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’ comp process

3. Expected Workshop Goals SAVE TIME MONEY

4. Expected Workshop Goals Reduce some of the stress associated with workers’ compensation

5. ORM Workers’ Comp Statistics 6100 active workers’ compensation claims Approximately 1000 of these paid compensation benefits on regular basis

6. ORM Workers’ Comp Statistics $48 million spent on workers’ compensation Money comes directly from agency budgets

7. WORKERS’ COMPENSATION IS THE LAW! Title 23 Louisiana Revised Statutes Employers MUST provide workers’ compensation coverage for all employees IW’s have the RIGHT to file a claim

8. 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

9. Office of Workers’ Compensation Administration (OWCA) Governing body that ensures the workers’ compensation statute is properly administered. State agency housed under the Department of Labor Judicial Authority –Issue Mediation Notices and Citations

10. Who should respond to OWCA Mediations and Citations? IW’s can file a disputed claim with Office of Workers’ Compensation ORM will respond to these on agency behalf Notify ORM adjuster when receive mediation notices and citations

11. Who Can Receive Workers’ Compensation? Anyone employed in the State of Louisiana who is injured on the job Coverage begins the moment employment begins Covered accidents must – arise out of employment – occur during course and scope of employment

12. What benefits are provided under Workers’ Compensation? IW may be entitled to medical benefits at the expense of his employer

13. What benefits are provided under Workers’ Compensation?

14. What doctor can an IW seek treatment from? Choice of physician in each field of specialty Approval needed to exceed $750.00 of non-emergency medical treatment Failure to obtain approval may result in non-payment of bills in excess of $750.00

15. Can an employer have an IW examined by doctor of its choosing? Employer or insurer has right to have IW examined from time to time during the course claim Failure to comply with exam may result in suspension of benefits until exam takes place Suspended period not recoverable

16. Who’s going to pay for this? Employer can give verification of initial medical treatment up to $750.00 of non- emergency treatment Notify the adjuster of what’s been approved

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

18. How long does IW have to file a claim for medical benefits? Claims for medical benefits must be filed within 1 year from date of accident Period for medical benefits is 3 years from date of last payment

19. What benefits are provided under Workers’ Compensation? IW may be entitled to income benefits at the expense of employer

20. What benefits are provided under Workers’ Compensation? Provisions for – Surviving spouse – Dependent children or – Surviving parents in the event of work - related death.

21. What benefits are provided under Workers’ Compensation? Surviving spouse and dependant children – Entitled to weekly benefits Surviving parents – Lump sum $75,000 each if – No surviving spouse – No dependent children $7500 burial expense

22. How long does IW have to file a claim for indemnity benefits? Claims for weekly benefits must be filed within 1 year from date of accident Weekly benefits open 1 year from date of last payment 3 years from date of last payment for SEB

23. 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.

24. CIVIL SERVICE RULE 11.21 Questions about leave with respect to workers’ compensation should be directed to Civil Service

25. Exclusive Remedy An IW cannot sue his employer in tort or for negligence, unless Employer intentionally tried to harm the IW

26. When should IW report an accident? Injured workers must notify immediate supervisor – as soon as an accident occurs

27. What should the supervisor do when an accident is reported? Supervisor immediately initiates paperwork for E-1 to be sent to ORM – Paper – Electronically

28. When should ORM be notified of an accident? Please notify ORM immediately of all accidents –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 date employer notified of accident

29. DON’T DROP THE BALL! DO NOT deny employees the right to file a claim –Increased litigation exposure –A filed claim does not mean a paid claim

30. Incidents Not Covered

31. IW intentionally injures himself or another employee

32. Incidents Not Covered IW deliberately failed to use adequate protection provided

33. Incidents Not Covered IW intoxicated at the time of the accident -alcoholic beverages -Rx -OTC -illegal narcotics Burden of proof on employer

34. Incidents Not Covered IW who is proven to be the aggressor unprovoked altercation

35. Incidents Not Covered Injuries resulting from Horseplay

36. Incidents Not Covered Incidents which arise out of purely personal matters

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

38. “Gray” Coverage Areas

39. Mental stress

40. “Gray” Coverage Areas Heart attacks Strokes

41. Gray” Coverage Areas Clear and convincing evidence that these are – Sudden – Unexpected – Extraordinary – Related to the employment Cannot be related to – Any other health condition – Personal situation

42. Are volunteers and community service workers covered for Workers’ Compensation? Covered for medical payments only Community service must be ordered by State court

43. When is IW entitled to receive WC Benefits? Eligibility to receive WC lost time benefits begins when injury prevents IW from RTW for more than 7 calendar days 7 day waiting period Benefits payable on 8 th day 1 st 7 days not recoverable unless IW loses more than 42 calendar days

44. When is the first indemnity check due? Comp checks are due 14 days after employer notified of accident

45. How are weekly benefits calculated? Based on 66 2/3 % – average weekly wage (AWW) – up to maximum (Maximum is $454.00)

46. How are weekly benefits calculated? If a worker earns less than the minimum – actual wage is comp rate Maximum and minimum – change every September 1 st Wages locked according to date of accident – in most cases

47. How are indemnity benefits initiated? To initiate benefits –Adjuster enters benefit record when claim setup OR –When lost time begins

48. WHEN ARE CHECKS PRINTED? INDEMNITY BENEFIT RECORD –Updated every other Monday –Checks generated every other Monday night or –Nearest date to regular pay day if holiday

49. WHEN ARE CHECKS MAILED? EVERY OTHER TUESDAY

50. Where is the indemnity benefits check mailed? Usually mailed to agency or region of employment Must be mailed directly to injured worker if requested

51. RS 23:1201.1 WORKERS’ COMPENSATION PAYMENTS, AT THE OPTION OF THE EMPLOYEE, SHALL BE MAILED TO THE EMPLOYEE AT THE ADDRESS DESIGNATED BY HIM.

52. HOW LONG IS THE CHECK GOOD? CHECKS EXPIRE 180 DAYS FROM ISSUE DATE

53. TELL US! COMP CHECK INCORRECT –TOO MUCH –TOO LITTLE –WRONG DATES

54. TELL US! EMPLOYEE OUT OF LEAVE –We don’t know until you tell us

55. TELL US! RETIRE QUIT BACK AT WORK

56. TELL US! WHEN AGENCY PERSONNEL CHANGES

57. How to get a check voided, reissued or payment stopped - Notify the adjuster of record –Supplemental –Phone –Email Name and phone number on check stub.

58. Can IW be on WC and FMLA? Employee can be on workers’ compensation and Family Medical Leave at the same time. Run concurrently

59. Can Workers’ Compensation injuries qualify for ADA protection? Some workers’ compensation injuries may qualify for accommodations under the Americans with Disabilities Act.

60. What if IW can RTW in a lesser capacity? If IW worker can earn wages but – Unable to earn wages equal to 90% or greater of pre- injury wage ENTITLED TO SEB – SEB based on 66 2/3 of difference between pre-injury wage and what employee is now capable of earning

61. When do workers’ compensation benefits stop? Once WC benefits are started –T hey continue until IW returns to work OR Is released to RTW, regular duties by treating physician

62. What can be done to stop WC benefits? Only way to stop payments altogether

63. Transitional Duty Employment

64. What is Transitional Duty Employment? TDE is that employment which enables an IW to go from here

65. Transitional Duty Employment To here

66. Stop and think about it! Would you like for your employee to sit here?

67. Stop and think about it! Or here?

68. When is Transitional Duty Employment done? Transitional Duty Employment is feasible – IW released to some form of employment TP decides RTW – Can’t RTW before doctor says so

69. When is Transitional Duty Employment done? When IW unable to return to his previous work OR Unable to earn wages equal to his pre-injury wage

70. What should an employer do when IW is released to restricted duties? Make every effort to – return IW back to work same employer – even if IW cannot return to work full duties

71. What if there is no Transitional Duty Employment? R. S. 23:1226 – Rehabilitative services Job placement Retraining

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

73. Who’s going to do that work? The work piles up!!!

74. It doesn’t matter what you call it! Job modification Light duty Restricted duty Transitional Duty Employment – Cuts cost of workers’ compensation claims

75. Successful Transitional Duty Open mind of employer required Employer must make accommodations when IW has been released to some form of restricted duty

76. Successful Transitional Duty Agency involvement is required –Committed to TDE –Communicate with the injured worker

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

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

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

80. Successful Transitional Duty Transitional duty employment should not have the effect of permanently lowering the employee’s Civil Service job title.

81. Transitional Duty Works Effective in both public and private sector 20% decrease in disability costs Keep productivity and employee moral up Get employee back into work environment as soon as medically possible

82. Transitional Duty Works Economical IW benefits Employer benefits RTW makes good business sense IT’S A WIN – WIN SITUATION

83. Successful Transitional Duty Department of Civil Service, Program Assistance Division can give guidance in evaluating transitional duty employment.

84. Can IW receive both retirement and Workers’ Compensation? Disability Retirement – benefits may be reduced Regular Retirement – benefits payable for 2 years gainfully employable ORM must be notified immediately

85. Can IW receive unemployment and Workers’ Compensation? CAN’T GET BOTH – Workers’ Compensation – Unemployment Benefits Notify the handling adjuster immediately

86. Attorneys IW not required to have an attorney Cannot discourage anyone from retaining an attorney Drive up the cost and settlement value of claims

87. Are Independent Contractors covered under State workers’ compensation? Ensure contractor has WC coverage for its employees If coverage lapses – State can be deemed the statutory employer of their employee - Must provide WC to their employees Check solvency of contractor periodically

88. What form is used to file a WC claim? Employers’ First Report (E-1) Five page form – Original ORM – OWCA > 7 days disability Death Amputation / Disfigurement – Employer – Injured Worker – Treating Physician

89. Completing the E-1 Social Security Number Location Code Purpose of the report is important – More than seven (7) days lost time – Death / amputation / disfigurement – Medical only – Possible dispute

90. Completing the E-1 Complete MM/DD/YY Time of day Date IW RTW Date disability began – if not back at work Complete – Name – Current residential address including city, state, zip – Current phone number Occupation

91. Completing the E-1 Place of accident is important – On the premises – On someone else’s premises These effect coverage

92. Completing the E-1 What was IW doing when accident occurred – Defenses Horseplay Intoxication Personal conflicts – Course and scope of employment – Arising out of the employment

93. Completing the E-1 Complete details on how injury occurred Is the accident due to mechanical defect – or An unsafe act?

94. Completing the E-1 If incident is result of MVA: – who’s at fault (who hit whom)? Subrogation rights

95. Completing the E-1 Retain damaged property –Product Liability

96. Completing the E-1 Part of body / nature of injury important What’s wrong with IW? If leg, arm, eye, ear, fingers or toes are hurt: – which one? Treating physician / hospital – – address and phone number

97. Completing the E-1 Name of Employer – Identify region district

98. Completing the E-1 Always give wage even if IW does not lose time Report wage on WEEKLY basis – overtime earned in the four (4) weeks prior to date of accident – Report any premium or differential pay – Report income that is taxable to employee – Report any part-time employment or second jobs

99. 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.

100. DID YOU KNOW? Report workers’ compensation claims on-line using a web-based application

101. Claims Reporting: the “OLD” Way Type claim form Write out E-1

102. Claims Reporting: the “OLD” Way Send claims through the mail or by fax

103. Claims Reporting: the “OLD” Way Wait for mail to be delivered to ORM

104. Claims Reporting: the “OLD” Way Your Claim At ORM!!!

105. ONLINE CLAIMS REPORTING ELIMATES: – Typewritten claims – Handwritten forms – Faxing Reduces time to receive claim Instant claim set-up Easier to authorize medical treatment

106. ONLINE CLAIMS REPORTING Once trained, no paper claims will be accepted

107. Supplemental Report Of Injury Notify ORM of changes in claim status – Beginning disability – Return to work – Corrected wage reporting – Corrected dates of loss – Retirement status

108. Drug Screening Post-accident drug screen WC accidents WC Statute: deny if IW is intoxicated at the time of the accident Intoxication can be due to alcohol, Rx, OTC medication or illegal narcotics Employer MUST have a written policy

109. Drug Screening RS 23:1081(1)(b) has guidelines on what constitutes policy ALL employees must be made aware of the policy Post-accident screening paid in conjunction with the WC claim 0.08 % or greater of alcohol = intoxication Screen pre-RTW (R.S. 23:1221.3.g)

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

111. What forms should be sent to ORM? E-1 Supplemental Report of Injury Employer’s Certificate of Compliance

112. POST-OFFER OF EMPLOYMENT MEDICAL INQUIRY (E-2) Used to secure second injury fund approval only Must be kept confidential Will be housed at agency of employment Must be updated every 2 years

113. POST-OFFER OF EMPLOYMENT MEDICAL INQUIRY (E-2) Compliant with HIPPA ADA FMLA

114. What is the Second Injury Fund? SIF established by the legislature to encourage employers to hire / retain persons with pre-existing disabilities Insurance companies pay a percentage of their workers’ compensation premiums into the fund Claims are filed with SIF on all qualified claims

115. Second Injury Fund Employer knowledge of pre-existing disability key to SIF approval Written statement needed from the employer about knowledge of pre-existing condition before the accident occurred Knowledge can be: disclosures on insurance and/or retirement forms / prior workers comp claims / E-2

116. Second Injury Fund Over $2.0 million received in recoveries last year Reimbursements credited against the qualifying claim Reduce the cost of the claims and premiums

117. Second Injury Fund - Vendor ORM utilizes a contract vendor to help identify and secure SIF approval Please work with vendor to provide needed information to get approvals

118. HANDOUT

119. Workers’ Compensation For State Agencies

120. ?????? Questions ?????? Are there any questions?