Workers Compensation Procedures Booklet

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1 Workers Compensation Procedures Booklet Supervisor s Guide (Revised January 2015)

2 TABLE OF CONTENTS WHO IS COVERED?... 2 INJURIES COVERED... 2 INJURIES NOT COVERED... 3 WHAT SHOULD I DO WHEN AN EMPLOYEE GETS INJURED OR CONTRACTS AN OCCUPATIONAL DISEASE?... 3 WHERE DO I SEND THE EMPLOYEE FOR MEDICAL TREATMENT?... 5 HOW DO I RETURN MY EMPLOYEE TO WORK?... 5 REQUIRED FORMS (Included in Packet)... 6 ADDITIONAL INFORMATION FOR SUPERVISORS

3 WHO IS COVERED? All Town of Leland employees are covered under the NCIRMA Workers Compensation Insurance Program, including full-time employees, part-time employees, reserve officers, auxiliary officers, and temporary employees (excluding those contracted through Temporary Agencies). INJURIES COVERED While many injuries may occur in the work place, not all are compensable under Workers Compensation. For example, a hernia or an injury to the back is compensable only if the injury is the result of a specific traumatic incident of the work assigned. All injuries must arise out of and in the course and scope of the covered employment to be compensated. An accident is an interruption of the regular work routine and the introduction of unusual circumstances, such as a slip, trip, fall, or other unusual activity, likely to result in unexpected consequences. An accident more than likely will warrant immediate physician s care. A specific traumatic incident, as defined by our courts, includes injuries that occur during normal work activities. The claimant need not show an instantaneous occurrence or an external cause or unusual conditions. However, injuries that occur gradually, over long periods of time, are not specific traumatic incidents. If the work-relatedness of a hernia is disputed, an employee must show that the hernia appeared suddenly following an accident and did not exist prior to the accident or incident. An occupational disease is due to a condition to which the employment significantly contributed, or the employment was a significant factor in causing the disease s development, and the employment exposed the worker to a greater risk of contracting the disease than the public generally. The following diseases are a sampling of the diseases defined by the N.C. Gen. Stat as occupational diseases: Anthrax, arsenic, lead, mercury poisoning Synovitis caused by trauma in employment Tenosynovitis caused by trauma in employment Asbestosis and Silicosis Loss of hearing caused by harmful noise in the employment Blisters or carpal tunnel due to use of tools or appliances Any other disease that meets the statutory definition 2

4 INJURIES NOT COVERED A near-miss is an incident where, given a slight shift in time, distance, or position, injury, ill-health or damage easily could have occurred. If the employee does not need first aid or any type of medical treatment by a physician, this occurrence is considered a near miss. Example: an employee trips over a rug. A first-aid injury is a one-time treatment that usually needs on-site medication and does not require medical care by a physician. Example: an employee gets a splinter in his/her hand and receives first-aid treatment in the work area. Important: If an employee gets a splinter in his/her hand, receives first-aid treatment in the work area but five days later the wound becomes infected, then a first aid incident has become serious enough for the employee to seek medical treatment and would then justify a worker s compensation claim. WHAT SHOULD I DO WHEN AN EMPLOYEE GETS INJURED OR CONTRACTS AN OCCUPATIONAL DISEASE? The Workers Compensation Act states that every employee is required to give or cause to be given a written notice to the employer immediately or as soon as practicable upon the occurrence of an accident or of being diagnosed as having a disease associated with employment. The supervisor is responsible for: Ensuring that the employee receives medical treatment; Immediately notifying Human Resources; Completing the required forms; Conducting the accident investigation; Maintaining contact with the injured employee; and Forwarding all doctor s notes and attending physician statements to Human Resources. Procedures for a Near Miss or an injury requiring First-Aid: Although no professional medical treatment is provided, the occurrence must still be documented as mandated by Occupational Safety and Health Administration (OSHA). Complete the First Report of Injury/Illness/Near Miss form and forward to Human Resources no later than 24 hours after the incident occurs. Take corrective measures to ensure the problem or situation is rectified. If a First-Aid later requires treatment from a medical professional, the incident then becomes a Workers Compensation claim and must be filed accordingly. Notify Human Resources immediately. Be sure to state that the injury was previously reported along with the date of the first report. Follow the same guidelines as provided under Procedures for an Accident. 3

5 Procedures for an Accident: If the accident is life threatening or serious, call 911 to dispatch emergency services and then notify Human Resources as soon as possible. Notify Human Resources of the accident immediately at the following: o Direct: (910) o Cell: (910) o IMPORTANT: An employer MUST report the following to the OSH Division at or (919) : o Within eight (8) hours: Any work-related fatality. o Within 24 hours: Any work-related in-patient hospitalization of one or more employees. Any work-related amputation. Any work-related loss of an eye. Send or take employee to an authorized treatment facility (listed on page 6) and provide the employee with a Medical Authorization and Attending Physician s form and Authorization to Obtain Medical Information form. Contact the treatment facility to advise them that a Town of Leland employee is being sent for treatment. Give injured employee a blank Notice of Accident to Employer and Claim (Form 18) to complete if they have not done so already as well as the Employee Statement form. Complete a First Report of Injury/Illness/Near Miss form. This form should be completed in its entirety and must be signed and dated. This information will be used to complete the Form 19 which is required under the provisions of the Workers Compensation Act to be transmitted to the Industrial Commission through our insurance carrier/claims administrator within 5 days after knowledge of accident. (Failure to submit paperwork timely will cause delays in the employee receiving the required authorization to obtain medical treatment or prescription drugs.) Forward all forms to Human Resources no later than 24 hours after the incident occurs. If town vehicle or town property/equipment was involved, then notify Finance immediately. It is important that the nature of each work-related injury or occupational disease be investigated. In most cases there is one event that causes the injury; however, some claims of work-related illness may not have a clear cause and effect relationship. Complete the Accident/Near Miss Investigation Report and Root Cause Fact Gathering Questionnaire. Forward completed forms to Human Resources. 4

6 WHERE DO I SEND THE EMPLOYEE FOR MEDICAL TREATMENT? Employees with life threatening work related injuries should seek immediate care at the nearest hospital. Employees may not choose their own doctor. Supervisors must ensure employees are sent to the following authorized medical facility: Carolina Comprehensive Health Network (formerly Carolina Family Medicine and Urgent Care) 509 Olde Waterford Way, Suite 101 Leland, NC Phone: (910) Fax: (910) Hours: Mon Fri: 8am - 7pm, Sat & Sun: 9am - 3pm If the authorized medical facility above is unable to see the employee within a reasonable time period, please contact Human Resources. Medical treatment received at an unauthorized facility could result in non-payment of claims. HOW DO I RETURN MY EMPLOYEE TO WORK? When the authorized treating physician releases the employee to return to work, there are three possible return to work authorizations: Types of Return to Work Employee Supervisor Reached maximum medical improvement. Released to return to work by their authorized treating physician without physical restrictions. Return the employee to his/her original or similar position held prior to the injury. Forward all medical notes to Human Resources Has not reached maximum medical improvement but is ready to return to restricted duty. Reached maximum medical improvement, but has a disability. Released to return to work by the authorized treating physician with physical restrictions. Released to return to work but disability may prohibit employment in original position due to permanent restrictions. Provide transitional work for the employee that is suitable to the work restrictions. Keep records of assigned duties. Forward all medical notes to Human Resources. Contact Human Resources if you are unable to meet the return to work restrictions. Meet with Human Resources as soon as possible. 5

7 Return to Work (Same Day): The employee is expected to return to work unless the authorized treating physician indicates in writing that the employee is unable to work. Return to Work (After Workers Compensation Leave): Once an employee has been released by the authorized treating physician to return to work, he/she is obligated to accept any suitable employment provided that it is in keeping with the employee s capability. Refusal to accept suitable employment may result in termination of compensation and may result in dismissal. Departments should work with Human Resources to develop a structured return to work plan to address restricted duty and an employee s inability to return to the original position at the time of injury. All transitional duty work is subject to the department s ability to provide such work. Note: If transitional duty work is obtained for the employee within another department, the hours worked will be charged to their normal departmental budget. REQUIRED FORMS (Included in Packet) All completed and signed forms must be sent to Human Resources within 24 hours of incident. First Report of Injury/Illness Form To be completed, signed and dated by supervisor. Notice of Accident to Employer and Claim (Form 18) Give to employee to complete if they have not done so already. Employee Statement Give to employee to complete. Medical Authorization and Attending Physician s Report Give to employee to give to physician. Authorization to Obtain Medical Information Give to employee to complete. Accident/Near Miss Investigation Report To be completed by supervisor. 6

8 ADDITIONAL INFORMATION FOR SUPERVISORS One misconception supervisors sometimes have regarding employees on workers compensation is that the employee is no longer their responsibility. Supervisors are still required to effectively manage their employee, which involves making sure absences are justified and any compensation paid by the Town is correct. Supervisors are required to collect the original copy of the Medical Authorization and Attending Physician s Report along with any additional medical documentation upon the employee s return to work. The employee should return to work following the initial doctor s visit. Forward the original documentation to Human Resources. Please comply with any restrictions or accommodations noted on the Attending Physician s Report. For example, if the physician states that the employee may not return to work for five days, he/she should be allowed the time away from work to get better. At the end of the five day period, the supervisor should expect the employee to return to work. If the employee does not return as scheduled, the absence is considered unauthorized unless the supervisor has a written updated medical status from the approved treating physician allowing the additional time. Send all doctor s notes and attending physician reports to Human Resources immediately. Adhere to the Return to Work section beginning on page 7 for more details. Not only should the supervisor keep in regular contact with the employee while he/she is out of work to stay abreast of his/her medical condition, but it is a great approach to showing the employee that he/she is a valuable asset to the Town. Occasionally, employees are billed for services they receive from an authorized medical provider because treatment was not coded as workers compensation. If this is the case, the employee needs to forward the bills to Human Resources. Any questions, please contact Christa Dees, Human Resources Director. Direct: (910) Cell: (910)

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