1. Workers’ Compensation for State Agencies Office of Risk Management Karen C. Jackson, Facilitator

2. Expected Workshop Goals Develop a better understanding of the workers’ compensation process.

3. Expected Workshop Goals Save Time Money

4. ORM Workers’ Comp Statistics 5500 active workers’ compensation claims. Approximately 1200 of these paid lost time benefits on regular basis.

5. ORM Workers’ Comp Statistics $48 million spent on workers’ compensation.

6. Overview of Workers’ Compensation Title 23 Louisiana Revised Statutes requires all employers to provide workers’ compensation coverage for their employees.

7. Overview of Workers’ Compensation IW have the RIGHT to file a claim. Let us decide if it’s a claim.

8. Overview of Workers’ Compensation R. S. 23:1031.A Anyone employed in the State of Louisiana who is injured on the job. Coverage begins immediately. Covered accidents must arise out of employment and occur during course and scope of employment.

9. Workers’ Compensation is a penalty-driven statute Anything required by the statute is subject to a penalty if it is not done it is not done correctly it is not done timely.

10. Overview of Workers’ Compensation R. S. 23:1203 / R. S. 23:1221 IW may be entitled to medical and/or indemnity benefits at the expense of his employer.

11. Overview of Workers’ Compensation R. S. 23:1231 Provisions for –surviving spouse –dependent children or surviving parents in the event of work - related death.

12. Notice of Accident R. S. 23:1302 Injured workers must notify supervisor as soon as an accident occurs.

13. Notice of Accident Supervisor immediately initiates paperwork for the Employers’ First Report of Injury (E-1) claim to be sent to ORM electronically via STARS.

14. Notice of Accident Report all incidents and near-misses in STARS even if the incident does not result in lost time or incur medical expenses.

15. Online Access To request access to STARS online reporting: www.doa.Louisiana.gov/orm Quick Links section ORM Data Liaison Application/change form

16. Notice of Accident Please notify ORM immediately –even if IW has enough sick leave to cover accident. –do not require IW to exhaust all of sick leave before ORM is notified. Benefits due 14 days from the date employer aware of accident.

17. Civil Service Rule 11.21 11.21 Workers’ Compensation Payments When an employee is absent from work due to disabilities for which he is entitled to workers’ compensation he (a) shall, to the extent of the amount accrued to his credit, be granted sick leave not to exceed the amount necessary to receive total payments for leave and workers’ compensation equal to his regular salary. (b) may, to the extent of the amount accrued to his credit, be granted annual leave or a combination of annual and sick leave not to exceed the amount necessary to receive total payments for leave and workers’ compensation equal to his regular salary. (c)may be granted leave without pay.

18. Volunteers and Community Service Workers Covered for medical payments only.

19. Independent Contractors R. S. 23: 1021.6 Insure contractor carries WC coverage for its employees. If coverage lapses the State pays WC benefits –check solvency of contractor periodically.

20. Records Retention ORM maintains all closed files for two (2) years on-site. Files are archived for three (3) years then destroyed.

21. Incidents Not Covered

22. Incidents Not Covered R. S. 23:1021(1) IW intentionally injures himself.

23. Incidents Not Covered R.S.23:1081.1.b IW intoxicated at the time of the accident.

24. Drug Screening R. S. 23:1081(1)(b) Employers can deny WC claims that result from intoxication if -have a written policy -notify employees of intent to perform post accident drug screening. Intoxication can be due to alcohol, Rx, OTC medication or illegal narcotics.

25. Drug Screening Post-accident drug screening paid in conjunction with the workers’ compensation claim.

26. Incidents Not Covered R. S. 23:1081.1c IW who is proven to be the aggressor in an unprovoked altercation.

27. Incidents Not Covered R. S. 23:1031D Injuries resulting from horseplay.

28. Incidents Not Covered R. S. 23:1031E Incidents which arise out of purely personal matters.

29. Incarceration and WC R. S. 23:1201.4 Benefits are not payable when an IW is incarcerated unless the IW can prove he has family who is dependant on the comp check for support.

30. Items Not Covered Personal items damaged in work-related accidents.

31. “Gray” Coverage Areas

32. “Gray” Coverage Areas R. S. 23:1021(7)(b) Mental stress

33. “Gray” Coverage Areas R. S. 23:1021(7)(e) Heart attacks Strokes

34. “Gray” Coverage Areas R. S. 23:1021(7) Clear and convincing evidence that these are –sudden –unexpected –extraordinary –related to the employment. Cannot be related to –any other health condition –personal situation.

35. “Gray” Coverage Areas It May Be Covered

36. Social Activities

37. Social Activities Questions to Ask 1)Did employer sponsor the event? 2)Did employer require employee attendance or participation? 3)Was employee paid for attending? 4)Did the employer finance the event? 5)Did the employer benefit through improved morale and/or good will?

38. Standing By Accidents which occur when the employee is waiting until a new task is given or unfavorable conditions change before the work can be resumed; i.e. rain.

39. On Call Accidents that occur while responding to an on call incident as well as traveling to and from the call are usually covered under workers’ compensation.

40. At Lunch or On Break Injuries that occur at the employer’s place of business during lunch or rest are usually covered under workers’ compensation.

41. Before and After Work Employees who arrive early or remain at the place of work after hours are covered under workers’ compensation if the period of time is reasonable.

42. To and From Work Accidents to and from work are not covered unless: 1) Employer asks employee to perform a task on the way to or from work. 2) If the employer furnishes the transportation.

43. Special Mission for Employer Employees on a special mission are within the course of employment from “portal-to-portal” or from home to the location of the mission or from the location of the mission to home.

44. While Traveling Accidents which occur while an employee is traveling on behalf of the employer are covered under workers’ compensation. Out of town Overnight At the hotel At the restaurant … if there is no deviation.

45. Threshold Doctrine There are special circumstances in which the employer’s premises is immediately adjacent to an unusually hazardous area of travel. The unusual risk is at the threshold of the employer’s premises. --railroad tracks --designated parking areas

46. Aggravation of Pre-Existing Condition Pre-existing disabilities or degenerative conditions (whether known or not) that are aggravated or accelerated by physical exertion or extraordinary mental stress may be eligible for workers’ compensation benefits.

47. Workers’ Compensation Benefits

48. Choice of Physician R. S. 23:1121(B)(1); R. S. 23:1142(B) By specialty. $750 of non-emergency treatment. Failure to obtain approval may result in non-payment of bills in excess of $750.

49. Examination of Injured Workers R. S. 23:1123-1124 Employer or insurer has right to have IW examined from time to time during the course of the claim.

50. Who’s going to pay for this? Employer can give verification of initial medical treatment up to $750 of non-emergency care.

51. Who’s going to pay for this? IW should NEVER pay out-of-pocket for medical services or use personal insurance to pay for covered medical expenses that result from a work related accident.

52. Weekly Indemnity Benefits R. S. 23:1224 Injury prevents IW from RTW for more than 7 days. 7 day waiting period –1 st 7 days not recoverable unless IW loses more than 41 calendar days. Benefits payable on 8 th day.

53. Weekly Indemnity Benefits R. S. 23:1201.B Comp checks are due 14 days after employer notified.

54. Calculation of Weekly Benefits R. S. 23:1221 Based on 66 2/3 % of average weekly wage up to maximum. (maximum is $522)

55. Calculation of Weekly Benefits If a worker earns less than the minimum his actual wage is his comp rate. Wages locked according to date of accident -in most cases. Maximum and minimum change September 1 st.

56. Compensation Checks To initiate benefits adjuster enters benefit record upon claim setup or when lost time begins.

57. Compensation Checks Usually mailed to agency of employment to buy back leave. Must be mailed directly to injured worker if requested.

58. R. S. 23:1201.1 Workers’ compensation payments, at the option of the employee, shall be mailed to the employee at the address designated by him.

59. When are checks mailed? Every other Tuesday

60. How long is the check good? Checks expire 180 days from issue date.

61. WC and the IRS R. S. 1021(10)(f) Workers’ compensation is a non-taxable income.

62. Leave Buy Back Report The Office of Risk Management has established a leave buy back report which agencies can run to aid in re-crediting leave. The report identifies: name of injured worker agency of employment amount of comp check average weekly waged used to determine comp rate payment period for the check

63. Tell us! Comp check incorrect –too much –too little –wrong dates.

64. Stop payment, Void or Reissue check Notify the adjuster of record –supplemental –phone –email Name and phone number on check stub.

65. Tell us! Retires Back at work Quits Out of leave

66. Tell us! When agency personnel changes.

67. Information we need from you Copy of pay stubs for four weeks prior to date of accident. This does not include the week of injury.

68. Information we need from you Copy of IW job description.

69. Information we need from you Supplemental Report of Injury Notify ORM of changes in claim status –beginning disability –return to work –corrected wage –corrected dates of loss –retirement status.

70. Information we need from you Employer’s Certificate of Compliance Certifies employer provides WC insurance. Certifies employer will not intentionally defeat IW WC claim.

71. OWCA Mediations and Citations DO NOT RESPOND TO EITHER OF THESE! ORM will secure representation from the attorney general’s office to respond on you behalf.

72. OWCA Mediations and Citations R. S. 39:1533b The representation of the state and state agencies in all claims covered by the Self-Insurance Fund, and in all tort claims whether or not covered by the Self-Insurance Fund, shall be provided by the attorney general or by private legal counsel appointed by the attorney general…,

73. OWCA CITATION

74. WC and FMLA Employee can be on workers’ compensation and family medical leave at the same time. These run concurrently.

75. WC and ADA Some workers’ compensation injuries may qualify for accommodations under the Americans with Disabilities Act.

76. Supplemental Earnings Benefits R. S. 23:1221(3)(a) Entitlement to SEB begins when an IW is unable to earn wages = 90% or > of pre-injury wage. SEB based on 66 2/3 of difference between pre-injury wage and what employee is now capable of earning.

77. Discontinuance of Benefits Once WC benefits are started they continue until IW returns to work or i s released to RTW, regular duties by treating physician.

78. Discontinuance of Benefits Only way to stop workers’ compensation payments altogether …

79. Transitional Duty Employment

80. Enables IW to go from here…

81. Transitional Duty Employment … to here.

82. Transitional Duty Employment Would you like for your employee to sit here?

83. Transitional Duty Employment Or here?

84. Transitional Duty Employment Should be done when IW unable to return to his previous work or unable to earn wages equal to his pre-injury wage.

85. No Transitional Duty Employment? R. S. 23:1226 rehabilitative services. Job placement Retraining

86. Transitional Duty Employment Make every effort to return IW back to work even if IW cannot return to work full duties.

87. Transitional Duty Employment When an employee is sitting home collecting a comp check -

88. Transitional Duty Employment The work piles up !!!

89. Transitional Duty Employment Job modification Light duty Restricted duty Transitional Duty –cuts cost of workers’ compensation claims.

90. Successful Transitional Duty Transitional Duty is feasible when the IW released to some form of employment by treating physician.

91. Successful Transitional Duty Agency involvement is required –committed to TDE –communicate with the injured worker.

92. Successful Transitional Duty Employers should exercise discretion and caution in determining the transitional duties to be assigned.

93. Successful Transitional Duty Transitional duty must not lower the performance standards and expectations of the job as a whole.

94. Successful Transitional Duty Transitional duty should not establish a precedent for a lower level of duties and performance that other employees might then expect to be applied to them.

95. Successful Transitional Duty Transitional duty should not have the effect of permanently lowering the employee’s civil service job title.

96. Successful Transitional Duty Department of Civil Service, Program Assistance Division can give guidance in evaluating transitional duty employment. (225-342-8274)

97. Retirement and Workers’ Comp R. S. 23:1223; 1225 Disability Retirement –benefits may be reduced Regular Retirement –benefits payable for 2 years gainfully employable ORM must be notified immediately.

98. Unemployment and Workers’ Compensation Can’t get both workers’ compensation benefits and unemployment benefits. Notify the handling adjuster immediately.

99. EMPLOYERS’ FIRST REPORT (E-1) Reviewing the Claim Form

100. E-1

101. Upper Right Corner Employee social security number

102. Purpose of Report More than seven (7) days lost time Death Amputation / Disfigurement Medical Only Possible Dispute

103. Body of the Report 1)Date of the report - The date the report is completed. 2)Date of injury – date the accident occurred. 3)Normal starting time – time employee normally scheduled to begin work. 4)Employee back to work – date IW returned to work. 5)At same wage.

104. Body of the Report 6)If fatal injury, date of death. 7)Date employer knew of injury - when injury or illness was brought to the employer's attention. 8)Date disability began - the first date that the employee lost time from work as a result of the injury or illness. 9)Last full day paid date – last day the employee was paid in full.

105. Injured Worker Information 10) Employee Name - injured worker's first, middle, last name. 11) Male, female - gender of the injured worker. 12) Employee telephone number – IW home telephone number.

106. Injured Worker Information 13) Employee’s most current residential address - Street address, city, parish, state, zip code. 14) Parish of injury - Name of the parish where injury / illness occurred.

107. Injured Worker Information 15) Date of hire - date injured worker began working with agency. 16) Date of birth - injured worker's date of birth. 17) Occupation - Employee's occupation. Example: Gardner. 18) Department or division regularly employed.

108. Place of Injury 19) Employer’s premises: YES or NO – If the injury did not occur on the employer's premises, coverage may be affected. 20) If "NO"- give the location of the injury including city and state.

109. What Work Activity was the Employee Doing? 21) What was the IW doing when the accident occurred? Example - Employee injured while lifting numerous 30 lb. boxes into truck at loading dock. Dollies are provided for this task but employee refused to use them.

110. What was IW Doing When Accident Occurred? Defenses horseplay intoxication personal conflicts Course and scope of employment Arising out of the employment

111. What Caused Incident to Happen? 22) The events which resulted in injury or disease. What happened and how it happened. Full details on all factors which led or contributed to injury or illness. Example: Employee complained of back pain after lifting boxes for 1 week (approximately 50 boxes per day).

112. What Caused Incident to Happen? Accidents due to mechanical defects or unsafe acts should have a safety review.

113. What Caused Incident to Happen? If incident is result of MVA, who’s at fault (who hit whom)? Subrogation rights

114. What Caused Incident to Happen? Retain damaged property Product Liability

115. Part of Body and Nature of Injury / Illness 23) Identify part(s) of body involved and the nature of the injury and illness to that body part(s). May include more than one part of body. Example: Sprain to upper and lower back. 24) If occupational disease – Date doctor diagnosed disease / illness as occupational.

116. Part of Body and Nature of Injury / Illness If leg, arm, eye, ear, fingers or toes are hurt: –which one?

117. Medical Information 25) Physician and address - Doctor who treated the employee for injury. 26) Hospital name and address.

118. Employer Name 27) Name of the agency injured worker employed by. 28) Person completing this report.

119. Employer Name Identify region district

120. Employer Information 29) Employer address - Include street address, city, state and zip. 30) Employer’s telephone - Phone number of person completing the form.

121. Employer Information 31) Employer’s mailing address – if different from address in Item 29. 32) Nature of business - Nature of employer’s business. Be specific.

122. Wage Information 33) Always report wage even if IW does not lose time. Report wage on WEEKLY basis.

123. Wage Information Overtime earned in the four (4) weeks prior to date of accident Premium or differential pay Income that is taxable to employee Part-time employment or second jobs.

124. Communication Share information with adjuster that will be helpful in making a determination on the claim. This can be done at any time during the claims process.

125. Handout

126. E-1

127. Employer’s Certificate of Compliance

128. Employee’s Certificate of Compliance

129. Supplemental Report of Injury

130. Website information ORM websites: http://www.doa.la.gov/orm/forms.htm http://www.doa.louisiana.gov/orm/pdf/tranduty.pdf _DOA-ORM-Help LDOL / OWCA website: http://www.ldol.louisiana.gov/qm_formsindexdetail.asp? LookupValue=OWCA ISIS website: http://www.doa.state.la.us/osis

131. Adjuster Assignments

132. Leave Buy Back Report Log on Web

133. Leave Buy Back Report Go to Reports

134. Leave Buy Back Report Available Reports

135. Leave Buy Back Report Report Group > AGENCY REP> Filter

136. Leave Buy Back Report FILTER > Leave Buy Back Report> Run

137. Contact Information Contact me: Karen C. Jackson State Risk Claims Manager P. O. Box 91106 Baton Rouge, LA 70821-9106 225-342-7390 (p) 225-342-4470 (f) Karen.Jackson@la.gov

138. REFERENCES LOUISIANA R. S. TITLE 23 LABI WORKERS’ COMPENSATION DESK BOOK MALONE AND JOHNSON TREATISE ON WORKERS’ COMPENSATION

139. ?????? Questions ?????? Are there any questions?