The JIF will pay all Workers Compensation benefits, which by law you, are required
Types of losses to be reported:
Any injury to one of your employees arising out of and in the course of
their employment for which medical treatment is required.
Any injury to a police, fire or rescue volunteer, or other qualified volunteer
as defined in the New Jersey Workers Compensation Act, which arises out
of and in the course of their public duty for which medical treatment is
Any alleged occupational exposure (injury occurring over a period of time
as opposed to a traumatic injury).
The purpose of this manual is to highlight the major coverages, limits, sub-limits, and extensions
as afforded through the Joint Insurance Fund. This manual is not a policy of insurance and in no
way modifies, restricts, expands or in any way changes the coverages afforded through the JIF.
For actual coverage determination, reference must be made to applicable coverage documents.
WORKERS’ COMPENSATION – Reporting Instructions
WORKERS COMPENSATION REPORTING
WHAT TO DO WHEN AN EMPLOYEE GETS HURT ON THE JOB
1. Show genuine concern for the injured employee's welfare.
2. Direct injured employee to authorized network physician using the "Workers
Compensation ID Card" (Sample Attached).
Do not use the emergency room unless emergency treatment is required.
3. Provide injured employee with "Injured on the Job?" pamphlet (Sample
4. Call CSG Services using the toll free telephone number and report the claim
A. Take all of the information necessary to complete the First
Report of Injury form (F.R.O.I.). See attached list of questions
they will ask you.
B. Immediately assign a nurse case manager to follow up with the
employee and physician to monitor medical treatment and return
to work status.
C. CSG will immediately notify Scibal of the claim.
D. CSG will fax you a copy of the completed First Report of Injury
or “F.R.O.I.”. Verify all information. CSG will transmit this
information to Scibal and Scibal will electronically file the
“F.R.O.I.” with the State of New Jersey.
6. Once Scibal is notified about your claim, they will assign an adjuster and send
an Acknowledgment Letter to you. The Acknowledgment will contain the
WORKERS’ COMPENSATION – Reporting Instructions
name of the adjuster assigned and the claim number, which you will use when
following up or when transmitting additional documents to their office.
7. Keep in contact with the injured employee, the employee's supervisor, the
physician, and the claims adjuster.
8. As soon as possible after the incident arrange for the supervisor to complete
the Incident Investigation Report and have the employee sign it. Once
completed, follow the distribution instructions noted on the bottom of the
Do not delay the reporting of Workers Compensation Claims!
Do not hold up reporting the claim simply because all of the information is not available.
Provide as much information as you have at the time and indicate that additional
information will be sent later.
WORKERS’ COMPENSATION – Reporting Instructions
WORKERS COMPENSATION ID CARD
Issue the above Workers Compensation ID Card to the injured
employee when an injury is reported for presentation to your
approved medical provider. This will make sure that medical
bills are directed to Scibal and not billed to the employee.
WORKERS’ COMPENSATION – Accident Checklist
[ ] ENSURE FIRST AID has been administered
[ ] PROVIDE the following information to the employee
• Name, address and phone number of your primary care physician
• Direct employee to this physician for immediate treatment using Workers
Compensation ID Card
[ ] REPORT the claim to CSG services
[ ] PROVIDE information to the Nurse Case Manager when he/she calls
• Employee's Job Description
• Copy of Injury Report describing how injury occurred
• Statement of your position on returning employees to work
• Availability of alternate duty; description of full duty requirements
[ ] INVESTIGATE the accident
• Secure area or equipment
• Obtain evidence and photographs
• Detail the events preceding the accident
• Complete the Incident Investigation Form •
[ ] CONTACT the employee within 24 hours
• Reassure the employee of the employer’s commitment to their well being
• Assess employee's understanding of treatment received and disability status
• Ask if employee has any questions [future plans, treatments]
• Arrange for employee’s supervisor to complete the Incident Investigation Form
[ ] Communicate with the assigned Nurse Case Manager
• Obtain details of additional treatment and disability status
• Communicate “Return To Work” expectations and obtain specific job restrictions
• Discuss ongoing progress with physician
• Discuss specific timetable for employee’s return to work
[ ] MAINTAIN contact with employee, case manager, and Scibal
• Contact employee on a regular basis - express concern about return to good health
• Discuss progress with nurse case manager
• Provide Scibal with relevant employee information on an ongoing basis
[ ] ESTABLISH an injury management record to contain
• Copy of injury report
• Documentation of initial treatment
• Employee's current Job Function Evaluation
• Copies of medical bills
• Log of phone conversations
• Progress reports from physician
• Release to Return To Work
The following are some helpful hints that will assist you in processing your workers
Be sure to keep a copy of all information sent to Scibal and to CSG.
Whenever an employee approaches you regarding workers compensation
benefits for an alleged injury, immediately report the claim to CSG
Services using the toll free telephone number and complete an Incident
Investigation Report. Reporting the claim to CSG does not automatically
make the employee eligible for benefits.
Any time you feel there are questionable circumstances surrounding the
loss, contact Scibal immediately.
Call in Workers Compensation losses to CSG as quickly as possible (day
they are reported to you).
If there is an accident (near miss) involving one of your employees, which
does not require medical care, an Incident Investigation Report should be
completed and kept at the municipality for record purposes.
DO NOT DELAY REPORTING OF WORKERS COMPENSATION CLAIMS FOR ANY REASON
These are some common errors that people make when reporting Workers
Waiting to submit a claim until all information is available.
Failing to immediately report the claim in the event of a serious or
Not giving a complete home address and the home phone number for
Omitting wage information.
Omitting information on lost time.
Omitting information on the status of treatment, if any.
Allowing the employee to call in his/her own claim.
Not filing an Incident Investigation Report.
Filing an incomplete Incident Investigation Report.
TO: Scibal Associates
FROM: Richard Rhoads, Supervisor
DATE: July 27, 2002
Please call me to discuss this claim. Major has recently been in an auto accident
with his personal car. He has never complained about the seat in the truck
before. The truck is only one year old and it has a lumbar support built in.
Never hesitate to attach notes to your Incident Investigation Reports.
MUNICIPAL JOINT INSURANCE FUND
TO: ALL EMPLOYEES
SUBJECT: WORKERS COMPENSATION BENEFITS
To preserve Workers Compensation benefits, employees are directed to
report all work related injuries to
Employees are further directed to use the following physician for initial
treatment of all work injuries except in the case of emergencies.*
(Name of Physician)
Deviation from these instructions may result in a denial of Workers
*In case of accident requiring immediate emergency care, the nearest
available medical facility should be used.
NOTE: Any employee who wishes to see a physician other than the
above designated physician, except for emergencies, must first
obtain approval from the Claims Administrator, Scibal
The JIF Safety Program recommends that the supervisor or someone in authority make a
detailed report about each accident, even when only a minor injury or no injury is the
The Incident Investigation Report should be completed as soon as possible after an
incident occurs. Copies of this report should be sent to the JIF Safety Director, the JIF
Claims Administrator, and the municipal Safety Coordinator. This process is important
because information about activities and conditions that preceded an occurrence helps
prevent future accidents. This information is particularly difficult to obtain if it is not
gathered promptly after the accident.
We have developed an Incident Investigation Report form that you can use to investigate
workers compensation accidents. At the back of this section you will find a letter with
instructions on how to use the Accident Investigation Report form. Additional supplies
of the Accident Investigation Report can be obtained from the Fund Administrator, the
Fund Safety Director, or the Claims Administrator.
Suggested steps in conducting an accident investigation are as follows:
1. Interview the employee or participant who is most directly involved.
2. Make sure the individual is at ease. Do not place the blame on any individual
for the accident. It is important that you let them know you are trying to
prevent a recurrence.
3. Privately conduct the interview at the scene of the accident, if possible.
4. Ask the employee’s or witness’ version of the accident. Request a step-by-step
account of what happened. It is important to be a good listener and avoid
making judgmental remarks, which may put the person on the defensive.
5. Phrase your questions in an open-ended manner that cannot be answered in a
simple “yes” or “no”.
6. Repeat the story back as you understand it. This assures the person that you
understood his or her account and allows for any corrections to be made.
7. With employees, end the interview on a positive note by discussing how certain
actions can be taken to avoid the accident from happening in the future.
Once you have performed your investigation, take action! Do your best to eliminate or
control those conditions that caused the accident. Remember, all your accident
investigation efforts will be wasted if the results are not used to your best advantage.
PEOSHA 300 LOG
When the Occupational Safety and Health Act was enacted, it exempted from its
coverage all federal, state, county, and municipal employees, thus leaving a large
segment of the working people unprotected. However, the Act provided for the
states to assume the responsibility for occupational safety and to develop and
submit to the federal government a plan that would be equal to or more stringent
than the Federal plan. This resulted in the development of NJPEOSHA (New
Jersey Public Employer Occupation Safety and Health Administration). Under the
New Jersey PEOSHA requirements, all public employees in the State of New
Jersey must comply with the Federal OSH Act injury and illness record keeping
According to the Occupational Safety and Health Act (OSHA) every employer
must maintain the following in each establishment:
Each employer who is subject to the record keeping requirements of the
Occupational Safety and Health Act of 1970 must maintain for each
establishment a log of all recordable occupational injuries and illnesses.
This form (OSHA No. 300) may be used for that purpose. A substitute
for the OSHA No. 300 is acceptable if it is as detailed.
Enter each recordable case on the log within six (6) workdays after
learning of its occurrence. Although other records must be maintained
at the establishment to which they refer, it is possible to prepare and
maintain the log at another location, using data processing equipment if
desired. If the log is prepared elsewhere, a copy updated to within 45
calendar days must be present at all times in the establishment.
Logs must be maintained and retained for five (5) years following the
end of the calendar year to which they relate. Logs must be available
(normally at the establishment) for inspection and copying by
representatives of the Department of Labor, or the Department of Health
and Human Services or States accorded jurisdiction under the Act.
Access to the log is also provided to employees, former employees and
OCCUPATIONAL INJURY is any injury such as a cut, fracture, sprain,
amputation, etc., which results from a work accident or form an exposure
involving a single incident in the work environment. Note Conditions resulting
from animal bites, such as insect or snake bites from one-time exposure to
chemicals, are considered to be injuries.
OCCUPATIONAL ILLNESS of an employee is any abnormal condition or
disorder, other than one resulting from an occupational injury caused by exposure
to environmental factors associated with employment. It includes acute and
chronic illnesses or diseases which may be caused by inhalation, absorption,
ingestion or direct contact.
MEDICAL TREATMENT includes treatment (other than first aid) administered
by a physician or by registered professional personnel under the standing orders of
a physician. Medical treatment does NOT include first aid treatment (one-time
treatment and subsequent observation of minor scratches, cuts, burns, splinters and
so forth, which do not ordinarily require medical care) even though provided by a
physician or registered professional personnel.
ESTABLISHMENT: A single physical location where business is conducted or
where services or industrial operations are performed (for example: a factory,
mill, store, hotel, restaurant, movie, theater, farm, ranch, bank, sales office,
warehouse or central administrative office). Where distinctly separate activities
are performed at a single physical location, such as construction activities operated
from the same physical location as a lumberyard, each activity shall be treated as a
For firms engaged in activities which may be physically dispersed, such as
agriculture; construction; communications; and electric, gas and sanitary services,
records may be maintained at a place to which employees report each day.
Records for personnel who do not primarily report or work at a single
establishment, such as traveling salesmen, technicians, engineers, etc., shall be
maintained at the location from which they are paid or the base from which
personnel operate to carry out their activities.
Work Environment is comprised of the physical location, equipment, materials
processed or used, and the kinds of operations performed in the course of an
employee’s work, whether on or off the employer’s premises.