2. North Carolina Department of Correction Workers’ Compensation And Salary Continuation Programs Tracy Ashworth Program Manager Tonya Marlin Program Assistant Phone - 919/716-3700 Fax - 919/716-3960 (Revised August 1, 2003)

3. Benefits Representative/Supervisory Responsibilities FORM 19FORM 19  Must be typed  Treatment by physician must be completed  Fax to the Personnel Office, Benefits Section within 24 hours  Mail the original Form 19 to the Benefits Section in Personnel  Do not send to the Industrial Commission

4. Address Will Remain the Same NO Wage Information Return To Work? Sought Medical Treatment? Don’t Forget! Does Not Apply

5.  Every question must be answered in the employees handwriting  Back of Form should ONLY be completed by facility nurse  Mail the original Form DOC-WC-4

6. Catastrophic Injuries Notify the Benefits Section and Key Risk Management ServicesNotify the Benefits Section and Key Risk Management Services Examples Include:Examples Include: –Death Caused by a job related injury –Amputation of a major extremity –Gun shot wound –Second or third degree burns over 25% of the body

7. Third Party Automobile Accidents Forward the following documents to the Benefits Section: A copy of the investigating police officer’s report A copy of the investigating police officer’s report A copy of the Motor Fleet Management report A copy of the Motor Fleet Management report Insurance information for the other vehicle Insurance information for the other vehicle

8. Employee Responsibilities  Immediately report injury to supervisor  Follow prescribed medical treatment provided by Key Risk Management Services  Provide management with medical restrictions and out of work medical excuses  Contact supervisor on a weekly basis while out of work

9. Salary Continuation (Injury Leave) Employees are required to use accumulated leave Benefit Reps/Supervisors must submit Out of Work Notes Time Sheets Memorandum requesting Injury Leave Approval at the end of each 28 day work cycle MUST REQUEST SPECIFIC DATES Who’s Covered? Employees that are in certified classes Non-certified employees injured by direct and deliberate act of an offender/inmate

10. After receiving injury leave approval, reinstate leave to the employee’s CURRENT DC-113 –Auditors request that the leave taken be struck through and replace with an “I” for injury leave Salary Continuation (Injury Leave)

11. Shift Premium  Employees whose position entitled them to shift premium pay prior to the injury shall continue to receive shift premium pay while out of work due to a compensable job related injury  it is the facility’s responsibility to make sure eligible employees receive shift premium pay while on approved “Injury Leave”  Must submit, to payroll, a memorandum requesting shift premium pay along with the employee’s time sheet.

12. Workers’ Compensation Leave Without Pay Due to Workers’ CompensationLeave Without Pay Due to Workers’ Compensation Who’s Covered? All Department of Correction employees including some temporary/contractual employees. required 7-day waiting periodrequired 7-day waiting period Employee placed on LWOP after the required waiting period Employee will receive 66 2/3% of their average weekly wage for the 52 weeks prior to the date of injury

13. Workers’ Compensation vs. Family Medical Leave When the employee is receiving Salary Continuation (Injury Leave) –If the employee is eligible, then designate Family Medical Leave When the employee is receiving Workers’ Compensation (Leave Without Pay due to Workers’ Compensation) –Do no designate Family Medical Leave (Per Office of State Personnel)

14. Medical Treatment The facility shall: –refer injured employees to a CompCare Provider physician –if EMERGENCY medical treatment is required, refer employee to the closest medical facility for treatment Payment/Status of Medical Bills –contact Dana McCormick, KRMS at 1-800-942-0225 ext. 388

15. Transitional Return to Work Program The Department of Correction accommodates temporary medical restrictions for an employee who has suffered a compensable job related injury The purpose of the Transitional Return to Work Program is to provide work to employees who are restricted from performing their normal job duties There is no limit of how long an employee can participate in the Transitional Return to Work Program

16. Goal of Transitional Return to Work Program To help employees during the healing process by: –returning employees to a normal lifestyle sooner –focusing on abilities instead of disabilities –improving employee morale –encourage cross training within Department of Correction

17. Transitional Return to Work Program Rules Employee must have sustained a compensable job related injury Employee must provide supervisor with a medical note from the treating physician that list the temporary medical restrictions and the duration of the restrictions Every attempt should be made to place the injured employee in a transitional job If a transitional job cannot be identified the supervisor must contact the Benefits Section immediately

18. Transitional Job Placements Examples Include: –clerical duties: filing, data entry, receptionist –control rooms –towers –any position short staffed where accommodation can be met

19. Return to Regular Duty The employee must submit a return to work note from the treating physician stating that the employee may return to regular duty

20. Americans with Disabilities Act Requirements –The employee’s treating physician must advise that the employee has reached maximum medical improvement –The employee must have permanent medical restrictions Process –The Benefits Section will send a copy of the employee’s essential job functions to the treating physician –If the employee cannot perform all of the essential job functions, the Benefits Section will ask the employee to complete the DC-730 (Request for Reasonable Accommodation) –The Benefits Section will forward the essential job functions and the DC-730 to the Division and await a decision regarding the accommodation –The Division will notify the employee and work location of the decision

21. Work Status Employee Participating in the Transitional Return to Work Program –the employee will continue to work light duty until the Division makes a decision regarding the accommodation Employee Not Working –the employee will remain out of work –the employee will continue to receive Salary Continuation or Workers’ Compensation until a decision has been made by the Division regarding the accommodation

22. Any Questions?