1. VSDP Employer Support Training Short-Term Disability and Long-Term Disability Management January 2019

2. 5/25/2019

3. Understanding Worker’s Compensation………..………………..…..……….
DHRM WCS Role and Responsibilities
Reed Group’s Role and Responsibilities
Questions………………………………………………………………………………………
Reminders…………………………………………………………………………………..…

4. Understanding Workers’ Compensation DHRM – Worker’s Compensation Services

5. DHRM- WCS Role and Responsibilities
Manage and administer the State Employee Workers’ Compensation Program
Assist customers with problems and service issues as they arise
Oversee service partner—MC Innovations
Assure coordination of benefits with VSDP/Reed Group

6. MC Innovations
Provide Third Party Claims Administration Services for the State Employee Worker’s Compensation Program
Assist customers with worker’s compensation problems and service issues as they arise
Notify VSDP of WC benefits Approved/Pending/Denied through WCS VSDP Coordinator

7. Reporting the Injury
VSDP—Employee or a designated person must report to Reed Group
WC—Employer reports the claim through VLW to MC Innovations

8. Missed steps slow it all down…
Employee:
Failure to notify VSDP
Failure to notify Reed Group
Failure to sign release of information form
Employer:
Delayed VLW claim submission
Failure to accurately report expected lost time
Failing to send WC Supplementary Reports and wage chart to MC Innovations

9. Paying the Employee
During the short-term disability, the agency issues employee their worker’s compensation benefit and any supplemental VSDP or personal leave benefit
Training on payment of benefits can be received from the Department of Accounts – Session planned in the Spring – DOA/VSDP/VRS/WCS/DHRM
WC reimburses agency the workers’ compensation benefit amount and will send the benefit checks payable to the agency
Gross pay should be based upon Action Report  

10. Denied WC Claims
Denial letter sent to employee, copy to the agency HR, and the panel physician
Work-related disability benefits are only authorized for those injuries that are deemed compensable
Appeal to Virginia Worker’s Compensation Commission available to employee 
Litigation period—VSDP non-work related
If employee wins—WC will reimburse amount AS AWARDED BY VWC only and notify Reed Group of the approval.

11. Communication is the key…
Timely Accurate facts
Opportunities/options
Optimal medical outcomes
RTW facilitation

12. Resources for VSDP/WC Who to call with questions:
Approval status/dates
Date notification sent to Reed Group
Action report
Questions regarding approval dates
Althea Burnett
VSDP Coordinator
Account Coordinators

13. Understanding Worker’s Compensation Reed Group

14. Reed Group’s Role and Responsibilities
Intake
At which point a claim is determined to be work related (we assess this on every intake), ReedGroup will send an to the Worker’s Comp team (Althea Burnett, MCI, and Kitty Hughes, DHRM) with the following information:
Date of injury
Date of disability
Reed Group’s claim number
Claim Management
Reed Group will follow normal STD claim management processes, until a WC decision has been made.
Case managers will apply all plan provisions associated with the STD benefit.
Important Note
If an employee is NOT ELIGIBLE for STD benefits because the date of hire is less than 12 months, the system will generate ineligibility letters to all parties during the intake process.
The claim will remain in a closed status until the leave is determined to be a compensable WC claim; at that time, the claim will be re-opened, and updated with the WC approval dates.
5/25/2019

15. Cont’d MCI Determination WC Approved WC Not Approved
Once the MCI report is received and the leave is determined to be a WC claim, ReedGroup will then flag the claim as WC and adjust the dates to match the WC determination
ReedGroup will not request additional documentation from the treating provider once MCI has determined the claim is WC
WC Approved
Determination letters do not disclose the approval dates for WC. The agencies will need to look at the DAR to determine the work comp status.
If WC has the employee on work restrictions, please note that Reed Group determination letters do not provide specific details on work restrictions.
WC Not Approved
If the WC claim is suspended or determined not to meet the WC definition, ReedGroup can review for STD benefits at the request of the employee.

16. Important Notes
In instances where the Statute of Limitations (up to 500 weeks) has run out, Reed Group will flag the claim as WC. This will provide the higher income replacement tiers as well as make the benefit non-taxable.
Employees are referred to their payroll department regarding wage replacement questions. ReedGroup does not manage payroll during the STD claim period.

17. Questions received via Email

18. Questions received via Email
How long it takes an employee to get paid once they have applied for disability?
WC – Once a claim is deemed compensable and the wage chart is received from the agency the first WC check should be received at the agency within 14 days from receipt of all required information.
For an injured worker who transitions from STD to LTD and proper notice is given to the Benefit Coordinator at MC Innovations (Agency is required to provide notice 2 weeks prior to date of separation from agency) then the check will be sent directly to the injured worker within 14 days of the date of separation.
How long is the duration of Short-Term Disability vs. Long-Term and what are the terms for an employee to switch from one to the other?
The VSDP plan allows a total of 125 work days for Short-Term Disability benefits.
The Long-Term Disability Effective date is the next calendar day following the 125th day of Short-Term Disability.
Unless the employee has been released to return to work full duty, they will transition to Long-Term Disability on the Long-Term Disability effective date.
Exceptions: Members of the State Police Offers’ Retirement System if certified by the Superintendent of State Police may be eligible for an additional six months of Short-Term Disability benefits for members injured in the line of duty.
How is an employee paid for short-term disability when it’s also WC?
Once a claim is deemed compensable and the wage chart is received from the agency the first WC check should be received at the agency within 14 days from receipt of all required information.
Please see CIPPS and Policy 4.57 DHRM for guidance regarding paying the injured worker once the action report or the WC Indemnity check is received.

19. Cont’d
We have employees teleworking outside of Virginia. Are they covered by Virginia’s worker compensation plan?
1. Most claims received to date for teleworkers have been handled under the Virginia Workers’ Compensation Act. WCS is working to secure coverage in all states based on the expansion of telework and the number of employees that work outside of the COV.
How is short term disability affected if a workers compensation claim is denied, but later awarded through an appeal?
1. ReedGroup will re-open and update the claim with the WC approval dates, flag it as a WC claim.

20. Questions?

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