OVERVIEW OF THE NORTH CAROLINA STATE GOVERNMENT WORKERS’ COMPENSATION PROGRAM

1. OVERVIEW OF THENORTH CAROLINA STATE GOVERNMENT WORKERS’ COMPENSATIONPROGRAM Prepared by Lou Kost Office of State Personnel October 2012

2. MISSION OF WC PROGRAM • The mission of the State Government WC Program is to ensure ethical and equitable treatment of injured employees in a cost efficient manner.

3. ADMINISTRATION OF WORKERS’ COMPENSATION • Workers’ Compensation Act • (G.S. Chapter 97) • North Carolina Industrial Commission • (Administrative Rules) • State Government Workers’ Compensation Program • (State Personnel Policy)

4. WC ADMINISTRATION POLICY • REFUSAL OF COVERAGE • RETURN TO WORK • REFUSAL OF SUITABLE EMPLOYMENT

5. WC LEAVE POLICY • Full Salary Day of Injury • Leave Options - Waiting Period • Use sick or vacation leave • Leave without pay • No leave for medical visits during scheduled work hours

6. WC LEAVE POLICY • SUPPLEMENTAL LEAVE • Use leave earned prior to injury • Purpose: Combined amount close to net pay • Annual schedule published by OSP

7. WC LEAVE POLICY • CONTINUATION OF BENEFITS • VACATION/SICK LEAVE • HEALTH INSURANCE • LONGEVITY • REINSTATEMENT SALARY • NO RETIREMENT SVC. CREDIT

8. WC PROGRAM RESPONSIBILTIESCORVEL • OVERALL CASE MANAGEMENT • PAYMENT OF MEDICAL BILLS • COMPENSATION PAYMENTS • INFO MANAGEMENT & REPORTS

9. WC PROGRAM RESPONSIBILTIESCOLLEGE~AGENCY~UNIVERSITY • COMMUNICATIONS: • EMPLOYEES * SUPERVISORS • MANAGEMENT * ADJUSTER • DIRECT INITIAL MEDICAL TREATMENT • RETURN TO WORK PROGRAM • REPORT REVIEW • TIMELY PAYMENTS TO WC FUND & TPA

10. WC PROGRAM RESPONSIBILTIESATTORNEY GENERAL • WC Section ~ 8 Attorneys • Partner with CorVel & WC Administrator • Attorney of the Week – General Questions • Represent the State in WC Litigation • Settlements • Mediations • NCIC Hearings • Civil Court Appeals

11. WC PROGRAM RESPONSIBILTIESSTATE CONTROLLER • ADMINISTRATION OF WC FUND • COORDINATION WITH TPA & STATE TREASURER • COORDINATION OF TPA INVOICES & AGENCYREIMBURSEMENTS

12. WC FUND • ADMINISTERED BY OFFICE OF STATE CONTROLLER • ANNUAL REVIEW OF BALANCE • MONTHLY REIMBURSEMENT • CHECK SUMMARY=CLAIM PAYMENTDOCUMENTATION

13. “TPA FEE” • ADMINISTERED BY OFFICE OF STATE CONTROLLER • FEE TO CORVEL FOR CLAIMS ADMINISTRATION • SPECIFIC FEE SCHEDULE AND CRITERIA • TPA FEE DETAIL REPORT= DOCUMENTATION

14. PRE-CLAIM PREPARATION MEDICAL TREATMENT • Select provider(s) from CorVel PPO List • Link PPO List to Internal WC Website • Print for posting in field • Emergencies to nearest facility

15. PRE-CLAIM PREPARATION SUPERVISOR GUIDE • Correct unsafe conditions • Refer to CorVel Preferred Provider • Forms for reporting accident/injury – Med. Auth RX forms • Name & phone # of: • WC Administrator • Safety Officer • Adjuster

16. PRE-CLAIM PREPARATION EMPLOYEE GUIDE • Go To Preferred Provider • Forms for reporting accident and selecting leave option • Name & phone number of WC Administrator • Note that absence must be authorized by Dr. statement

17. MANAGER/SUPERVISOR RESPONSIBILITIES • Required Documentation • Employer Report of Injury (Form 19 or via CareMC) • Supervisor Accident Investigation • “Employee Statement and Leave Options Form”

18. MANAGER/SUPERVISOR RESPONSIBILITIES • Report injury to WCA ~ 24 Hours • Assist TPA with claim investigation • Identify Transitional Duty • Maintain Contact with Employee • Communicate return to work/out of work activity to WCA immediately

19. LIABILITY DETERMINATION • Employer/employee relationship • Injury arose out of employment • Injured in course of employment • Injury caused by accident • Backs/Hernias • Occupational Diseases

20. WORKERS’ COMPENSATION CLAIM TYPES • MEDICAL ONLY • NO LOST TIME COMPENSATION • LESS THAN $2000 MEDICAL COST • INDEMNITY • DISABILITY COMPENSATION PAID

21. BENEFITS • All Authorized Medical Costs • Pharmaceuticals • Mileage Reimbursement • Disability Costs • 7 Day Waiting Period (can be non-consecutive) • Temporary Total Disability (TTD) • Temporary Partial Disability (TPD) • Permanent Partial Disability (PPD) • Permanent Total Disability (PTD) • Weekly Benefit = 66 2/3 of average weekly wage (of previous 52 weeks per FORM 22) Annual Maximum set by NCIC (2012 = $862)

22. Legislative ChangesMost effective with new claims eff. 6/24/2011 • 500 Week Cap on TTD • Extended TPD & Death Benefits from 300 to 500 weeks • Burial Expense increased from $3500 to $10,000 • PTD may now include severe burns, spinal & head injuries • New law governing Vocational Rehabilitation Procedures • Employers given “reasonable access” to medical information • Written communication with medical providers allowed without authorization of employee when additional information needed (Employee must be copied) • Employer may give provider relevant additional medical information with consent of employee • “Suitable employment “formally defined • Changes in composition of Industrial Commission

23. WC PROGRAM INTERACTIONS • ADA • FMLA • DISABILITY INCOME • RETIREMENT

24. SETTLEMENTS • Aka “Clinchers” – Closes Out the Claim • Adjuster Negotiates/Recommends • AG Attorney Negotiates/Approves • Agency Authorizes & Pays • Only AG Rep Communicates With Plaintiff & Attorney when Case in Litigation • Employee must usually separate • Over $75,000 – Special Deposit • Consider Medicare Set-a-side

25. RETURN TO WORK • Benefits Employees and State • Entire School-wide Effort • Transitional Duty

26. Return To Work Is: • A proactive process, where early intervention is the key • Opportunity to prevent “learned disability” • An opportunity to control the personal and economic costs of workplace injury and disability • Empowerment of both the employee and management to have mutual responsibility

27. Reduce direct disability costs: • $75 million paid in WC costs in 2011-12 • $27.6 million was for lost work time compensation

28. Reduce indirect disability costs: • Continuing other benefits • Continued and escalated medical costs • Recruitment & Training Costs • Disability Income and Disability Retirement Costs • Overtime • Reduced productivity

29. Statistical Reasons for RTW • 75% of Employees return to the workforce if out of work less than 30 days • 50% of Employees will return to the workforce if out of work 6 months • 25% of Employees will return to work if out of work 1 year

30. SUMMARY • DIRECT MEDICAL CARE • COMMUNICATE • EMPLOYEES • SAFETY OFFICER • WC ADMINISTRATOR • CORVEL ADJUSTER • RETURN-TO-WORK

31. RESOURCES • NC Industrial Commission • www.comp.state.nc.us • OSP Programs & Services www.osp.state.nc.us • CorVel www.corvel.com • OSP WC Program Manager lou.kost@osp.nc.gov