RISK MANAGEMENT PROCEDURE

Transcription

1 RISK MANAGEMENT PROCEDURE SUBJECT: REPORTING ON THE JOB INJURIES R 3.0 EFFECTIVE: 01/04/88 REVISED: 1/4/16 I. PURPOSE The purpose of this procedure is to outline the procedures for reporting on-the-job injuries and to furnish guidelines for the proper completion of the Employer s First Report of Injury or Illness, the DWC Form-6 Employer s Supplemental Report of Injury, the Injury Investigation Form, and the Employee Statement Form. II. SCOPE This procedure applies to all City employees, including part time employees & temporary employees paid by the City. The procedure also applies to uniformed police and fire employees. III. DEFINITIONS Lost Time Injury A work related injury causing an absence from work. No Lost Time Injury A work related injury which does not cause an absence from work. TPA - Third Party Administrator is contracted by the City of Corpus Christi to manage all Workers Compensation claims. DWC Texas Department of Insurance, Division of Workers Compensation; a division of the agency which governs administration of work related injury or illness in the State of Texas. City of Corpus Christi First Report of Injury/Illness Data Sheet - This form may be found on the City s intranet website at This form must be completed by the injured employee s supervisor or the department/divisions designated safety representative and turned in within 24 hours to the person designated to electronically submit claims to the City s TPA. R 3.0 Reporting on the Job Injuries Page 1 of 9

2 IV. PROCEDURE The intent of this procedure is to ensure employees receive proper medical care and Workers Compensation benefits during a period of disability as required by the Texas Workers Compensation Act. Under the terms of Chapter 504 of the Texas Labor Code, the City of Corpus Christi will provide Workers Compensation benefits to its employees. V. PROCEDURES A. Electronic Submission of Employer s First Report of Injury or Illness The City of Corpus Christi First Report of Injury or Illness Data Sheet (Attachment A) can be found on the City s intranet website; compensation, and shall be completed by the injured employee s supervisor or the department Safety Representative. It will then be provided as soon as possible, but no later than 24 hours after the injury is reported, to the designated staff member, or alternate staff member, responsible for entering the data electronically. A copy of the electronically generated first report of injury must be given to the injured employee. Each department/division shall designate one staff member and one alternate staff member to electronically file injury reports using the information on the City of Corpus Christi First Report of Injury or Illness Data Sheet. Risk Management must be notified in the event the designated staff member and/or alternate staff member changes so that appropriate login, passwords, and training may be provided. It is essential that the information from the injury report data sheet be entered via electronic submission to the City s TPA within 72 hours from the time the injury is reported. Failure to enter the report within this time frame may result in a fine by the Texas Department of Insurance Division of Workers Compensation (DWC). All questions concerning the City of Corpus Christi First Report of Injury or Illness Data Sheet, or the electronic submission process should be directed to the City s workers compensation TPA or the Risk Management Division. B. DWC Form 6 Supplemental Report of Injury When lost time occurs, the DWC Form-6, Supplemental Report of Injury (Attachment B) must be sent to the City s worker s compensation TPA via fax at within the following timeframes: 1) within three (3) days after the injured employee is placed on, or released from, a no work status by the attending physician in writing; 2) within three (3) days after the injured employee returns to work from any additional lost time due to the injury; 3) within three (3) days when the employee, after returning to work, has an additional day or days of lost time because of the injury; 4) within ten (10) days after the end of each pay period in which the employee has an increase or decrease of earnings due to his/her work related injury; 5) within ten (10) days after the employee resigns or is terminated. R 3.0 Reporting on the Job Injuries Page 2 of 9

3 Managers/Supervisors: It is the responsibility of the direct supervisor or designated person to complete the DWC Form 6, Supplemental Report of Injury. Instructions for the DWC Form 6, Supplemental Report of Injury can be found on Attachment B and on the City s intranet website; compensation. All questions concerning this form should be directed to the Risk Management Division. C. Injury Investigation Form The Injury Investigation Form (Attachment C) shall be completed by a Safety Coordinator or Supervisor. It should be signed by the department s safety coordinator and the department Director or Assistant Director. This form is to be completed whenever an Employer s First Report of Injury or Illness is required, as well as whenever an accident occurs which does not involve an injury. The Injury Investigation Form can be found on the City s intranet website; compensation. D. Employee Statement Form The Employee Statement Form (Attachment D) can be found on the City s intranet website; compensation. It should be completed, signed by the injured employee, and faxed to the City s workers compensation TPA local office at within 72 hours from the time the injury is reported. A copy will be given to the employee and the original kept in the departmental files. VI. Workers Compensation 504 Medical Care Program Effective September 28, 2015, The City of Corpus Christi implemented a medical provider panel called My Texas Direct as a part of its self-funded Workers Compensation Program. This 504 Medical Care Program will require employees with an on-the-job injury or illness to use a primary medical care provider from the My Texas Direct provider list. There will be both primary care physicians/facilities and specialists included in the provider panel that has been approved to provide medical care to City of Corpus Christi employees. Except in the case of a true emergency, employees must use one of the approved primary medical care providers in order to have the medical care paid by the City of Corpus Christi Workers Compensation Program through its administrator, York Risk Services Group. A. Employees Responsibility: Employee must immediately notify their supervisor of the work related injury or illness. A first report of injury form and employee statement will be completed at that time, Employees can also contact the Risk Management Division for reporting injuries at to complete a first report of injury form and an Employee Statement Form. If medical care is necessary, you will be provided a list of approved primary care providers. If you need non-emergency care after normal business hours, consult My Texas Direct web page at for Primary Care Physicians that are open after normal business hours. In case of an emergency, call 911 or seek the nearest emergency facility. R 3.0 Reporting on the Job Injuries Page 3 of 9

4 B. Department Head/Supervisor Responsibility: The employee will need to complete the first report of injury (FROI or DWC-1) form and both (department head/supervisor and employee) will need to sign the form. Provide the injured employee with the list of approved primary medical care providers available through My Texas Direct. VII. PROCEDURE UPDATE This procedure shall be reviewed on an annual basis by the Safety Advisory Board (S.A.B.). Revisions to the procedure shall be approved by the Safety & Risk Manager and by the City Attorney. VII. CONSEQUENCES FOR VIOLATION OF THIS PROCEDURE Failure to comply with this procedure may result in disciplinary action up to and including termination. VIII. QUESTIONS REGARDING THIS PROCEDURE Questions regarding this Procedure shall be directed to the Safety & Risk Manager, or designee, who may be contacted at R 3.0 Reporting on the Job Injuries Page 4 of 9

5 R 3.0 Reporting on the Job Injuries Attachment A Page 5 of 9

6 R 3.0 Reporting on the Job Injuries Attachment B Page 6 of 9

7 R 3.0 Reporting on the Job Injuries Attachment B Page 7 of 9

8 R 3.0 Reporting on the Job Injuries Attachment C Page 8 of 9

9 R 3.0 Reporting on the Job Injuries Attachment D Page 9 of 9