FUNCTIONAL AREA #4 Health, Safety & Workers Compensation

Transcription

1 FUNCTIONAL AREA #4 Health, Safety & Workers Compensation Presented by: Gina de Miranda, M.A., SPHR-CA, SHRM-SCP TPO Bilingual Consultant PHRca Instructor

2 HEALTH, SAFETY & WORKER S COMPENSATION This area is worth 12% of your test score Responsibilities under this functional area include: Develop and implement policies and procedures to comply with state laws and regulations regarding health and safety administration Ensure compliance with state laws and regulations regarding health and safety Provide state required training programs governing health and safety 2017 TPO-The HR Experts. All rights reserved. 2

3 HEALTH, SAFETY & WORKER S COMPENSATION This area is worth 12% of your test score Cont Responsibilities under this functional area include: Develop and implement compliant policies and procedures regarding workers compensation, including return to work Ensure compliance with state laws and regulations regarding workers compensation Establish and administer documentation and records retention policies and procedures required under state law governing health, safety, and workers compensation 2017 TPO-The HR Experts. All rights reserved. 3

4 HEALTH, SAFETY & WORKER S COMPENSATION This area is worth 12% of your test score Knowledge under this functional area includes: Cal/OSHA requirements Injury and Illness Prevention Program (IIPP) requirements Heat illness prevention requirements Ergonomics reporting requirements 2017 TPO-The HR Experts. All rights reserved. 4

5 HEALTH, SAFETY & WORKER S COMPENSATION This area is worth 12% of your test score Cont Knowledge under this functional area includes: Workers compensation notification and reporting requirements, claims administration, and fraud Return to work requirements CA Drug Free Workplace Act Legal requirements for postings and notices Documentation and records retention requirements 2017 TPO-The HR Experts. All rights reserved. 5

6 WHAT DOES Cal/OSHA STAND FOR? CA Occupational Safety and Health Act CA Occupational Safety and Health Act or Cal/OSHA is the LAW Division of Occupational Safety and Health (DOSH) is the DIVISION that sets and monitors the standards for health and safety in CA Cal/OSHA, enacted in 1973, is a federally approved workplace safety program. CA, through state and local laws, provides greater levels of workplace health, safety and Workers Compensation than federal law The federal Occupational Safety and Health Act (OSHA) honors state laws that exceed or at least equal the provisions under Cal/OSHA 2017 TPO-The HR Experts. All rights reserved. 6

7 THE DOSH & Cal/OSHA FRAMEWORK Both the federal government and the state regulate safety The CA Department of Industrial Relations has oversight over DOSH DOSH monitors safety and health in all industries General Industry Safety Orders or GISO spell out safety standards in the workplace TITLE 8 of the CA CODE OF REGULATIONS requires that employers have Illness and Injury Prevention Plans (IIPP) and specifies their contents to a certain extent 2017 TPO-The HR Experts. All rights reserved. 7

8 GENERAL INDUSTRY SAFETY ORDERS (GISO) The Most Generally Cited GISOs include: 1. Injury and Illness Prevention Program 2. Personal Protective Equipment 3. Emergency Action Plans 4. Fire Prevention Plans 5. Hazard Communication 6. Machine-Guarding 7. Lockout-Tag out 8. Industrial Trucks 9. Blood Borne Pathogens 10. First-Aid 11. Storage of Materials 12. Good Housekeeping 13. Safe Work Surfaces, Aisle Ways, and Walkways 14. Building Codes 2017 TPO-The HR Experts. All rights reserved. 8

9 OFFICE OF EMERGENCY SERVICES (OES) This office is under the Governor of the State of CA The OES is based on four (4) phases of emergency management: 1) Preparedness 2) Response 3) Recovery and 4) Mitigation 2017 TPO-The HR Experts. All rights reserved. 9

10 OFFICE OF EMERGENCY SERVICES (OES) Support training activities for their local government and the community Support preparedness and disaster-recovery training for their managers and workers Become a link between the government and the public. Research and learn about state and federal disaster assistance programs TPO-The HR Experts. All rights reserved. 10

11 EMPLOYEE RIGHTS UNDER Cal/OSHA To receive training from their employer about workplace hazards and worker s rights To receive information on injuries, illnesses, and hazardous substances in their workplace, such as material safety data sheets (MSDSs) and exposure records (now called SDS) To request action from their employer to correct hazards or violations The ability to file a complaint with Cal/OSHA if it appears that there are either violations of Cal/OSHA standards or workplace hazards To be involved in Cal/OSHA s inspection of their workplace by participating in the walk-around or walk-through To find out the results of a Cal/OSHA inspection 2017 TPO-The HR Experts. All rights reserved. 11

12 EMPLOYEE RESPONSIBILITIES UNDER Cal/OSHA Comply with all Cal/OSHA rules, regulations and standards Follow all lawful employer safety and health rules and regulations Use all required personal protective equipment (PPE) while working 2017 TPO-The HR Experts. All rights reserved. 12

13 EMPLOYER RIGHTS UNDER Cal/OSHA Appeal citations issued by DOSH Protect their trade secrets Participate in developing new standards before the Occupational Safety and Health Standards Board Seek variances from Cal/OSHA standards 2017 TPO-The HR Experts. All rights reserved. 13

14 EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA As of July 1, 2017 : Establish, implement and maintain an effective Injury and Illness Prevention Program (IIPP). Provisions included: Train workers in safety and tool usage Inspect the workplace to identify and correct unsafe or hazardous conditions Ensure safe tools and that equipment is properly maintained Warn employees of potential hazards in the workplace Establish and communicate operating procedures for health and safety Provide medical examinations required by Cal/OSHA standards 2017 TPO-The HR Experts. All rights reserved. 14

15 EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA Report serious injury, illness or death immediately, and no later than (8) hours, by telephone or fax to the nearest Cal/OSHA Enforcement Unit Non-reporters can be fined ($5,000) Employees serving in supervisory management or similar roles may be individually liable for up to (1) year in jail and/or a ($15,000) fine Corporations face fines up to ($150,000) 2017 TPO-The HR Experts. All rights reserved. 15

16 EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA Keep records (Cal/OSHA Log 300) of work-related injuries or illnesses, unless exempted by the regulations Post Safety and Health Protection on the Job at a prominent location within the workplace, the Cal/OSHA poster informing employees of their rights and responsibilities TPO-The HR Experts. All rights reserved. 16

17 WORKPLACE SAFETY POSTINGS and NOTICES All CA employers are required to post the Safety and Health Protection on the Job Cal/OSHA poster Postings of the list of emergency phone numbers (If using hazardous or toxic substances) the access to Medical and Exposure Records notice All covered CA employers with eleven (11) or more employees in the previous year are required to post the Cal/OSHA Summary of Occupational Injuries and Illnesses (Form 300A) from February 1-April 30 each year The Whistleblowers Protections notice (size 14 font+) No smoking signs 2017 TPO-The HR Experts. All rights reserved. 17

18 TARGETED INSPECTION & CONSULTATION PROGRAM (TICP) A Cal/OSHA program that: identifies certain high-hazard employers requires them to pay a fee to fund a special inspection unit. offers other consultation services to help businesses avoid investigations and costly fines 2017 TPO-The HR Experts. All rights reserved. 18

19 INJURY & ILLNESS PREVENTION PROGRAM (IIPP) Required elements of an IIPP include: Management commitment Assignment of responsibilities Safety communications systems with employees System for assuring employee compliance with safe work practices Scheduled inspections/evaluation system Accident investigation procedures Procedures for correcting unsafe/unhealthy conditions Safety and health training and instruction Recordkeeping and documentation 2017 TPO-The HR Experts. All rights reserved. 19

20 SUCCESSFUL IIPP WILL INCLUDE: Actual objectives for accident and illness prevention An emphasis on staff's safety and health responsibilities The implicit message that management staff, supervisors and employees will be held accountable and back this up with action Provide a means for employees to report unsafe conditions with assurance that management will take action Allocate company resources for identifying and controlling hazards in new and existing activities 2017 TPO-The HR Experts. All rights reserved. 20

21 IIPP SAFETY COMMITTEES Meet regularly but not less than quarterly Prepare and make available written records of the safety and health issues discussed and maintained those for review by the Division upon request Review results of the periodic scheduled worksite inspections Review investigations of occupational accidents and exposure to hazardous substances Submit suggestions to management for prevention of future incidents 2017 TPO-The HR Experts. All rights reserved. 21

22 IIPP SAFETY COMMUNICATIONS Occupational accident and injury history with possible comparisons to other company locations Feedback from the employees Guest speakers from WC insurance carriers or agencies concerned with safety Brief audio-visual industry-related materials Control of the meetings Stress that the meeting s purpose is safety Management should attend these meetings 2017 TPO-The HR Experts. All rights reserved. 22

23 HAZARD ASSESSMENT & CONTROL (Inspections) Every Injury and Illness Prevention Program begins with the required hazard assessment survey/inspection by a qualified person An effective hazard control assessment identifies: Hazards that exist or develop in the workplace How to correct those hazards Steps that can be taken to prevent recurrence Provides that baseline against which progress is measured 2017 TPO-The HR Experts. All rights reserved. 23

24 ONGOING INSPECTIONS Ongoing inspections to identify and evaluate hazards: Whenever new substances, processes, procedures, or equipment are introduced to the workplace that represent a new occupational safety and health hazard; and Whenever the employer is made aware of a new or previously unrecognized hazard Include steps to protect employees until the hazard is abated Follow up on previous changes to see if those changes were effective in mitigating hazard 2017 TPO-The HR Experts. All rights reserved. 24

25 HAZARD ASSESSMENT & CONTROL Hazards should be corrected as soon as they are identified. For any that can't be immediately corrected, set a target date for correction Provide interim protection to employees who need it while correction of hazards is proceeding A written tracking system such as a log helps monitor the progress of hazard correction 2017 TPO-The HR Experts. All rights reserved. 25

26 ACCIDENT INVESTIGATIONS Cal/OSHA requires that employers include a procedure to investigate occupational injury or occupational illness as a part of the IIPP Accident and near-miss investigations are critical components of all safety programs Accident investigations should focus on why it occurred and what actions can be taken to prevent a recurrence The investigation should be in writing and identify the causal events as well as prevention 2017 TPO-The HR Experts. All rights reserved. 26

27 ACCIDENT INVESTIGATIONS Who? What? When? Where? Why? How? Accidents must be followed up corrective measures were they successful Document actions taken and pending Any pending corrective action and reason for delaying its implementation should be identified 2017 TPO-The HR Experts. All rights reserved. 27

28 SAFETY & HEALTH TRAINING Training is one of the most important elements of any IIPP Training allows employees to learn their job, how to use tools and equipment and reinforces existing practices Employees benefit from such training through fewer work-related injuries and illnesses Employers benefit from reduced workplace injuries and illnesses, through increased productivity Cal/OSHA requires IIPPs to include training for both supervisors and employees 2017 TPO-The HR Experts. All rights reserved. 28

29 SAFETY & HEALTH TRAINING for SUPERVISORS Supervisors are key to the successful implementation of an IIPP Supervisors need training on the importance of establishing and maintaining safe and healthful working conditions They need to know: what the dangers are, how to recognize the symptoms of exposure and how to teach their workers how to avoid problems and how to respond to incidents in the workplace 2017 TPO-The HR Experts. All rights reserved. 29

30 SAFETY & HEALTH TRAINING for EMPLOYEES Any IIPP s success depends upon the employees using: General safe work practices as well as those that are job-specific Using personal protective equipment (PPE) appropriately and maintaining it in good condition How to react in emergencies and when medical attention is needed Not undertaking a job without proper safety instructions Ensuring that mechanical safeguards are used Reporting unsafe working conditions Reporting any injury or illness immediately 2017 TPO-The HR Experts. All rights reserved. 30

31 SAFETY & HEALTH TRAINING for EMPLOYEES To all employees when the IIPP is first established To all new employees To employees changing jobs Whenever anything new to the workplace presents a new hazard For all supervisors to familiarize them with the safety and health hazards Temporary workers and vendors/independent contractors 2017 TPO-The HR Experts. All rights reserved. 31

32 REVIEW of CURRENT IIPP for a SAFETY & HEALTH SURVEY Accident, injury or illness data Workers Compensation costs Rates of employee turnover or absenteeism Information on safety and health activities ongoing or previously tried Company policy statements Rules-both work and safety Guidelines for proper work practices and procedures Records of training programs Compliance with requirements of CA's Right to Know Law and Hazards Communications Standard Employee capabilities 2017 TPO-The HR Experts. All rights reserved. 32

33 CITATION &PENALTIES For NOT Complying with CA Workplace Safety Laws: Non-serious or minor violations, up to ($7,000) Repeat or willful violations from ($5,000) to ($70,000) Serious violations up to ($25,000) Failure to correct or abate a violation up ($15,000) for each day that failure continues 2017 TPO-The HR Experts. All rights reserved. 33

34 FILING a COMPLAINT of WORKPLACE SAFETY in CA When a Cal/OSHA inspector conducts an investigation or on-site inspection at a workplace: Employees have the right to tell the inspector about unsafe or unhealthful conditions Upon request, Cal/OSHA will withhold the names of employees who make statements during an investigation or inspection 2017 TPO-The HR Experts. All rights reserved. 34

35 EVALUATING the SUCCESS of SAFETY & HEALTH ACTIVITIES Reduction or elimination of injuries or illnesses Reduced Workers Compensation Claims 2017 TPO-The HR Experts. All rights reserved. 35

36 SAFETY & HEALTH REPORTING & RECORDKEEPING REQUIREMENTS Each employer (unless exempt by size or industry) must record each work-related, fatality, injury, or illness that meets one (1) or more of the general recording criteria specified by Title 8 Record each injury or illness on the Cal/ OSHA Log of Occupational Work Related Injuries and Illnesses (Form 300) Prepare an Injury and Illness Incident Report (Form 301) Annually review and certify the Cal/OSHA Form 300 and post the Form 300A no later than February 1st where employees can see it until April 30th Maintain the last five (5) years of these records in the files 2017 TPO-The HR Experts. All rights reserved. 36

37 FILING a COMPLAINT of WORKPLACE SAFETY in CA Even though the basic Cal/OSHA records are for reportable injuries and illnesses It is still a good idea for CA employers to include all (including non-reportable) workplace safety and health-related incidents to assist in pinpointing unsafe acts, conditions or procedures Employees must be given access to these logs Cal OSHA specifies what personally identifying info may be deleted from reports before they are circulated 2017 TPO-The HR Experts. All rights reserved. 37

38 EXPOSURE RECORDS In addition to IIPP records: Toxic Substances & Hazardous Exposures Records Physical Exam Reports Employment Records Regulated Carcinogens Additional Reporting and Recordkeeping Exposure records Must be Maintained for thirty (30) years 38

39 SAFETY & HEALTH REPORTING RECORD KEEPING REQUIREMENTS Records of scheduled and periodic inspections The records are to be maintained for at least one (1) year Documentation of safety and health training This documentation is to be maintained for one year There are several exceptions to these recordkeeping requirements 39

40 MODEL PROGRAMS Three model IIPP s are available from DOSH 1A High Hazard Employers 1B Non-High Hazard Employers 1C Employers with Intermittent Workers There are no requirements to use these exact programs 40

41 CAL/OSHA CONSULTATION SERVICE Separate and Distinct from the enforcement activities of DOSH Consultants do not issue citations or assess penalties, Free Professional Assistance: Identify actual and potential safety or health hazards Technical assistance support Written summary reports Standards Interpretation Injury and Illness Prevention Programs (IIPP) Helping develop and/or conduct safety and health training 41

42 HAZARD EVALUATION SYSTEM & INFORMATION SYSTEMS (HESIS) Answers questions about the health effects of chemical and physical agents in the workplace Includes procedures for identifying and evaluating workplace hazards and scheduling periodic inspections Exception: Employers with <10> employees Permitted to orally communicate and instruct employees about job-specific assignments 42

43 SAFETY & HEALTH RECORD KEEPING REQUIREMENTS Required Records of steps to implement & maintain the IIPP: Scheduled and periodic inspections Documentation of safety and health training Periodic meetings Identify Safety Coordinator Recordkeeping Exceptions (Listed on page 140) Employers with <10> employees Low hazard employers with <20> employees Joint Power Authority (JPA) Labor/Management Safety & Health Committee <1> year of employment Emergency Medical Response (EMR) 1.1 or less 43

44 CODE OF SAFE PRACTICES A written CODE OF SAFETY PRACTICES is required: It Must: Be posted at a conspicuous location at each job site office, or Be provided to each supervisor who shall have it readily available Employers Must: Hold periodic meetings of supervisory employees to review safety problems and past accidents See that supervisors conduct safety meetings at least every ten (10) working days to emphasize safety 44

45 REPETITIVE MOTION INJURIES (RMI) The Repetitive Motion Injuries (RMI) Standard is commonly referred to as the Ergonomics Standard Ergonomics is the scientific study of the relationship between people and their work environments The RMI Standard requires employers to address workplace injuries due to repetitive motions hazards: Work tasks that require repeated actions with the additional stress of improper ergonomics or work-station design Employee must report injury within 12 months 45

46 CA s HEAT & AGRICULTURE PROGRAM CA employers are required to take four (4) steps to prevent potential heat illness for outside workers: 1. Train all employees and supervisors 2. Provide fresh water 3. Access to shade (80+) encourage cool down breaks 4. Written procedures 46

47 CA s HEAT & AGRICULTURE PROGRAM Additional employee protections for temperatures (95+): Communication Observation Emergency Medical Services Access Reminders to drink water Pre-Shift meetings For Agriculture: 10 minute cool down breaks every 2 hours 47

48 HEAT ILLNESS TRAINING ALL supervisory staff should be trained in: The specifics relating to employee work environment Risks associated with the equipment used Rest periods, acclimation, and water requirements The importance of reporting, and how and to whom to report First aid available and from whom Signs and symptoms to look out for Emergency medical services contact information How to monitor and respond to hot weather reports 48

49 CA s HAZ-COM STANDARD All hazardous materials are required to have: Pictograms A signal word Hazard and precautionary statements The product identifier Supplier identification Labels cannot be removed or defaced 49

50 CA s HAZ-COM STANDARD 1. What employers, types of substances and exceptions 2. Hazard determination 3. Safety Data Sheets (SDS) 4. Labels and other forms of warning 5. Written hazard communication program 6. Employee information and training 7. Trade secret protection (Page 145) 50

51 INDUSTRY SPECIFIC WORKPLACE SAFETY UNITS Temporary & Permanent Amusement Rides The Crane Unit Mining and Tunneling Pressure Vessel Unit 51

52 WORKPLACE VIOLENCE PREVENTION & RESPONSE Hospitals must adopt Workplace Violence Prevention and Response Programs California DOSH has issued an Injury and Illness Prevention Model Program for Workplace Security 52

53 CLASSES OF THREATS Type I threats or assaults that may result in injury or fatality that occur during the commission of a robbery or some other crime Type II acts of violence that may be committed by someone who either receives or is object of a service provided by the affected workplace or victim Type III workplace violence caused by an individual who has some employment-related involvement with the workplace 53

54 STEPS to MINIMIZE WORKPLACE VIOLENCE Establish an in-house team for workplace violence prevention Include as part of the IIPP Prohibit threats and acts of violence in the workplace Consider creating a Domestic Violence Policy Train managers, supervisors and employees on the early warning signs of workplace violence and what to do if such signs are spotted. Handle all terminations and other adverse job actions with care and respect Review and update policies and procedures 54

55 DOMESTIC VIOLENCE CA and federal law provide protections and rights for employees who are victims of domestic violence. The California Workplace Violence Act of 1995 provides: The right for employees to obtain restraining orders and injunctions Ways for employees to help victims of domestic violence Employers (who can show a credible threat of violence exists) may also obtain a restraining order or injunction to help protect other workers 55

56 SAFE DRINKING WATER & TOXIC ENFORCEMENT - PROP 65 Prohibits businesses from discharging toxic chemicals into sources of drinking water Requires businesses to give a clear warning with regard to chemicals listed by the state as causing cancer or reproductive harm 56

57 ASBESTOS NOTIFICATION ACT of 1989 (CONSTRUCTION) Applies to the owners of buildings constructed prior to 1979 Requires building owners and employers who know that the building has asbestos-containing construction materials to notify coowners, employees, lessees, and tenants of the presence of asbestos in the building 57

58 CORPORATE CRIMINAL LIABILITY ACT (CLAA 1989) Commonly referred to as the Be a Manager, Go to Jail Act Criminal liability for failing to disclose concealed hazards. The penalties include: Punishment of imprisonment up to three (3) years, or a fine not exceeding: Twenty-Five Thousand Dollars ($25,000) for an individual manager or up to One Million Dollars ($1,000,000) for a covered employer or by both imprisonment and a fine 58

59 SUITABLE SEATING Most CA Wage Orders Provide That: All working employees shall be provided with suitable seats When nature of the work requires standing, seats shall be provided and employees shall be permitted to use such seats when it does not interfere with the performance of their duties 59

60 CA s NO SMOKING LAW (1994) Bans smoking in virtually every indoor workplace To protect workers and citizens from diseases allegedly caused by exposure to secondhand smoke There are also a number of anti-smoking local CA city and county ordinances that can be even stricter than state law 60

61 WIRELESS TELEPHONE AUTOMOBILE SAFETY ACT (2008) prohibits use of wireless telephones (cell phones) by a driver while operating a motor vehicle unless a hands-free device is used Employers are encouraged to have specific cell phone policies and may want to consider providing their workers with hands-free devices 61

62 CA UNIFORM TRADE SECRETS ACT (UTSA ) A trade secret means information, including a formula, pattern, compilation, program, device, method, technique or process, that: 1. Derives independent economic value, actual or potential, from not being generally known to the public or other persons who can obtain economic value from its disclosure or use, and 2. Is the subject of reasonable efforts to maintain its secrecy CA courts have stated more simply that a trade secret is information which is valuable because it is unknown to others, and which the owner has attempted to keep secret. 62

63 CA UNIFORM TRADE SECRETS ACT (UTSA ) To protect intellectual property and other assets, CA employers generally should: Limit access to trade secrets only to individuals who have a need to know take electronic measures to protect trade secrets Adopt policies or agreements, approved by their legal counsel, to help provide further protection for information and other assets that the employer wants to protect Have solid Exit Procedures for all employees, consultants, and contractors NOTE: See the Employee & Labor Relations module for further discussion of the UTSA in relation to other important California laws, such as Section and unfair competition. In addition, the key elements of a so-called e-policy, which many employers have chosen to adopt, appear in the Employee & Labor Relations module under Privacy. 63

64 CA s WORKERS' COMPENSATION INSURANCE (CWC) Required income reimbursement and medical coverage program No-fault insurance Required if even one (1) employee Roofers with no employees required to WC insurance All employees are covered on their first day of employment Independent Contractors are excluded Sole owner provisions apply 64

65 CWC EMPLOYER S COVERAGE ALL employers are required to either: Purchase a WC insurance policy from a licensed insurer authorized to write policies in CA or become self-insured Self-insurance requires state approval and has many legal requirements Resources: The Division of Workers' Compensation (DWC) does not provide Workers' Compensation insurance or information The Workers' Compensation Insurance Rating Bureau (WCIRB) can provide information about WC insurance The State Compensation Insurance Fund is required to provide employers with coverage, however, there are other options 65

66 CWC PREMIUMS WC insurance premium rates are not regulated by the state The WC Insurance Rating Bureau issues recommended rates and carriers must file their rates with the CA Dept. of Insurance; rates can vary from carrier to carrier Many factors determine premium costs including: Industry classification, Employer s past history of work-related injuries (known as the experience modification or XMOD), payroll, any special underwriting adjustments such as use of a certified health care organization, and any special group or dividend programs eligible WC insurance is 100% paid by the employers, employees cannot be asked to pay any part of the premium 66

67 CWC POSTER & REQUIRED PAMPHLET Required Notice to Employees poster: In a conspicuous place at the work site Provides employees with information on WC coverage and where to get medical care for work injuries Failure to post this notice is a misdemeanor that can result in a civil penalty of up to ($7,000) per violation California insurers are required to provide this poster to their clients New employees must be given the Workers' Compensation pamphlet explaining their rights and responsibilities 67

68 CWC INJURY & ILLNESS COVERAGE An injury or illness will be covered by Workers' Compensation if: It occurs while the employee is engaged in their work The job played an active role and was a positive factor in the injury During activities that are incidental to their work (i.e., arriving or leaving the workplace) The injury happened at home, if the employee s work duties require tasks at home If they are at a company-sponsored event The injury or illness can be considered specific, relating to one (1) incident or exposure, or cumulative, meaning it occurred after repetitive mental or physical activity The injury was caused by something to which the employee was exposed during his/her employment period Travel time to, or from, work is not included, unless the employer has control of the employee during this time. 68

69 CWC INJURY & ILLNESS COVERAGE WC covers the following types of injuries regardless of whether first aid or surgery is required so long as the injury is either work disabling or medical treatment is required and is job related: Cumulative mental/psychiatric injury Specific mental/psychiatric injury Cumulative physical injury Specific physical injury 69

70 CWC INJURY COVERAGE Some injuries may be excluded from WC coverage under the below scenarios: Employee was intoxicated or under the influence of drugs or alcohol Employee s injury was intentionally inflicted Employee was involved in roughhouse actions Employee was convicted of a felony at the time of the injury Workers Comp 70

71 DOCUMENTATION & RETURN TO WORK The carrier or TPA, if self-insured, must provide the claim forms free of charge. In the event of a workplace injury or illness, employers must within (1) working day: One Day Provide a WC claim form to them after the work-related injury or illness is reported Return a copy of the completed form to the employee of receipt Forward the claim form, along with the report of occupational injury or illness, to the claims administrator) of receipt Of receiving the employee s claim, authorize up to ($10,000) in appropriate medical treatment If the employee is the victim of a crime that happened at work, notice of Workers' Compensation eligibility must be given within (1) working day of the crime Provide transitional work (light duty) whenever appropriate 71

72 DOCUMENTATION & RETURN TO WORK An injured employee s treating doctor will examine him/her and describe: Clear and specific limits to the employee s job tasks or any restrictions during recovery Any changes needed to the employee s schedule, assignments, equipment or other working conditions while recovering If the employee cannot work while recovering, then the employee cannot be required to work If medically authorized to return to work without restrictions, an employer usually must give the employee the same job and pay that he/she had before the injury 72

73 DOCUMENTATION & RETURN TO WORK When medically released to return, could involve: Regular Work The employee s old job Modified Work The employee s old job with some changes/modifications Alternative Work A new job at the same employer Employers are only allowed to request INFORMATION THAT IS RELATED to the diagnosis and treatment provided for the injury or illness. Not the specific diagnosis or treatment. 73

74 MODIFIED or ALTERNATIVE WORK May be required to accept or reject the work within thirty (30) days Should the employee not respond within thirty (30) days, the offer may be withdrawn If the employee fails to respond modified or alternative work offered within thirty (30) days or rejects the work, the employee will probably not be entitled to supplemental job displacement benefits 74

75 MEDICAL PROVIDER NETWORK (MPN) HEALTH CARE ORGANIZATION (HCO) A Medical Provider Network (MPN) is: A group of health care providers set up by the insurer (or the employer if self-insured) and approved by DWC's administrative director to treat workers injured on the job If the employees are covered by an MPN, their Workers' Compensation medical needs will be taken care of by health care providers in the network except for employees with predesignated health care provider A Health Care Organization (HCO) is: An organization certified by the DWC to provide managed medical care to injured workers. 75

76 PRE-DESIGNATED MEDICAL PROVIDER The employee can give a written notice pre-designating his/her personal physician or medical group prior to the date of injury for which treatment is sought and the notice includes the physician's name and business address The employee has healthcare coverage for non-occupational injuries or illnesses on the date of injury in a plan, policy or fund The employee's personal physician or medical group agrees to be pre-designated prior to the dates of injury. 76

77 DWC FORM 1 It is illegal for an employer to pay medical bills directly A claim form (DWC form 1) must be filed with the claims administrator for all injuries that require more than first aid 77

78 WORKERS' COMPENSATION FRAUD WC Fraud is a Crime, examples: A Worker saying they were injured on the job when their injury really occurred while skiing; An Employer saying their employees work at desk jobs when they re really construction laborers; A Medical Provider billing for six (6) treatments on an injured worker when they only provided two (2). If a Claim Appears Invalid employers should: Report that opinion to their WC claims administrator Tell them all the facts, any witnesses, and the people they should talk to Follow up any phone or verbal report with a letter 78

79 FAILURE to HAVE WORKERS' COMPENSATION COVERAGE Is a Criminal Offense: Section of the CA Labor Code makes it a misdemeanor punishable by a fine of not less than ($10,000) or imprisonment in the county jail for up to (1) year, or both CA issues penalties of up ($100,000) against illegally uninsured employers Proof of insurance should be maintained onsite and is provided to employers from their insurance carrier 79

80 This Concludes Functional Area 4 HEALTH, SAFETY & WORKERS COMPENSATION 80