"Sample Workers Compensation Policy - DOC"
WORKERS COMPENSATION The JIF will pay all Workers Compensation benefits, which by law you, are required to pay. 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 required. 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. C:\Docstoc\Working\pdf\f1d57f87-0393-44b5-a2bb-5652f50f6167.doc WORKERS’ COMPENSATION – Reporting Instructions WORKERS COMPENSATION REPORTING INSTRUCTIONS 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 attached) 4. Call CSG Services using the toll free telephone number and report the claim immediately. CSG will: 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 form. 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 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 WORKERS’ COMPENSATION HELPFUL HINTS The following are some helpful hints that will assist you in processing your workers compensation claims. 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 WORKERS’ COMPENSATION COMMON ERRORS These are some common errors that people make when reporting Workers Compensation claims. Waiting to submit a claim until all information is available. Failing to immediately report the claim in the event of a serious or catastrophic accident! Not giving a complete home address and the home phone number for the employee. 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. WORKERS’ COMPENSATION 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. Thanks Richard Rhoads Never hesitate to attach notes to your Incident Investigation Reports. WORKERS’ COMPENSATION NOTICE 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 (Supervisor/Claims Coordinator) 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) (Address/Telephone Number) Deviation from these instructions may result in a denial of Workers Compensation benefits. *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 Associates (609-653-8400). WORKERS’ COMPENSATION INCIDENT INVESTIGATION (Workers Compensation) 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 result. 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 requirements. 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 their representatives. DEFINITIONS 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 separate establishment. 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.