Q & As about Workers Comp

Transcription

1 When an employee is injured on the job, there is a process that needs to be quickly activated. The following information will provide you with information regarding the process and answer additional questions. Q: An employee is injured at work. What steps should be taken? A: Procedure for Medical Care: 1. The employee should seek assistance at Employee Health and Wellness (EH&W) for appropriate assessment and/or treatment. 2. The employee should seek assistance at SAMC Emergency Department for urgent/life threatening injuries or medical attention needed outside the normal operating hours of EH&W. 3. If the employee must go to the Emergency Department because EH&W is closed, the employee must follow up with EH&W as soon as possible after the employee receives appropriate assessment and/or treatment. 4. It is the responsibility of the employee to provide his/her supervisor with a detailed written statement regarding working restrictions/modifications (Work Status Form). If the employee is put off work by an authorized health care provider, it is the employee s responsibility to communicate and provide documentation to their supervisor. 5. Employees should NOT go to their personal health care provider. Those who disregard this instruction may lose compensation benefits for that care. Injury Reporting: Required Employee Reports: 1. Employee s Report of Injury Form/INSIDE SAMC 2. ReadySet/INSIDE SAMC The timely completion of the required Employee s Report of Injury Form (located on INSIDE SAMC) by the employee will speed the review of the process that determines whether the injury and the costs associated will be covered by workers compensation. 1. It is the responsibility of the employee who is injured on the job to report an injury to the appropriate supervisor immediately or as soon as practical, but no later than the conclusion of the staff member s shift. 2. It is the responsibility of the employee to properly complete an Employee s Report of Injury Form at the time of the injury, unless an emergency situation exist, and submit it to his/her appropriate supervisor. 3. The supervisor is responsible for investigating the accident and reporting in their section of the Employee s Report of Injury Form at the time of the injury, unless an emergency situation exists. If medical attention is needed, the employee will be referred to EH&W. 4. The employee must take the Employee s Report of Injury Form to EH&W or the Emergency Department. 5. The employee is responsible for submitting the completed Employee s Report of Injury Form to EH&W at the time of service or within 24 hours of the injury. 6. The employee will be assisted by EH&W in recording the required information in ReadySet (located on INSIDE SAMC). EH_Workers Comp-Q&As 10/13/16 (1/6) #3169

2 Returning to Work When an employee has an on-the-job injury, the authorized health care provider may release the employee back to work, although it may be with some work restrictions. The following will provide information regarding the return to work process. Q: What is the process when an employee is able to return to work with no restrictions? A: Procedure for Return to Work Full Duty: 1. The authorized health care provider may release the employee to full duty based on the physical demands listed on the employee s job description, considering the extent and nature of the employee injury. 2. The return to work date will be discussed with the employee and documented on the Work Status Report Form (EH&W original form/employee copy) 3. The authorized health care provider and the employee will sign the Work Status Report Form. 4. The employee is responsible for reviewing the Work Status Report Form with their supervisor. The Q: What is the procedure for returning to work with restricted/modified duties? A: Procedure for Return to Work/Restrictions: An employee may return to work after an injury with duties that are restricted or modified. These accommodations will assist employees in returning to their regular work routine and limiting time off from work. This, in turn, will allow the employee the opportunity of maintaining productive work habits while recovering from their injury. Returning to work, even with temporary work restrictions, is perhaps the most significant factor in a rapid recovery. Work restrictions/modifications may relate to the number of hours the injured employee can work, the amount of weight that may be lifted, the length of time permitted to stand, and/or other physical limitations as listed in the specific job descriptions. The restrictions/modifications will require both the employee and the supervisor to have a good understanding of how restrictions/modifications translate into day-to-day job responsibilities. 1. The restrictions/modifications will be given to the employee by an authorized treating health care provider. The restrictions/modifications will be based on the physical demands listed on the employee s job description, considering the extent and nature of the employee injury. 2. Work restrictions/modifications will be discussed with the employee and documented on the Work Status Report Form. (EH&W original form/employee copy). 3. The authorized health care provider and the employee will sign the Work Status Report Form. 4. The employee is responsible for submitting the Work Status Report Form to their supervisor and reviewing all documented work restrictions/modifications and follow up appointments. The 5. If the employee is released to work with restrictions/modifications, the employee should report to his/her supervisor for placement in a job consistent with the specified restrictions/modifications. If a suitable position is not available in that department, the supervisor will contact EH&W for a suitable job placement in another area of the Medical Center. EH_Workers Comp-Q&As 10/13/16 (2/6) #3169

3 6. All rules of work (Attendance and Punctuality Policy, Job Abandonment, etc.) are applicable to employees who are working with job restrictions or modifications due to a work related injury. Q: What is the procedure when follow up health care visits are required? A: Procedure for Follow Up: The employee may be released to full duty with no follow up required. -OR- The EH&W health care provider or the authorized treating health care provider is responsible for providing follow up medical treatment and keeping the employee informed about how soon he/she will be able to return to work, with or without any job restrictions/modifications. In the case of restrictions/ modifications, the duration of these will be noted. 1. Work restrictions/modifications will be discussed with the employee and documented on the Work Status Report Form (EH&W original form/employee copy). 2. The authorized health care provider and the employee will sign the Work Status Report Form. 3. The employee is responsible for submitting the Work Status Report Form to their supervisor and reviewing all documented work restrictions/modifications and follow up appointments. The 4. If the employee is released to work with restrictions/modifications, the employee should report to his/her supervisor for placement in a job consistent with the specified restrictions/modifications. If a suitable position is not available in that department, the supervisor will contact EH&W for a suitable job placement in another area of the Medical Center. 5. All rules of work (Attendance and Punctuality Policy, Job Abandonment, etc.) are applicable to employees who are working with job restrictions or modifications due to a work related injury. Q: What happens if an employee s department cannot accommodate the work restrictions/ modifications? A: A temporary work assignment will be given to the employee that accommodates their work restrictions/modifications. The assignment may be in or outside of their department. If Unable to Work Very rarely an employee will have an on-the-job injury that is serious enough that the employee is unable to work. The following will provide information regarding the lost time process. Procedure When Unable to Work: 1. The authorized health care provider and the employee will sign the Work Status Report Form. 2. The employee is responsible for reviewing the Work Status Report Form with their supervisor. The 3. If the authorized health care provider determines that the employee is unable to work, a statement from that authorized health care provider must be forwarded by the employee immediately to the appropriate supervisor. If the authorized health care provider is someone other than an EH&W health care provider, the statement must immediately be forwarded by the employee to EH&W and the appropriate supervisor. EH_Workers Comp-Q&As 10/13/16 (3/6) #3169

4 Lost Time Compensation/Benefits: Q: How is an employee paid when out of work? A: In accordance with the Alabama Workers Compensation Law, the following compensation and benefits may be available to the employee. 1. The cost of the medical care can include medical prescriptions, physical therapy, durable medical equipment and mileage reimbursement to referrals outside of Medical Center campus. These costs may be paid through the workers compensation administrator when treatment is authorized, provided by an authorized health care provider and the injury is a workers compensation claim. 2. Employees who go to appointments related to their workers compensation claim at locations other than EH&W should clock out. The employee may use EIB for these appointments. 3. Charges incurred by an employee will be the responsibility of that employee to pay and then submit to the workers compensation administrator for reimbursement, unless otherwise approved by the provider and the Medical Center. This includes after hour (Medical Center Employee Pharmacy) emergent pharmacy purchases. All other workers compensation pharmacy purchases must be made at Medical Center Employee Pharmacy. 4. According to Alabama Workers Compensation Law, if an employee is unable to work due to a work related injury, no temporary disability payments are considered for payment until after the fourth missed day following the injury. 5. Employees may use their Extended Illness Benefit (EIB) for the three day or 24 hour waiting period. After using EIB for the first three days or 24 hours the employee may not receive EIB benefits until they return to work. 6. If the employee does not have 24 hours of EIB and is out of work for the same work related injury in excess of 21 days, the workers compensation administrator will reimburse the original three days missed. 7. Lost work time compensation is paid on the basis of a 66 2/3 gross average weekly wage income. 8. Lost time payments are discontinued when the employee returns to work. 9. As long as the employee continues to pay their premiums for health insurance, retirement, etc., the Medical Center will continue to make its contributions. Because there are no deductions taken from the workers compensation check, the employee will need to establish a process to ensure that the employee portion of any premium or deductions continues. The employee should contact Human Resources for additional information regarding deductions or premiums. Q: When should an employee receive the first workers compensation check? A: The workers compensation administrator will send a lost time check to the employee s home address. After the employee has been out of work for the waiting period (3 working days or 24 hours), the date of the first check will vary depending on administrative processing time. Q: How is the average weekly wage calculated? A: The average weekly wage is calculated by dividing the employee s gross wages over the past 52 weeks by 66 2/3. This amount is the lost time compensation paid weekly. There are variations depending on individual circumstances. For more specific questions, contact Human Resources. EH_Workers Comp-Q&As 10/13/16 (4/6) #3169

5 Q: How long can an employee receive workers compensation? A: Medical care for compensable injuries generally continues until the employee is released by the authorized health care provider. Q: Who pays for the cost of the employee s medical care? A: The cost of the employee s medical care is paid through workers compensation when the treatment is authorized, provided by an authorized health care provider and the injury is accepted as a workers compensation claim. The employee will not be responsible for deductibles or copays for authorized treatment. The employee must let the authorized health care provider know that the treatment is being provided for an on-the-job injury each time he or she receives medical care. 1. The cost of the medical care can include medical prescriptions, physical therapy, durable medical equipment and mileage reimbursement to referrals outside of Medical Center campus. These costs may be reimbursed through the workers compensation administrator when treatment is authorized, provided by an authorized health care provider and the injury is a workers compensation claim. 2. Charges incurred by an employee will be the responsibility of that employee to pay and then submit to the workers compensation administrator for reimbursement, unless otherwise approved by the provider and the Medical Center. This includes after hour (Medical Center Employee Pharmacy) emergent pharmacy purchases. All other workers compensation pharmacy purchases must be made at Medical Center Employee Pharmacy. 3. Employees who go to appointments related to their workers compensation claim at locations other than EH&W should clock out. The employee may use EIB for these appointments. Q: How is it determined whether the injury is covered under workers compensation? A: Each injury report is forwarded to EH&W. The EH&W representative or Third Party Administrator (TPA) may interview the employee regarding the relevant medical history and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers compensation. If the circumstances are very complex the workers compensation administrator may also consult with legal and or medical counsel and /or request to review the relevant medical records, and/or request additional information from the employee s supervisor. Once the review is completed, a decision is made regarding whether the injury is covered under workers compensation. Q: How long does it take to receive a determination? A: Determination may be made immediately upon EH&W receiving and reviewing the completed Employee Report of Injury. Delays may occur if additional information is needed and/or a delay in reporting occurs. Injuries must be reported within 24 hours of occurrence. Q: Who informs the employee of the outcome of the workers compensation review? A: An EH&W representative will contact the employee with the result of the review. EH_Workers Comp-Q&As 10/13/16 (5/6) #3169

6 Q: Who should be contacted if there are questions about the workers compensation process? A: EH&W should be contacted if the employee has questions about the workers compensation process. Q: Can an employee receive treatment from a personal doctor rather than from EH&W? A: Employees should NOT go to their personal physician. Those who disregard this instruction may lose compensation benefits for that care. Q: What should an employee do if they are receiving treatment for a non-work related condition and an on-the-job injury by the same health care provider? A: Only the treatment for the job related injury is covered under workers compensation. The cost of the medical care for non-work related injuries would continue to be the responsibility of the employee. The authorized health care provider will separate the care that is provided for the work injury and the employee will be referred back to the regular health care provider for treatment of any non-work related health condition. Q: Can an employee request a change in health care provider? A: Generally, the authorized health care provider will be from EH&W. Under certain circumstances an employee may be considered for an alternate health care provider. Q: How long can an employee receive medical care through workers compensation? A: Medical care for compensable injuries generally continues until the employee is released by the authorized health care provider. Q: If an employee has to travel to receive medical treatment (including physical therapy), is the employee eligible to receive mileage reimbursement? A: Yes, in some cases if the treatment is off Medical Center premises. The employee should contact EH&W for information on reimbursement. Q: If an employee is referred for surgery will this be covered? A: Inpatient treatment and inpatient surgery are types of medical care that are covered under workers compensation. Unless the situation is an emergency, preauthorization from the workers compensation office may be required. Q: Who would perform the surgery? A: When specialist care is needed, EH&W will select a qualified physician (and/or) provider to ensure the employee receives the optimal care. Q: Is physical therapy covered? A: Physical therapy is also a type of medical care covered under workers compensation when ordered by the authorized health care provider. EH_Workers Comp-Q&As 10/13/16 (6/6) #3169