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

Workers’ Compensation for

State Agencies

Office

of

Risk Management

Karen C. Jackson,

Facilitator

Expected Workshop Goals

Develop a better understanding of the workers’ compensation process.

Expected Workshop Goals

Save

Time Money

ORM Workers’ Comp Statistics

5500 active workers’ compensation claims.

Approximately 1200 of these paid lost time benefits on regular basis.

ORM Workers’ Comp Statistics

$48 million spent on

workers’

compensation.

Overview of Workers’ Compensation

Title 23 Louisiana Revised Statutes requires all employers to provide workers’ compensation

coverage for their employees.


IW have the RIGHT to file a claim.

Let us decide if it’s a claim.


R. S. 23:1031.A

Anyone employed in the Stateof 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.

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.

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.


R. S. 23:1231

Provisions for– surviving spouse – dependent children or

surviving parents in the event of work - related death.

Notice of AccidentR. S. 23:1302

Injured workers must notify supervisor as soon as an accident occurs.

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.

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.

Online Access

To request access to STARS online reporting:

www.doa.Louisiana.gov/orm

Quick Links sectionORM Data Liaison Application/change form

http://www.doa.louisiana.gov/orm

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 fromthe date employer aware of accident.

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.

Volunteers and Community Service Workers

Covered for medical

payments only.

Independent ContractorsR. 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.

Records Retention

ORM maintains all closed files for two (2) years on-site.

Files are archived for three (3) years then destroyed.

Incidents Not Covered

Incidents Not CoveredR. S. 23:1021(1)

IW intentionally injures himself.

Incidents Not Covered R.S.23:1081.1.b

IW intoxicated at the time of the accident.

Drug ScreeningR. 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 orillegal narcotics.

Drug Screening

Post-accident drug screening paid in conjunction with the workers’ compensation

claim.

Incidents Not Covered R. S. 23:1081.1c

IW who is proven to be the aggressor in an

unprovoked altercation.

Incidents Not Covered R. S. 23:1031D

Injuries resulting from horseplay.

Incidents Not Covered R. S. 23:1031E

Incidents which arise out of purely personal matters.

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.

Items Not Covered

Personal items damaged in work-related accidents.

“Gray” Coverage Areas

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

Mental stress

“Gray” Coverage Areas R. S. 23:1021(7)(e)

Heart attacks

Strokes

“Gray” Coverage Areas R. S. 23:1021(7)

Clear and convincingevidence that these are

– sudden – unexpected– extraordinary– related to the employment.

Cannot be related to– any other health condition– personal situation.

“Gray” Coverage Areas It May Be Covered

Social Activities

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?

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.

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.

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.

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.

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.

Special Mission for Employer

Employees on a special mission are within the course ofemployment from “portal-to-portal” or from home to the

location of the mission or from the location of the mission to home.

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.

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

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.

Workers’ Compensation Benefits

Choice of Physician R. S. 23:1121(B)(1); R. S. 23:1142(B)

By specialty.

$750 of non-emergencytreatment.

Failure to obtain approval may result in non-payment of bills in excess of $750.

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.

Who’s going to pay for this?

Employer can give verification of initial medical

treatment up to $750 of non-emergency care.

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.

Weekly Indemnity Benefits R. S. 23:1224

Injury prevents IW from RTW for more than 7 days.

7 day waiting period – 1st 7 days not recoverable

unless IW loses more than 41 calendar days.

Benefits payable on 8th day.

Weekly Indemnity Benefits R. S. 23:1201.B

Comp checks are due 14 days after

employer notified.

Calculation of Weekly Benefits R. S. 23:1221

Based on 66 2/3 % of average weekly wage up

to maximum.

(maximum is $522)

Calculation of Weekly Benefits

If a worker earns less thanthe minimum his actual wage is his comp rate.

Wages locked accordingto date of accident-in most cases.

Maximum and minimumchange September 1st.

Compensation Checks

To initiate benefits adjuster enters benefit record upon claim setup or when lost time

begins.

Compensation Checks

Usually mailed to agency of employment to buy back leave.

Must be mailed directly to injured worker ifrequested.

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.

When are checks mailed?

Every other Tuesday

How long is the check good?

Checks expire 180 days from issue date.

WC and the IRS R. S. 1021(10)(f)

Workers’ compensation is a non-taxable income.

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 workeragency of employmentamount of comp check

average weekly waged used to determine comp ratepayment period for the check

Tell us!

Comp check incorrect– too much– too little– wrong dates.

Stop payment, Void orReissue check

Notify the adjuster ofrecord

– supplemental– phone– email

Name and phone number on check stub.

Tell us!

Retires

Back at work

Quits

Out of leave

Tell us!

When agency personnel changes.

Information we need from you

Copy of pay stubs for four weeks prior to dateof accident.

This does not include the week of injury.


Copy of IW job description.

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.


Employer’s Certificate of Compliance

Certifies employer provides WC insurance.

Certifies employer will not intentionally

defeat IW WC claim.

OWCA Mediations and Citations

DO NOT RESPOND TO

EITHER OF THESE!

ORM will securerepresentation from theattorney general’s office

to respond on you behalf.

OWCA Mediations and CitationsR. 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…,

OWCA CITATION

WC and FMLA

Employee can be on

workers’ compensation

and family medical

leave at the same time.

These run concurrently.

WC and ADA

Some workers’ compensation injuries may qualify for accommodations under the

Americans with Disabilities Act.

Supplemental Earnings BenefitsR. 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.

Discontinuance of Benefits

Once WC benefits are started they continue until

IW returns to work or is released to RTW, regular

duties by treating physician.

Discontinuance of Benefits

Only way to stop workers’ compensation payments altogether …

Transitional Duty Employment


Enables IW to go from here…


… to here.


Would you like for your employee to sit here?


Or here?


Should be done when IW unable to return to his previous work

or

unable to earn wagesequal to his pre-injury wage.

No Transitional Duty Employment?

R. S. 23:1226 rehabilitative services.

Job placement Retraining


Make every effort to return IW back to work

even if IW cannot return to work full duties.


When an employee is sitting home collecting a

comp check -


The work piles up !!!


Job modification

Light duty

Restricted duty

Transitional Duty– cuts cost of workers’

compensation claims.

Successful Transitional Duty

Transitional Duty is

feasible when the IW

released to some form

of employment by

treating physician.


Agency involvement is

required– committed to TDE– communicate with

the injured worker.


Employers should exercise discretion and caution in

determining the transitional duties to be assigned.


Transitional duty must not lower the performance

standards and expectations of the job as a whole.


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.


Transitional duty should not have the effect of

permanently lowering the employee’s civil service job title.


Department of Civil

Service, Program

Assistance Division

can give guidance in

evaluating transitional duty

employment.

(225-342-8274)

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.

Unemployment and Workers’ Compensation

Can’t get both workers’

compensation benefits

and unemployment

benefits.

Notify the handling

adjuster immediately.

EMPLOYERS’ FIRST REPORT(E-1)

Reviewing the Claim Form

E-1

Upper Right Corner

Employee social security number

Purpose of Report

More than seven (7) days lost time

Death

Amputation / Disfigurement

Medical Only

Possible Dispute

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.

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.

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.


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.


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 .

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.

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.

What was IW Doing When Accident Occurred?

Defenseshorseplayintoxicationpersonal conflicts

Course and scope of employment

Arising out of the employment

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).


Accidents due to mechanical defects or

unsafe acts should have a safety review.


If incident is result of MVA, who’s at fault

(who hit whom)?

Subrogation rights


Retain damaged property

Product Liability

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.

Part of Body and Nature of Injury / Illness

If leg, arm, eye, ear, fingers or toes are hurt: – which one?

Medical Information

25) Physician and address - Doctor

who treated the employee for injury.

26) Hospital name and address.

Employer Name

27) Name of the agency injured worker

employed by.

28) Person completing this report.

Employer Name

Identify• region • district

Employer Information

29) Employer address - Include street address, city, state and zip.

30) Employer’s telephone - Phone number of person completing the form.

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.

Wage Information

33) Always report wage even if IW does not lose time.

Report wage on WEEKLY basis.

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.

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.

Handout

E-1

Employer’s Certificate of Compliance

Employee’s Certificate of Compliance

Supplemental Report of Injury

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

http://www.doa.la.gov/orm/forms.htm

http://www.doa.louisiana.gov/orm/pdf/tranduty.pdf

http://www.ldol.louisiana.gov/qm_formsindexdetail.asp?LookupValue=OWCA

http://www.ldol.louisiana.gov/qm_formsindexdetail.asp?LookupValue=OWCA

Adjuster Assignments


Log on Web


Go to Reports


Available Reports


Report Group > AGENCY REP> Filter


FILTER > Leave Buy Back Report> Run

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)

[email protected]

REFERENCES

LOUISIANA R. S. TITLE 23

LABI WORKERS’ COMPENSATION DESK

BOOK

MALONE AND JOHNSON TREATISE ON

WORKERS’ COMPENSATION

?????? Questions ??????

Are there any

questions?

Documents

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