1. HEALTH MANAGEMENT PROGRAM – STD Roles and Responsibilities CLAIM MANAGEMENT CLAIM INITIATION Seek medical treatment and have APS completed and returned to Health Management in a timely manner. Complete APS, treatment plan, and work limitations/ capabilities. Ensure confidentiality and document all contact. Await Employee’s APS and determine absence authorization. Notify Payroll of status, if required. Advise Employee that union is available for support as applicable. EMPLOYEE SUPERVISOR HEALTH MANAGEMENT TREATING HEALTHCARE PROVIDERS (THCP) UNION Notify Supervisor of absence daily (up to 5 days). If absence is known to be > 5 days, obtain/receive Attending Physician’s Statement (APS) from Health Management. Responsible for being aware of all STD absences. Notify Health Management of absence if known to be > 5 days. Provide related attendance history, if requested. Maintain contact with Employee (at agreed upon intervals) to reinforce value and to provide connection. (Do not solicit medical information). Document all contact. Provide APS to employee if > 5 days of absence or repeated absences. Request attendance history, if needed. Maintain communication with all parties to provide awareness of Employee status. Maintain contact with Supervisor at agreed upon intervals. Actively participate in treatment to promote recovery. Provide updated medical, as requested. Maintain contact with Health Management. Review medical to support Employee is in receipt of appropriate care. Explore RTW and MW based on capabilities. Explore internal & external resources, as required. E.g., IME/FAE, ergonomist, mediator. Communicate with THCP, if required. Request updated medical, as required. Continue to provide treatment information/capabilities/ medical status to Health Management. Participate in LTD application process if required. Consult with management as to departmental requirements, e.g., budget, roles. Complete LTD application form. If RTW is delayed, provide Employee with LTD forms/process. Advise appropriate department/union. Explore RTW, MW based on capabilities provided by employee and/or Health Management. Assist Employee as required. Ensure confidentiality. Abbreviation Key APS – Attending Physician’s Statement FAE - Functional Abilities Evaluation IME - Independent Medical Evaluation LTD - Long Term Disability MW - Modified Work RTW - Return to Work RTWP - Return to Work Plan STD - Short Term Disability THCP - Treating Healthcare Professional

2. SHORT TERM DISABILITY (STD)/NON-OCCUPATIONAL FLOWCHART RETURN TO WORK LTD OR Schedule regular meetings with Employee to discuss progress and update plan. Advise Health Management of return to full duties or complications. Monitor RTW. Request updated medical as needed. OR Update progress to full duties. OR Provide assistance, if requested by Employee. Attend RTWP meetings, if requested. OR Participate in RTW Progress discussions. Identify any complications or return to full duties. EMPLOYEE SUPERVISOR HEALTH MANAGEMENT TREATING HEALTHCARE PROVIDERS (THCP) UNION 75 to 105 DAYS STD ELIMINATION PERIOD Return to regular duties or participate in MW/RTW discussions with supervisor, Health Management and union as appropriate. Attend and participate in RTW meetings and participate in RTWP. Notified by Health Management when RTW clearance received. Explore RTW based on capabilities with Health Management. RTW meeting held to discuss plan. Monitor Employee’s progress while on RTWP. Copy of RTWP signed and given to parties and Health Management. Obtain functional capabilities for RTW planning. Explore RTW based on capabilities with Supervisor. Participate in RTW meeting with Employee, Supervisor, Union, if requested. Copy of RTWP signed and given to the parties. Complete LTD application form and participate in LTD process as needed, which may start at 75 days of STD elimination period. Receive updates from Health Management regarding LTD status. Monitor condition with LTD carrier and update relevant parties on status. Prepare LTD application package. Send to employee and LTD carrier. Follow up with Employee as determined by condition. If condition improves, refer to RTW process, which may also include LTD carrier. If condition improves, refer to RTW process, which may also include LTD carrier. Complete LTD application form. Continue to manage health care of Employee. If condition continues beyond 2 years, apply for CPP and participate in CPP process. If condition improves, refer to RTW process, which may also include LTD carrier. If condition improves, refer to RTW process, which may also include LTD carrier. Complete CPP forms, if required. Provide clearance to RTW, when required, with or without modified duties. 02/07