1. INCIDENT REPORTING RISK MANAGEMENT WORKERS COMPENSATION PROGRAM

2. WHAT SHOULD BE REPORTED? All incidents and accidents involving employees, no matter how insignificant they seem.  This documents relative facts.  Provides a loss control tool.

3. REPORTING EMPLOYEE INCIDENTS For injuries NOT requiring Medical Treatment (minor injuries that do not require immediate medical treatment other than first aid), the Employee needs to: Notify your agency Workers Compensation Contact; Assist the Contact in completion of an on-line incident report and file with Risk Management; Completing and filing this form with Risk Management Workers Compensation serves as a record of notification to your employer in the event you require medical treatment in the future (up to one year). An on-line incident report should be submitted to Risk Management Workers Compensation within 24 hours of receiving the report of injury.

4. REPORTING EMPLOYEE INCIDENTS For injuries that do require Medical Treatment, the Employee’s Supervisor/Workers Compensation Contact needs to: Complete First Report of Injury Form, (SFN 2828) and file it with Workforce Safety & Insurance (WSI) within 24 hours after learning of the injury. Traumatic Injuries require : Supervisor to immediately file the SFN 2828 and notify Risk Management by phone (328-7583), fax (328-7585) or email (drwaliser@nd.gov); and Employee must complete SFN 2828 as soon as possible thereafter.

5. REPORTING EMPLOYEE INCIDENTS For injuries that do require Medical Treatment, the Employee needs to: Notify your agency Workers Compensation Contact; Assist the Contact in completion of an on-line incident report and file with Risk Management; Complete SFN 2828 Sections 1 and 2 and file it with Workforce Safety & Insurance; Obtain initial treatment from the pre-selected designated medical provider; Have care provider complete C-3; Return C-3 to supervisor or Workers Compensation Contact as soon as possible, but no longer than 24 hours after treatment.

6. REPORTING EMPLOYEE INCIDENTS n I filed a Workers Comp Claim - NOW WHAT n You will be contacted by a Claims Adjuster from Workforce Safety & Insurance and if the claim results in lost work time you will be contacted by a Nurse Case Manager. n These professionals will assist you with your claim and help answer any questions that you may have.

7. REPORTING EMPLOYEE INCIDENTS n You will also receive in the mail a letter from Workforce Safety & Insurance notifying you that your claim has been accepted or denied. n If your claim is denied the letter will also explain what steps you can take to have your claim reviewed. n AT ALL TIMES YOU ARE REQUIRED TO FOLLOW THE REQUIREMENTS SET FORTH BY YOUR MEDICAL PROVIDER AND WORKFORCE SAFETY & INSURANCE.

8. REPORTING EMPLOYEE INCIDENTS What if my injury won’t allow me to return to my regular job for a while? n You will be placed in Transitional Duty until you can do your regular job. n Transitional Duty is work that is modified to meet the restrictions placed on you by your medical provider. n All attempts will be made to find Transitional Duty in your agency - however if this is not possible you may be placed with another agency.

9. REPORTING EMPLOYEE INCIDENTS QUESTIONS ON TRANSITIONAL DUTY n How long will I be on Transitional Duty? n Will my assignments change? n How will my pay be affected? n Where will my assignment be located? n What are the benefits of Transitional Duty? n Can I elect not to participate?

10. WHEN WILL TRANSITIONAL DUTY END? n 90 days after starting of the assignment n You are released to your pre-injury position n The assignment is no longer available n The workers compensation claim is denied n Transitional work with the employing agency is available n The restrictions become permanent

11. ABOUT TRANSITIONAL DUTY n This is a temporary position n The job duties will change as medical restrictions and limitations change n The work will be meaningful n The work will be within 25 miles of your regular job

12. HOW WILL I BE PAID? n You will remain in your regular classification and position n Wages and benefits will be prorated for hours worked n Wages are supplemented up to 66.6% by NDWC n You can use leave benefits to keep pay at regular level

13. COMMUNICATION n The Worker, Supervisor, RMWCP, and WSI must be kept informed about: F Benefit information F Medical Treatments F Concerns of the worker

14. BENEFITS OF TRANSITIONAL DUTY n Speeds up recovery n Keeps employees working n Reduces compensation costs n Prevents abuse

15. IS TRANSITIONAL DUTY MY CHOICE? n You can elect not to participate in your transitional duty assignment- however, it may affect the benefits you receive from Workforce Safety & Insurance.