Workers’ Compensation for State Agencies

1. Workers’ Compensation forState Agencies Office of Risk Management Karen C. Jackson, Facilitator

2. Expected Workshop Goals Develop a better understanding of the workers’ compensation process.

3. Expected Workshop Goals Save Time Money

4. ORM Workers’ Comp Statistics 5500 active workers’ compensation claims. Approximately 1200 of these paid lost time benefits on regular basis.

5. ORM Workers’ Comp Statistics $48 million spent on workers’ compensation.

6. Overview of Workers’ Compensation Title 23 Louisiana Revised Statutes requires all employers to provide workers’ compensation coverage for their employees.

7. Overview of Workers’ Compensation IW have the RIGHT to file a claim. Let us decide if it’s a claim.

8. Overview of Workers’ CompensationR. S. 23:1031.A Anyone employed in the State of 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.

9. 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.

10. Overview of Workers’ CompensationR. S. 23:1203 / R. S. 23:1221 IW may be entitled to medical and/or indemnity benefits at the expense of his employer.

11. Overview of Workers’ CompensationR. S. 23:1231 Provisions for • surviving spouse • dependent children or surviving parents in the event of work - related death.

12. Notice of AccidentR. S. 23:1302 Injured workers must notify supervisor as soon as an accident occurs.

13. 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.

14. 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.

15. Online Access To request access to STARS online reporting: www.doa.Louisiana.gov/orm Quick Links section ORM Data Liaison Application/change form

16. 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 from the date employer aware of accident.

17. 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.

18. Volunteers and Community Service Workers Covered for medical payments only.

19. 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.

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

21. Incidents Not Covered

22. Incidents Not CoveredR. S. 23:1021(1) IW intentionally injures himself.

23. Incidents Not CoveredR.S.23:1081.1.b IW intoxicated at the time of the accident.

24. 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 or illegal narcotics.

25. Drug Screening Post-accident drug screening paid in conjunction with the workers’ compensation claim.

26. Incidents Not CoveredR. S. 23:1081.1c IW who is proven to be the aggressor in an unprovoked altercation.

27. Incidents Not CoveredR. S. 23:1031D Injuries resulting from horseplay.

28. Incidents Not CoveredR. S. 23:1031E Incidents which arise out of purely personal matters.

29. Incarceration and WCR. 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.

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

31. “Gray” Coverage Areas

32. “Gray” Coverage AreasR. S. 23:1021(7)(b) Mental stress

33. “Gray” Coverage AreasR. S. 23:1021(7)(e) Heart attacks Strokes

34. “Gray” Coverage AreasR. S. 23:1021(7) Clear and convincing evidence that these are • sudden • unexpected • extraordinary • related to the employment. Cannot be related to • any other health condition • personal situation.

35. “Gray” Coverage Areas It May Be Covered

36. Social Activities

37. Social Activities Questions to Ask • Did employer sponsor the event? • Did employer require employee attendance or participation? • Was employee paid for attending? • Did the employer finance the event? • Did the employer benefit through improved morale and/or good will?

38. 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.

39. 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.

40. 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.

41. 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.

42. 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.

43. Special Mission for Employer Employees on a special mission are within the course of employment from “portal-to-portal” or from home to the location of the mission or from the location of the mission to home.

44. 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.

45. 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

46. 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.

47. Workers’ Compensation Benefits

48. Choice of PhysicianR. S. 23:1121(B)(1); R. S. 23:1142(B) By specialty. $750 of non-emergency treatment. Failure to obtain approval may result in non-payment of bills in excess of $750.

49. Examination of Injured WorkersR. S. 23:1123-1124 Employer or insurer has right to have IW examined from time to time during the course of the claim.

50. Who’s going to pay for this? Employer can give verification of initial medical treatment up to $750 of non-emergency care.