Workers’ Compensation For State Agencies

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

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

3. Expected Workshop Goals SAVE TIME MONEY

4. Expected Workshop Goals Reduce some of the stress associated with workers’ compensation

5. ORM Workers’ Comp Statistics 6100 active workers’ compensation claims Approximately 1000 of these paid compensation benefits on regular basis

6. ORM Workers’ Comp Statistics $48 million spent on workers’ compensation Money comes directly from agency budgets

7. WORKERS’ COMPENSATION IS THE LAW! • Title 23 Louisiana Revised Statutes • Employers MUST provide workers’ compensation coverage for all employees • IW’s have the RIGHT to file a claim

8. 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

9. Office of Workers’ Compensation Administration (OWCA) • Governing body that ensures the workers’ compensation statute is properly administered. • State agency housed under the Department of Labor • Judicial Authority • Issue Mediation Notices and Citations

10. Who should respond to OWCA Mediations and Citations? IW’s can file a disputed claim with Office of Workers’ Compensation ORM will respond to these on agency behalf Notify ORM adjuster when receive mediation notices and citations

11. Who Can Receive Workers’ Compensation? Anyone employed in the State of Louisiana who is injured on the job Coverage begins the moment employment begins Covered accidents must • arise out of employment • occur during course and scope of employment

12. What benefits are provided under Workers’ Compensation? IW may be entitled to medical benefits at the expense of his employer

13. What benefits are provided under Workers’ Compensation?

14. What doctor can an IW seek treatment from? • Choice of physician in each field of specialty • Approval needed to exceed $750.00 of non-emergency medical treatment • Failure to obtain approval may result in non-payment of bills in excess of $750.00

15. Can an employer have an IW examined by doctor of its choosing? • Employer or insurer has right to have IW examined from time to time during the course claim • Failure to comply with exam may result in suspension of benefits until exam takes place • Suspended period not recoverable

16. Who’s going to pay for this? • Employer can give verification of initial medical treatment up to $750.00 of non-emergency treatment • Notify the adjuster of what’s been approved

17. Who’s going to pay for this? • IW should NEVER pay out-of-pocket for medical services or use personal insurance to pay for medical expenses that result from a work related accident.

18. How long does IW have to file a claim for medical benefits? Claims for medical benefits must be filed within 1 year from date of accident Period for medical benefits is 3 years from date of last payment

19. What benefits are provided under Workers’ Compensation? IW may be entitled to income benefits at the expense of employer

20. What benefits are provided under Workers’ Compensation? Provisions for • Surviving spouse • Dependent children or • Surviving parents in the event of work - related death.

21. What benefits are provided under Workers’ Compensation? Surviving spouse and dependant children • Entitled to weekly benefits Surviving parents • Lump sum • $75,000 each if • No surviving spouse • No dependent children $7500 burial expense

22. How long does IW have to file a claim for indemnity benefits? • Claims for weekly benefits must be filed within 1 year from date of accident • Weekly benefits open 1 year from date of last payment • 3 years from date of last payment for SEB

23. 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.

24. CIVIL SERVICE RULE 11.21 Questions about leave with respect to workers’ compensation should be directed to Civil Service

25. Exclusive Remedy • An IW cannot sue his employer in tort or for negligence, unless • Employer intentionally tried to harm the IW

26. When should IW report an accident? Injured workers must notify immediate supervisor • as soon as an accident occurs

27. What should the supervisor do when an accident is reported? Supervisor immediately initiates paperwork for E-1 to be sent to ORM • Paper • Electronically

28. When should ORM be notified of an accident? Please notify ORM immediately of all accidents • 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 date employer notified of accident

29. DON’T DROP THE BALL! DO NOT deny employees the right to file a claim • Increased litigation exposure • A filed claim does not mean a paid claim

30. Incidents Not Covered

31. Incidents Not Covered IW intentionally injures himself or another employee

32. Incidents Not Covered IW deliberately failed to use adequate protection provided

33. Incidents Not Covered IW intoxicated at the time of the accident -alcoholic beverages -Rx -OTC -illegal narcotics Burden of proof on employer

34. Incidents Not Covered IW who is proven to be the aggressor unprovoked altercation

35. Incidents Not Covered Injuries resulting from Horseplay

36. Incidents Not Covered Incidents which arise out of purely personal matters

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

38. “Gray” Coverage Areas

39. “Gray” Coverage Areas Mental stress

40. “Gray” Coverage Areas Heart attacks Strokes

41. Gray” Coverage Areas Clear and convincing evidence that these are • Sudden • Unexpected • Extraordinary • Related to the employment Cannot be related to • Any other health condition • Personal situation

42. Are volunteers and community service workers covered for Workers’ Compensation? • Covered for medical payments only • Community service must be ordered by State court

43. When is IW entitled to receive WC Benefits? Eligibility to receive WC lost time benefits begins when injury prevents IW from RTW for more than 7 calendar days 7 day waiting period Benefits payable on 8th day 1st 7 days not recoverable • unless IW loses more than 42 calendar days

44. When is the first indemnity check due? Comp checks are due 14 days after employer notified of accident

45. How are weekly benefits calculated? Based on 66 2/3 % • average weekly wage (AWW) • up to maximum (Maximum is $454.00)

46. How are weekly benefits calculated? If a worker earns less than the minimum • actual wage is comp rate Maximum and minimum • change every September 1st Wages locked according to date of accident • in most cases

47. How are indemnity benefits initiated? To initiate benefits • Adjuster enters benefit record when claim setup OR • When lost time begins

48. WHEN ARE CHECKS PRINTED? INDEMNITY BENEFIT RECORD • Updated every other Monday • Checks generated every other Monday night or • Nearest date to regular pay day if holiday

49. WHEN ARE CHECKS MAILED? EVERY OTHER TUESDAY

50. Where is the indemnity benefits check mailed? Usually mailed to agency or region of employment Must be mailed directly to injured worker if requested