Good afternoon. Thank you for taking time to attend the IAC meeting. Today we will provide a brief overview of what employers and supervisors need to know about workers compensation and return to work programs. Please hold all questions until the end of the presentation. 1
Let s review the objectives for the presentation: Define state employees workers compensation. Identify who is covered under workers compensation. Understand the process of reporting an injury/illness. Different types of indemnity benefits. Understand the statute of limitations. And how to handle legal correspondence. You will also be able to report suspected fraudulent activity and Understand a Return-to-Work Program. 2
Let s define State Employees Workers Compensation: An insurance plan provided by the State of Florida that covers all WCauthorized, reasonable, and necessary medical care if a state employee sustains an injury or occupational illness arising out of the course and scope of his or her employment. 3
Let s identify who is covered under state employees workers compensation. 4
All full-time, part-time, and temporary employees, excluding temporary employees from leasing agencies. Volunteers working for your agency are covered for medical benefits, and, in some situations, may also receive indemnity benefits if they have other employment and are unable to return to work due to their injury, - F.S. 110.504 Offenders sentenced through the Circuit Court and who are in a work-release program or in a pre-trial sentencing program are considered an employee for medical benefits only. F.S. 948-036 (1) (2). The only exception is if they are sentenced as a result of a DUI no coverage. 5
Let s now discuss how to report an injury or illness. 6
The employee should report the injury or illness as soon as possible, but no later than 30 days from the date of occurrence. The claim may be denied if it is not reported timely. Exceptions to this include: If the employer had knowledge of the injury and it was not reported to AmeriSys. If the employer did not notify the employee of his or her requirement to report the accident. 7
For emergency injuries/illnesses: Immediately call 911. For non-emergency injuries/illnesses: The supervisor should call AmeriSys within 7 days after knowledge of the injury or illness. AmeriSys will complete the First Report of Injury and submit the claim to the Division. AmeriSys will also schedule all non-emergency medical treatment for the employee filing a workers compensation claim. Workers compensation coordinators should ensure that all injuries or illnesses are reported properly to AmeriSys. The safety coordinator should investigate and document work-related injuries or illnesses and ensure appropriate action has been taken to correct unsafe conditions or behavior. If the safety coordinator is unable to investigate the accident directly, the documented accident investigation should be submitted for the safety coordinator s review. 8
Before reporting the injury or illness to AmeriSys, please make sure to have the information on the next two slides accessible. Additionally, make sure all information is current. 9
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After AmeriSys completes the First Report of Injury, and, if warranted, directs the employee for medical treatment, a copy of the Florida Workers Compensation Uniform Medical Treatment/Status Reporting form (also known as the DWC-25) is provided to the employer if medical treatment is authorized. 11
Now let s discuss and review some of the key elements of the DWC-25. 12
The DWC-25 is the required documentation for physicians to consistently report the injured employee s medical treatment and status to the employer. Additional DWC-25s should be available after each follow-up visit. The supervisor should review the DWC-25 upon receipt for any changes to the employee s work restrictions and medical status. 13
When reviewing the DWC-25, it s important to note the above boxes for the most current work restrictions. 14
Now let s discuss the two types of indemnity payments that may be provided to the injured employee. Temporary Partial Disability, also known as TPD, is paid when the employer cannot accommodate the functional limitations and restrictions set forth by the authorized workers compensation treating provider. Please let the DRM adjuster know if the injured worker will be returning to work full time. 15
Temporary Total Disability, also known as TTD, is paid when the injured worker has been taken out of work by the authorized workers compensation treating provider. The agency or university is responsible for reimbursing Risk Management for the first ten weeks of TTD. A wage statement will need to be completed. 16
The wage statement provides the employee s earnings 13 weeks immediately preceding the date of injury/illness. Instructions on how to complete the wage statement are provided in the handout included in your packet. What happens after indemnity benefits are no longer provided to the injured worker? The physician assigns maximum medical improvement and a permanent impairment rating is given. An injured worker is no longer entitled to indemnity benefits unless the MMI/PIR is rescinded. After MMI/PIR is assigned, the injured worker is responsible for a $10 copayment for medical appointments. 17
Maximum medical improvement, also known as MMI, occurs when an injured employee reaches a state where their condition cannot be improved any further or has stabilized to the point that no major medical change can be expected in their condition. After MMI is reached, the authorized treating physician will determine the permanent impairment rating. The permanent impairment rating, also known as PIR, is used to assess the degree of damage that resulted from the work-related injury or illness. Supervisors should review the PIR restrictions to determine if the employee can continue to perform the essential functions of their position. The employer will need to determine if they can continue to employ the injured worker with their permanent restrictions. If the employer is unable to find work for the injured worker within their permanent restrictions, please notify the adjuster at DRM immediately. 18
Let s briefly discuss the statute of limitations. 19
For all medical and indemnity benefits: The claim will remain open no less than 2 years from the date of the injury or illness or 1 year from the last date of authorized medical services or paid benefits once it has been more than 2 years since the date of the accident (Section 440.19, Florida Statutes). 104 weeks is the maximum cap for indemnity benefits. 20
Now we will briefly review what to do when legal correspondence or a phone call is received from an attorney on a claim. 21
If you receive any legal correspondence or phone calls from an attorney regarding a claim, please forward and direct them to the adjuster. 22
If you receive a Petition for Benefits, which is also a type of legal correspondence, please forward it to the adjuster. For an example of a PFB, please refer to the handout included in your packet. Legal activity may extend the statute of limitations on a claim. Time is of the essence. 23
Fraudulent workers compensation claims and abuse of the workers compensation system cost us all time, money, and lost productivity. If you suspect fraud or abuse please notify the adjuster immediately. 24
Communication is very important. If you have any knowledge regarding the claimant or the injury, please notify the adjuster. Personal and pre-existing conditions may play a role in determining the compensability of the claim. 25
Let s now turn our attention to the return-to-work process. 26
What is a return-to-work program? Simply put, a return-to-work program is an employer program designed to encourage and enable an injured worker to remain at work or to return to work to perform job duties within the functional restrictions and limitations established by the employee s authorized medical provider. The purpose of implementing a return-to-work program is to successfully re-integrate the injured employee back into the work environment. 27
Who is required to have a return-to-work program in place? According to Section 284.50(3), Florida Statutes, The Department of Financial Services and all agencies that are provided workers compensation insurance coverage by the State Risk Management Trust Fund and employ more than 3,000 full-time employees shall establish and maintain return-to-work programs for employees who are receiving workers compensation benefits. 28
Why have a return-to-work program? Even if your agency is not statutorily required to have a return-to-work program, implementing one can result in a number of significant benefits to both the employer and the employee. Benefits to the employer include not only lower medical costs, but reduced indemnity payments, less need to replace employees, and quicker claim resolution. Active monitoring of return-to-work processes also benefits the employee by promoting positive morale and helping to maintain work conditioning. Therefore, return-to-work efforts should be implemented as soon as possible after an employee has experienced a workplace injury. Timely implementation fulfills the employee s need to feel valued and saves your agency in claim costs. 29
An effective return-to-work program consists of several key elements: Documented return-to-work policies that establish program objectives and communicate them to supervisors and employees. Agency-wide monitoring and coordination of the program that includes review of lost-time, claim data, and regular communication with the injured employee, supervisor, medical case management provider, and Division of Risk Management adjuster. Providing the injured employee with meaningful, reasonable, and productive work opportunities within the employee s functional limitations and restrictions. These alternate or modified duties are a stepping stone toward enabling the employee to return to a work level as close as possible to his or her pre-injury status. 30
Now that we know what a return-to-work program is and why having one is an advantage, let s identify the major program players. From the moment an employee becomes injured, the return-to-work program involves the participation of the employee, his or her supervisor, the agency workers compensation coordinator, the authorized workers compensation treating physician, the medical case management provider, and the Division of Risk Management. An agency safety coordinator or risk manager may also play a part in return-to-work oversight. Each of these participants should work together as a team to contribute to the success of the program. 31
What are the responsibilities of these return-to-work program roles? The injured employee must attend medical appointments; agree to the terms of the program; provide the employer with all medical documentation; and perform alternate or modified duties as assigned. The employee s supervisor determines if modified or alternate duty is available; ensures that work duties meet restrictions and limitations; and communicates concerns to the agency workers compensation coordinator. The workers compensation coordinator notifies the employee and communicates with the Division of Risk Management adjuster and other key program participants. 32
The authorized workers compensation treating physician determines medical condition; functional limitations and restrictions; and ultimately, maximum medical improvement. The physician also completes the DWC-25 form. The medical case management provider assigns a nurse case manager to coordinate medical treatment and documentation of restrictions and limitations on the DWC-25 form, and provides the DWC-25 to the employer and workers compensation adjuster. The Division of Risk Management determines compensability of the claim, and pays medical bills and indemnity benefits to the injured employee. The Division of Risk Management adjuster is responsible for the handling of the claim. 33
Working to identify alternate-duty options is essential to controlling workers compensation costs. Alternate duties are defined as temporary duties established away from the employee s regular work area and responsibilities. Effective alternate duty speeds recovery time and enhances return to full duty. Modified duties are temporary duties established within the employee s regular position. Effective modified duty is temporary, progressive, and meaningful. Both alternate and modified duties must be within the functional limitations and restrictions outlined by the authorized workers compensation treating medical provider. In addition to lowering workers compensation indemnity, medical, and litigation costs, alternate duty can keep the recovering employee productive and close to his or her work team. 34
As we conclude our presentation, before we open the floor for questions, let s briefly review our objectives. We have: Defined state employees workers compensation. Identified who is covered under workers compensation. Discussed the process of reporting an injury/illness. Reviewed the different types of indemnity benefits. Covered the statute of limitations and how to handle legal correspondence. Reviewed the importance of reporting suspected fraudulent activity. Went over the basics of a Return-to-Work Program (RTW). 35
Are there any questions at this time? 36
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This completes today s presentation on workers compensation and the return to work program. 41