SCHERTZ-CIBOLO-UNIVERSAL CITY ISD WORKERS' COMPENSATION OVERVIEW

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1 SCHERTZ-CIBOLO-UNIVERSAL CITY ISD WORKERS' COMPENSATION OVERVIEW As a District, we strive very hard to provide a safe environment for our employees and students. It is very important that we adhere to sound loss control practices in order to decrease the potential for injuries and losses. The Schertz-Cibolo-Universal City Independent School District provides workers' compensation coverage for all of its employees through a self-funded (self-insurance) program with excess workers' compensation insurance and has a successful and established self-funded workers' compensation program. The District s Risk Manager coordinates the workers' compensation program and tries to implement remedies to help temper both the frequency and severity of its workers' compensation claims. Thus, the Risk Manager is responsible for reporting all notices of injury requiring treatment and/or lost time to the Division of Workers Compensation - Texas Department of Insurance. Through the continued cooperation and diligence of the employees, the district continues to experience a very successful program. This continued success allows the district to redirect a portion of the funds which would normally be allocated for workers compensation costs to other various needs, such as salaries and benefits. In order to continue this successful trend, the District has implemented numerous safety and health programs to minimize accident frequency and severity, contribute to the employees morale, and provide a safe and healthy environment for its employees and students. The following administrative policies contribute to this continued success. Please review and adhere to these policies to help continue the District s successful trend. Process for Workers Compensation Claims: If you are injured at work, think the injury was caused by work, or a doctor tells you the injury/illness is work-related, the following steps must be taken: 1. You must immediately report the incident to your supervisor. You will be asked to complete the Job Related Injury/Illness Report and the TXHCN Employee Notice of Certified Network form. The supervisor will then need to fill out form DWC-1 and the Workers Compensation Supplemental Form. You may be asked questions to enable the Nursing, Payroll or Risk Management staff to complete the state-required employer s first report of injury. We will need to know what, when, and where the injury occurred, who was involved, what part of your body was injured, what caused the accident, and who saw it happen. 2. If required, the injured worker should seek immediate medical attention after the injury. The employee should go to Concentra Medical Center. This does not mean that the employee has to continue treatment with Concentra Medical Center. To be referred to a specialist, employees must first be seen by a general 146

2 practitioner. Within 60 days of the injury, the employee has the right to change treating doctors. 3. If you have any questions or need information relating to your claim, contact: Reginna Agee SCUCISD Risk Manager Central Office Tele: 210/ Fax: 210/ Per Texas Workers Compensation laws, the SCUCISD is not required to pay injured workers for the first seven days off work. However, the district will pay the injured employee for up to five (5) work days with no deduction from salary or leave balance, provided the employee has obtained a medical certification from a TXHCN participating physician indicating that the employee is unable to work. If an employee does not obtain medical certification as to the disability, income benefits shall be implemented in accordance with the Texas Workers Compensation Act, which states that income benefits begin to accrue on the eighth day of disability. 5. After the seventh day of absence, the district workers compensation program will pay 70% to 75% of the employee s average weekly wage, subject to the maximum and minimum amounts established by law. This is not salary or a paycheck. It is called Temporary Income Benefits (TIBS). 6. You should report to your supervisor each time you go to the doctor. The doctor should give you a Physician Activity Status Report or DWC work status report (DWC-73 form) after the appointment. If your treating doctor releases you to return to work with modified physical restrictions, you will need to contact your supervisor to see if the district is able to accommodate your restrictions. An employee is required to have a return to work release form from their attending physician in order to return to their full regular duties. For questions regarding return to work, contact your departmental supervisor or Reginna Agee at

3 ADMINISTRATIVE POLICY SUBJECT: On-The-Job Injury Reporting DATE EFFECTIVE: September 1, 2013 Due to State of Texas requirements for the prompt reporting of on-the-job injuries and work-related illnesses, it is imperative that such incidents are reported promptly and accurately. Failure to report may result in substantial fines assessed against the Schertz-Cibolo-Universal City ISD by the Division of Workers Compensation. ALL injuries and/or work related illnesses sustained by employees while acting in the course and scope of employment, especially those which require medical attention or result in lost time, must immediately be reported by the affected school or department, to the Risk Management Department at 210/ or by to Provide the employee s name, date of injury, a brief description of the injury/illness and whether the employee is seeking medical attention. PROCEDURE 1. Non life threatening injury 1.1 An employee will report an alleged on-the-job injury to his/her supervisor by the conclusion of the shift in which the injury occurred. If a supervisor is not on duty, report alleged injury to a co-worker and then to immediate supervisor by the conclusion of the next work day. Failure to comply with the reporting guidelines places the burden of proof of the incident on the injured employee. 1.2 If the injured employee requires medical attention, the supervisor or designee will issue an Authorization for Medical Treatment Form and send the affected employee to the appropriate medical provider. Call or the Risk Management Department when this occurs. If after normal work hours, leave a message on the voice mail or call by the conclusion of the next work day. 1.3 When an employee reports an on-the-job injury or illness, the injured employee s supervisor, principal, or department manager or designee will have the employee complete the Job Related Injury or Illness Report and the TXHCN acknowledgment form at that time. The supervisor or designee will then complete an Employer s First Report of Injury or Illness Report and Workers Compensation Injury Supplemental Form and forward to the Risk Management Department as soon as possible. Only the Job Related Injury or Illness Report is to be completed by the employee. All forms are to be submitted regardless of whether medical treatment is required. 148

4 1.4 The injured employee s immediate supervisor or designee will call or the Risk Management Department as soon as an employee begins losing time due to an alleged on-the-job injury. (Follow the phone call with a written confirmation memo or .) If after normal work hours, leave a message on the voice mail or call by the conclusion of the next work day. If during a school holiday break, see Holiday Reporting, Section Charge all physician certified absences from work due to an alleged onthe-job injury to Workers Comp. No workers compensation benefits will be paid without a physician s statement taking the employee off work. All follow-up visits for medical treatment must be taken at the employee s expense, either outside of their normal work hours or by use of the employee s leave time. 1.6 When the employee returns to work after receiving medical treatment, the employee must submit Texas Department of Insurance prescribed work status form (DWC-73) prior to being allowed to commence work activities. If the employee received medical treatment from Concentra Medical Center, the Physician s Activity Status Report provided by the Center will be accepted. The employee s supervisor or designee will call or the Risk Management Department within twenty-four (24) hours of the employee s return and forward all paperwork submitted by the employee. 2. Life Threatening Injury 2.1 As soon as an alleged life threatening on-the-job injury has occurred, the injured employee s co-worker or supervisor should contact the following people in the order listed below: First Call: Second Call: Third Call: Ambulance (if one is needed); Injured employee s immediate supervisor (if not already at the scene of the accident); Risk Management Department (If after normal work hours, 8:00 a.m. to 4:30 p.m. Monday-Friday, contact Reginna Agee at 210/ ) 2.2 After the employee has been taken, or sent, for appropriate medical treatment, the supervisor should investigate the circumstances surrounding the accident. If there were witnesses to the accident, their written statements should be obtained immediately. 2.3 By the conclusion of the next work day after the occurrence of an alleged on-the-job injury, the injured employee s supervisor or designee will complete an Employer s First Report of Injury or Illness Report and Workers Compensation Injury Supplemental Form and forward to the Risk Management Department. These forms are not to be completed by the employee. 149

5 2.4 The injured employee s immediate supervisor or designee must notify the Risk Management Department as soon as an employee begins losing time due to an alleged on-the-job injury. (If by phone call, follow the phone call with a written confirmation memo or .) If after normal work hours, leave a message on voice mail or call by the conclusion of the next work day. If during a school holiday break, see Holiday Reporting, Section Charge all physician certified absences from work due to an alleged onthe-job injury to Workers Comp. No workers compensation benefits will be paid without a physician s statement taking the employee off work. All follow-up visits for medical treatment must be taken at the employee s expense, either outside of their normal work hours or by use of the employee s leave time. 2.6 When the employee returns to work after receiving medical treatment, the employee must submit the Texas Department of Insurance prescribed work status form (DWC-73) prior to being allowed to commence work activities. If the employee received medical treatment from Concentra Medical Center, the Physician s Activity Status Report provided by the Center will be accepted. The employee s supervisor or designee will notify the Risk Management Department within twenty-four (24) hours of the employee s return and forward all paperwork submitted by the employee. 3. Holiday Reporting If an injured employee loses two or more work days due to an on-the-job injury, the injured employee s immediate supervisor, if unable to contact the SCUCISD Risk Management Office or Reginna Agee, shall call the District s claims representative at Sedgwick Claims Management (210/ ) and inform him/her of the situation. Questions concerning on-the-job injury reporting shall be directed to the Risk Management Department at or 210/

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7 ADMINISTRATIVE POLICY SUBJECT: Return to Work Program DATE EFFECTIVE: September 1, 2013 PURPOSE To aid employees in returning to work from an on-the-job injury or illness, the Schertz- Cibolo-Universal City ISD has established a return-to-work program. All SCUCISD employees who, for medical reasons, may not return to full duty as the result of an onthe-job injury or illness are eligible for this program. For the purpose of this policy, restricted, limited or modified duty will be any duty as a result of restrictions placed on an employee by a physician which will not allow the employee to perform the full course and scope of his/her job duties, or the need for assistive devices to be able to perform the full course and scope of his/her job duties. GENERAL ADMINISTRATION 1.0 Risk Management s Responsibilities 1.1 The Risk Management Department will coordinate the return to work program. 1.2 All limited/modified duty job assignments will be approved by the Risk Management Department. 2.0 Length of Limited/Modified Duty 2.1 Limited/modified duty assignments will not exceed a total of 60 work days unless a variance or extension is approved by the employee s supervisor, the Director of Human Resources, and Risk Manager. 2.2 After 60 days on limited/modified duty, the employee will return to his/her original job or will be placed on workers compensation leave unless additional limited/modified duty is approved per 2.1 above. 2.3 Each affected employee is responsible for obtaining an evaluative medical examination at least once each month, and the results of this examination will be provided to the Risk Management Department within two (2) working days of the date of the examination. Failure to have such an examination conducted or report the results will result in disciplinary action up to and including termination of limited/modified duty benefits. 2.4 If the evaluative medical examination is performed by a provider other than Concentra Medical Center, the initial report will be provided on the Texas Department of Insurance s form, DWC-73, with a full narrative to follow. The narrative will specifically define and state an employee s medical 152

8 3.0 Benefits condition; a prognosis for recovery with an expected time period for recovery; an outline of the treatment, therapy, etc., to be conducted to promote recovery; and an identification of any physical performance limitations or restrictions of activity (both occupational as well as nonoccupational). The Physician s Activity Status Report submitted by Concentra Medical Center will be in lieu of the DWC-73 form. All benefits will continue while an employee is on limited/modified duty. Employees on limited/modified duty may take any available leave subject to compliance with the policy pertaining to such leave and with the approval of the appropriate department director or supervisor. 4.0 Limited/Modified Duty Access When a physician determines that an employee cannot return to their original position and perform the essential functions of that position, but could perform a limited/modified duty assignment: 4.1 The employee will submit Concentra s Physician s Activity Status Report or a DWC-73 from the treating physician to his/her department director or supervisor outlining any limitations which would prevent the employee from performing the essential functions of his/her position. 4.2 The department director or supervisor, after consultation with the Risk Manager, will attempt to place the employee in a limited/modified duty position. 4.3 If limited/modified duty is not available within the employee s department, the department director or supervisor will contact the Risk Manager. 4.4 The Risk Manager will attempt to place the employee in a limited/modified duty position in another department if a position is not available in the injured employee s own department. 4.5 The number and type of limited/modified duty positions available are available on a limited basis; therefore, if a limited/modified duty position is not available, the employee will remain on workers compensation leave. 4.6 If an employee refuses to accept a job assignment within the capabilities as approved by the treating physician, the employee will be disqualified from participating in the Limited/Modified Duty Program and may be placed in an off-duty status from employment. 4.7 If the treating physician restricts an employee from taking part in, or performing certain physical activities which would extend outside the workplace, the employee will abide by these restrictions both in the 153

9 workplace and outside the workplace. The violation of these physical restrictions will be grounds for the termination of benefits and employment. 5.0 Limited/Modified Duty Time Records 5.1 If limited/modified duty is available in the employee s home department, the employee s Kronos records will reflect as though the employee were on regular duty. 5.2 If limited/modified duty is in a department other than the home department, the employee will clock into Kronos as usual and this will reflect as though the employee were on regular duty. 6.0 Medical Support If it becomes questionable as to the need of the ability of an employee to be on limited/modified duty, the Risk Manager will arrange an independent medical evaluation of the employee. 154