Return to Work 101Return to Work 101 Injury Reporting Injury Reporting

May 14th, 2009May 14th, 2009

Presented by: Presented by: Cathy Stein-RomoCathy Stein-Romo

Chief Executive OfficeChief Executive OfficeRisk Management/WC UnitRisk Management/WC Unit

(213) 738-2228(213) 738-2228cstein@ceo.lacounty.govcstein@ceo.lacounty.gov

Topics CoveredTopics Covered

• WC/RTW Overview• Forms/Process

-Completing forms-Seeking medical

treatment via Pre-designationORITC/MPN

• Work Hardening (WHTAA)

• Maintaining File/Contact with Employee

Workers’ Compensation Workers’ Compensation OverviewOverview

Injury definition: any injury or disease arising in the course and scope of employment Specific Cumulative Presumptive (safety only)

Applicable labor code section;Applicable labor code section; “…“…shall be liberally construed by shall be liberally construed by

the courts with the purpose of the courts with the purpose of extending their benefit for the extending their benefit for the protection of persons injured in the protection of persons injured in the course of their employment.” course of their employment.” (LC3202)(LC3202)

Workers’ Compensation Overview, Workers’ Compensation Overview, Cont…Cont…

Third Party Administrator Contractor hired by County of Los

Angeles to administer workers’ compensation benefits for County employees

Decides whether workers’ compensation claims are compensable (work-related)

Decision must be made within 90 days of receiving claim form

ReturnReturn to Work Overview to Work Overview

DefinitionDefinition

Program designed to return Program designed to return employees to work in a employees to work in a productive capacity as productive capacity as quickly as possible after an quickly as possible after an injury or illness.injury or illness.

PurposePurpose

Minimize the costs of injuries Minimize the costs of injuries and illnesses while and illnesses while maintaining an inclusive maintaining an inclusive work environment.work environment.

Injury Reporting Form Packet Contains…

•Emergency

•Non-Emergency

•Refusal of Treatment

•Referral to Treatment

•CEO Website:http://ceo.lacounty.gov/mpn

Breakdown of Injury Reporting

• Emergency Injury Reporting

• Non-Emergency Injury Reporting

• Employee Seeks Treatment

• Employee Injury/Illness File

• Employee on Temporary Total Disability • Employee Released to Full Duties

• Employee Released to Modified or

Alternate Work

• Required Forms

Emergency Injury Emergency Injury ReportedReported

Call 911

Emergency Injury Reported, Cont..

Once the situation is stable, youshould:

1. Complete the Job Description form.

2. Complete the DWC1 Claim Form, and the Employer’s Report of Injury (5020) and call into the 800 number within 24 hours.

We have included an optional fax cover sheet for your convenience…

Non-EmergencyNon-EmergencyInjury ReportedInjury Reported

If Employee Declines Treatment:

1. Employee must complete the Employee’s Statement Declining Treatment form.

A copy of the form must be sent to the RTW Coordinator or Personnel.

2. Employee must sign Receipt of Employee Packet, and be given the packet.

Employee Seeks Employee Seeks TreatmentTreatment

Review the Employee’s Review the Employee’s Guide for Injury Guide for Injury Reporting withReporting with

the employee.the employee.

Complete the Injury Complete the Injury Reporting forms with theReporting forms with the

employee. The packet must employee. The packet must contain the fourcontain the four

forms below:forms below:– The completed The completed

Treatment Referral Treatment Referral SlipSlip

– The completed The completed Treating Physician’s Treating Physician’s letter (for physical letter (for physical injuries only) injuries only)

– A copy of the blank A copy of the blank Patient Status Report Patient Status Report

Employee Seeks Treatment Employee Seeks Treatment Cont…Cont…

– And, a copy of the completed Job And, a copy of the completed Job DescriptionDescription should be included in the Medical Providershould be included in the Medical Provider Packet.Packet.

Send the four documents with the Send the four documents with the employee to the Pre-designated employee to the Pre-designated physician OR ITC, as applicable.physician OR ITC, as applicable.

Employee Seeks Treatment, Employee Seeks Treatment, Cont…Cont…

Ask the employee if they have Pre-Ask the employee if they have Pre-designated a treating physician.designated a treating physician.

If they have notIf they have not, send them to the , send them to the Medical Provider Network (MPN) Initial Medical Provider Network (MPN) Initial Treatment Center (ITC). A list of those Treatment Center (ITC). A list of those centers can be obtained on the centers can be obtained on the County’s MPN website at:County’s MPN website at:http://http://ceo.lacounty.gov/mpnceo.lacounty.gov/mpn

Employee Seeks Treatment, Employee Seeks Treatment, Cont…Cont…

Fill out the DWC1 Claim Form, and Fill out the DWC1 Claim Form, and Employer’s Report (5020) form. Employer’s Report (5020) form. The injury must be called into the The injury must be called into the 800 number within 24 hours upon 800 number within 24 hours upon notice of the injury.notice of the injury.

Call the 800 number and report the Call the 800 number and report the injury.injury.

In some departments, the main RTW In some departments, the main RTW Unit staff calls in the injury, in others Unit staff calls in the injury, in others the supervisor or location designee the supervisor or location designee calls it in.calls it in.

MPN Initial Treatment Centers MPN Initial Treatment Centers (ITC)(ITC)

If Employee has not Pre-If Employee has not Pre-designated their personal designated their personal treating physician, the work treating physician, the work location Supervisor or designee location Supervisor or designee must direct them into the must direct them into the County’s Medical Provider County’s Medical Provider Network (MPNs), via an Initial Network (MPNs), via an Initial Treatment Center (ITC)Treatment Center (ITC)

Employee on TemporaryEmployee on TemporaryTotal Disability Total Disability Employee is Employee is taken off work by physician after injurytaken off work by physician after injury

Location Supervisor should Location Supervisor should ffax a copy of the ax a copy of the Patient Status Report to the RTW Patient Status Report to the RTW Unit/Personnel.Unit/Personnel.

Make sure that the time card is coded Make sure that the time card is coded appropriately.appropriately.

Call the employee for status.Call the employee for status.The employee should be called on a weekly The employee should be called on a weekly basis to determine their status, follow-up on basis to determine their status, follow-up on their recovery, and answer any questions they their recovery, and answer any questions they may have regarding the process.may have regarding the process.

Employee Released to Full Employee Released to Full DutiesDuties

Return the employee to work.Return the employee to work.

Communicate with the Communicate with the employee to make sure they employee to make sure they are able to continue working are able to continue working their Usual and Customary (U their Usual and Customary (U & C) duties.& C) duties.

The department RTW Unit The department RTW Unit should be informed of status should be informed of status in writing, and of any in writing, and of any problems or concerns.problems or concerns.

Close the employee Close the employee injury/illness file in 45 days injury/illness file in 45 days from the date of injury if the from the date of injury if the employee continues to work employee continues to work their U & C job.their U & C job.

Employee Released to Employee Released to Modified or Alternate WorkModified or Alternate Work

Physician has provided Physician has provided restrictions that prevent employee restrictions that prevent employee from immediately returning to their from immediately returning to their

Usual and Customary (U&C) jobUsual and Customary (U&C) job

Review the work restrictions to make sure they Review the work restrictions to make sure they are compatible with the duties listed in the job are compatible with the duties listed in the job description. description.

If the work restrictions are compatible, return the If the work restrictions are compatible, return the employee to work.employee to work.

If modification of the job duties is required, make If modification of the job duties is required, make the necessary modifications.the necessary modifications.

Communicate those temporary modifications and Communicate those temporary modifications and time limits to the employee.time limits to the employee.

If modification of the job is done, a Work If modification of the job is done, a Work Hardening Transitional Assignment Agreement Hardening Transitional Assignment Agreement (WHTAA) must be completed (WHTAA) must be completed withwith the employee. the employee.(This (This should be done during the Interactive should be done during the Interactive meeting and by either or both the RTW Unit staff meeting and by either or both the RTW Unit staff or the location Supervisor or designee along with or the location Supervisor or designee along with the employee.)the employee.)

Location Supervisor/designated staff and Location Supervisor/designated staff and department RTW Unit staff should both department RTW Unit staff should both have a signed copy of WHTAA, along have a signed copy of WHTAA, along with the employee. with the employee.

Retain a copy of the WHTAA in the Retain a copy of the WHTAA in the employee’s injury/illness file.employee’s injury/illness file.

If modification of the job is not possible, If modification of the job is not possible, explore available job tasks within the explore available job tasks within the work unit.work unit.

If the location is able to provide alternate If the location is able to provide alternate work, a WHTAA work, a WHTAA must be completed must be completed with the employeewith the employee..

If no alternate or modified job is available after If no alternate or modified job is available after a thorougha thorough and reasonable search is and reasonable search is conductedconducted, contact the , contact the Supervisor/Management at work location and Supervisor/Management at work location and human resources staff human resources staff to asto assist with a plan to sist with a plan to monitor situation and expand search for monitor situation and expand search for other other job placement opportunities within the job placement opportunities within the department.department.

Catalog a follow-up date with department staff.Catalog a follow-up date with department staff.

When an assignment is locatedWhen an assignment is located, c, complete the omplete the WHTAA with the employee on their first day WHTAA with the employee on their first day back to work.back to work.

Make sure a signed WHTAA is obtained and Make sure a signed WHTAA is obtained and mamaintained between the department intained between the department RTW Unit RTW Unit and the and the work location/supervisor/RTW work location/supervisor/RTW CoordinatorCoordinator..

If there is no work assignment for the If there is no work assignment for the employee, the supervisor should continue to employee, the supervisor should continue to call the employee weekly (call the employee weekly (ReminderReminder: log all : log all phone calls on the Telephone Log).phone calls on the Telephone Log).

If there is a problem reaching the employee at If there is a problem reaching the employee at home, document attempts on the home, document attempts on the Telephone Telephone Log and work with other County TPA staff as Log and work with other County TPA staff as appropriate to verify contact information. If appropriate to verify contact information. If necessary you can contact the treating necessary you can contact the treating physician to request medical certification physician to request medical certification reflecting any restrictions or to verify employee reflecting any restrictions or to verify employee is taken off work.is taken off work.

If you suspect any behavior or receive any If you suspect any behavior or receive any information regarding fraudulent activities or information regarding fraudulent activities or abuse, this information should be shared abuse, this information should be shared with with our TPA staff once their file is set up. our TPA staff once their file is set up.

Review of Required Forms for Reporting an

Industrial Injury

• Receipt of Employee Packet• Employee’s Statement Declining

Medical Treatment• First Alert or other proof of Fax as

appropriate• DWC 1 Claim Form• Employer’s Report (5020) Form• Job Description Form • Treating Physician’s Letter• Treatment Referral Slip• Work Hardening Transitional

Assignment Agreement• Weekly Call Verification Sheet• To locate more forms see:

http://ceo.lacounty.gov/mpn

Review of Employee Responsibilities

• Complete DWC-1 Employee Claim Form

• Complete Employee’s Report of Accident

• Return the Completed forms to your supervisor/ including all Medical Certifications from your treating physician

Employee Injury/Illness File

It is important that an injury/illness file be maintained on

employees. The injury/illness file should contain, at a minimum, the following documents:

A copy of the Claim Form (DWC Form 1) A copy of the Employer’s Report (5020) Employee’s Report of Accident Supervisor Weekly Telephone Log Sheet Copy of the Job Description/Essential Job

Functions listing Patient Status Reports Work Hardening Agreements Any other documentation that you may receive on

this injury

QUESTIONS???QUESTIONS???