Colville Confederate Tribes Workmen’s Compensation What is Workmen’s Compensation?

General Information If you are hurt on the job after January 1, 1984, you are covered under the Tribes Self- Insurance Program. The tribe will pay medical cost and time loss. If injured prior to January 1, 1984 will continue to be the responsibility of the State Department of Labor and Industries.

Medical Costs Your employer will pay all related costs according to an agreed fee schedule. You are not to charged for any authorized treatment. If you find it necessary to pay a bill, submit it to the tribe or service company for reimbursement.

Time Loss Compensation Qualification: You must 1. Disabled and unable to work due to the injury or disease. 2. Under care of and treatment by an authorized practitioner. 3. Authorized to be off work by the authorized practitioner.

Time Loss Amount: The rate of time loss compensation is determined by your marital status and number of dependents. The maximum available is 75% of injured employee’s wage. The minimum available is 60% of injured employee’s wage.

Time Loss Waiting Period: 1. No payment is made the day of the injury. 2. No payment is made for the first three days following the date of injury. Duration: You will continue to receive time loss benefits until: 1. Your doctor releases you for work and you return to work. 2. You return to modified work which your doctor approves. 3. You refuse or obstruct reasonable treatment.

Time Loss Closure and Openings: Your claim will be closed when no further curative treatment is indicated. The tribe may authorize reopening of your claim if medical evidence indicates further curative treatment is warranted.

Permanent Awards Permanent partial disability is based on medical evidence that you have lost a percent of the function of a body part due to injury or disease. The monetary value is decided by the tribe. Permanent total disability is an industrially-related condition supported by medical vocational opinion which prevents you from being able to perform gainful employment. Such condition may qualify you for lifetime pension. Survivors benefits are pension benefits available for your dependents should you suffer an on-the-job fatality. In such case, you dependents should apply for survivors benefits.

Reconsideration and Appeals Any action take on your claim can be protested should you disagree. You should put your protest in writing and submit it to:  Executive Director  P.O. Box 150  Nespelem, WA  Or call (509)

Workman’s Compensation Appeal Decision by Insurer: Notice to Claimant and Tribes (including instructions on appeal rights) 30 Days: Notice of Appeal to Board by Claimant (Board is Executive Director, Medical Personnel, HEW Chair) Board may use Tribal attorneys for legal advice. 45 Days: Written Presentation to Board by Appellant (Claimant). 45 Days: Written Presentation to Board by Insurer and Appellant (Sedgwick and The Tribe) 15 Days: Written Response to Insurer’s and Appellant's presentation by Appellant (Claimant) 90 Days: Board decides in writing by Majority Vote – or Claimant receives full benefits claimed in appeal – no further appeal – final for Tribes. * Benefits allowed to Claimant by Insurer shall continue to be paid during appealing process.

Worker’s Compensation Program Employees of the Tribe and its Enterprises becomes INJURIED on the job are entitled to file a claim. Which can include: Time Loss payment, and payment of medical billings related to the on the job injury. The employee and employer must have file a claim for these benefits.

How to file a claim: The employee reports the injury or illness immediately to the Supervisor or Manager, however, the employee is not required to file a claim at that time. The employee has 1 (one) year from the date of injury to file a claim. Keep in mind that time loss payments will not be issued until a claim has been filed. If outside medical attention is necessary, the Supervisor will supply the injured employee with a Worker’s Compensation Claim Packet, which includes the Industrial Accident Report, Physician’s Initial Report, Supervisory Accident Investigation Report and Report of Return to Work of Injured Employee. These forms can be obtained at the Benefits/TOSHA office. It is imperative that the Industrial Accident Report, the Physician’s Initial Report and the Supervisory Accident Investigation Report are completed in order to submit and initiate a claim. In addition, it is also imperative for the final two forms (consent to Develop Medical and Wage information and the Report of Return To Work of Injured Employee) to be completed in a timely manner to initiate time loss payments. This is important especially if the injured employee is missing work due to their injury. After completing all forms you must return the forms to Benefits/TOSHA Office. Currently, all completed forms will forward to the third party administrator – Sedgwick CMS. Upon receipt of the Worker’s Compensation claim packet, Sedgwick CMS creates a claim file and will initiate time loss if needed. The injured employee will not return to work until they obtain a Physician’s release to work. The goal in each case is the restoration of the injured worker to maximum bodily function and gainful employment. Return all forms back to Workers Compensation program. If you have any questions call Benefits Office at (509) or ext. 2020, 2019, 2018.