send written confirmation of the date, time, and place of the adjudication to all parties.

8 5. Pre-Adjudication Procedures and Discovery: a. At the request of either party or on his or her own motion, the Hearing Officer may convene a Pre-Adjudication conference to narrow and clarify the legal and factual issues, resolve discovery disputes, determine admissibility of evidence, or for any other purpose. b. The parties may submit written discovery not to exceed twenty single part questions. The discovery requests shall be answered in writing within twenty days of receipt. c. No later than twenty-five days before the adjudication, the parties shall exchange copies of all exhibits that will be submitted into evidence. This deadline may be extended if a party, despite using due diligence, has been unable to obtain medical records by use of authorizations to release medical information. d. The following documents will be presumed to be authentic and may be admitted into evidence, if relevant, provided that they have been exchanged with the opposing party at least twenty-five days prior to the date of the adjudication: i. Medical Records of the Firefighter. ii. Copies of non-privileged portions of the Office of Risk Management's file. iii. Employment Records of the Firefighter. iv. Records of the Fire Department showing the Firefighter's work activities for the 14 day period prior to the claimed work event. e. A party objecting to the authenticity of any document provided under paragraph 4 above shall provide a written pleading setting forth the basis for each objection no later than seven days after receipt of the exhibits. f. Upon Motion or Stipulation of the parties, the Hearing Officer may allow taking of evidentiary depositions of medical experts or other expert witnesses. g. The Hearing Officer may issue subpoenas for the attendance of witnesses and the production of documents. The Colorado Rules of Civil Procedure applicable to services of subpoenas and witness fees will apply. 6. The Adjudication Hearing;_ a. The Colorado Rules of Evidence as used in trials to the Court will apply. b. The hearing will be recorded and the recording will be preserved for a period of ninety days unless an appeal of the Hearing Officer's decision is filed. c. The Hearing Officer may: 1. Grant continuances of the hearing not to exceed thirty days for good cause shown.

9 2. Adjourn the hearing for completion of testimony. 3. For good cause shown, allow submission of evidentiary depositions taken before or after the hearing is commenced. 4. Permit the parties to submit position statements after hearing the evidence. d. No later than thirty days after the evidence is closed and the position statements are submitted, the Hearing Officer will submit a written decision containing: 1. A statement of the issues to be determined and any stipulations of the parties. 2. Specific findings of fact concerning all disputed factual issues. 3. Conclusions of law based upon Senate Bill and other relevant authorities. 4. An order stating whether relief is granted or denied. If benefits are awarded, the order shall state the amount and period of benefits that are awarded with references made to Senate Bill and these Rules. 5. A statement. concerning the parties' right to appeal the decision C.R.C.P. 106(4). 6. If the Hearing Officer's decision is not appealed as set forth in subsection E below, it will become binding on the City and the Firefighter. e. Any party who intends to appeal the Hearing Officer's decision pursuant to Rule 106(a)(4) shall file a Notice of Appeal with the Hearing Officer and provide a copy to the opposing party. f. Upon receipt of the Notice of Appeal, all evidence and recordings of the proceedings shall be preserved until there is a final judgment from the District Court or the appellate courts. g. The official record on appeal shall be prepared and submitted to the District Court as required under C.R.C.P. 106(4). h. Neither the Hearing Officer nor the Office of Risk Management have the power to extend the time for filing an appeal pursuant to C.R.C.P. 106(a)(4). i. The decision of the Hearing Officer after an Adjudication Proceeding is "quasi-judicial" as that term is used in C.R.C.P. 106(a)(4).

10 Chief Financial Officer,.,/) / Manager, Cash, Risk & Capital Fun ing Gl 0 JJ~ Director Of Risk Management