Transcript Disability Training - Health human resources

Workers’ Compensation
UCLA Health System
1
Who is eligible?
• Career, casual, Per Diem employees are covered from
the first date of employment
• Vanpool injuries
• Non-UCLA employees are covered by their respective
employers, e.g. Traveler’s, Registry, other temporary
workers
• Volunteers
2
Initial Employee Contact
• Was this injury work related?
• If
the employee believes it was work-related or is unsure,
provide Workers’ Compensation forms and direct the employee
to seek immediate medical treatment at either Occupational
Health Facility or the UCLA Emergency Department
• Employee
should tell the UCLA Emergency Department that they
are a UCLAMC employee and that they are being treated for a
work-related injury
• Follow
•
all procedures for a leave of absence
Where to send the employee for treatment?
Employee should be seen by Occupational Health Facility or the
UCLA Emergency Department for the first 30 days
3
Cal-OSHA
In case of Serious Injury or DEATH or if an employee is hospitalized:
Page the Health System Safety Department pager 90248
immediately or call the Campus 24-hour call-in phone number
EH&S Hotline: 310-825-9797
Call Health System Safety Department (310) 825-4012 for any
follow-up
OSHA requires notice within 8 hours of Serious Injury
Serious Injury is:
Death
Amputation
Fracture
Burn
Concussion
Crushing injury
Laceration with stitches or significant bleeding
Hospitalization beyond Observation
4
WHEN AN EMPLOYEE IS INJURED ON THE JOB...
Provide the employee with:
1. A completed Workers’ Compensation Claim Form (DWC-1) and
Notice of Potential Eligibility
This form must be provided within 1 working day of notice that an injury
or illness has occurred as mandated by California state law. (Exception:
First Aid incidents)
2. A completed UCLA Incident Report and Referral for Medical
Treatment
3. Workers’ Compensation Information Sheet
(SEE HANDOUT FOR LINE BY LINE INSTRUCTIONS)
5
WHAT TO DO WITH THE PAPERWORK?
1. Please review and complete all lines. Sign where appropriate.
The person to whom the injury is reported should sign all forms where indicated
2. Department keeps one copy for department records.
If notification was by phone, mail the form to the employee. Certified mail is
advisable as proof of mailing.
3. Immediately:
1.
FAX a copy of the completed form to the WC FAX line Health System HR 310 794 3337 or
2.
EMAIL to [email protected] or
3.
CALL 877-6UC-RPRT (877-682-7778) with the information on the form (see Step #5)
4. Employee keeps one copy of completed form.
5. Send all other copies of the form immediately to Health System HR for further
distribution.
6. Notify Health System HR Workers’ Comp x40500 as soon as you know an
employee has been taken off work.
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WORKERS’ COMPENSATION PROCESS
Employee notifies supervisor that a work-related incident has happened.
Supervisor provides UCLA Incident Report and Referral for Medical Treatment
form and directs Employee to Occupational Health or the Emergency Medicine
Center for medical treatment.
Medical Treatment is provided. Medical provider completes a Work Status slip.
Employee gives Work Status slip to Supervisor immediately.
IF EMPLOYEE WAS SEEN AT THE EMERGENCY ROOM, direct employee to
follow-up at UCLA Occupational Health.
If treatment is beyond First Aid
- Employer provides Workers’ Compensation Claim Form (DWC 1) within 1
working day of injury or knowledge of injury
- Employee signs Workers’ Compensation Claim Form (DWC 1) and returns it to
Department or Health System HR
7
Claims Process
Sedgwick CMS (Third Party Administrator or TPA) makes 3-point contact: with Employee, with
Supervisor, and with Medical Provider
Return all phone calls from Sedgwick CMS as soon as possible.
Employer may investigate an incident. The law allows up to 90 days to delay a decision on
compensability. If the claim form was provided and returned timely, medical treatment
will be provided up to $10,000 during the decision process
TPA reviews the claim and determines what benefits the employee should receive. TPA
notifies the employee by mail and by phone whether claim is accepted, delayed, or
denied.
If the injury is delayed or denied and the employee is taken off work by a medical provider,
employee should file for disability benefits.
COMPLETE THE ONLINE LEAVE OF ABSENCE NOTIFICATION ON THE HR
WEBSITE
If the injury is approved as work related and the employee is taken off work by a medical
provider, the employee will receive a temporary disability check from TPA.
Health System HR WC contacts the employee about WC Options via phone or letter
to the employee and also notifies the department EDB preparer.
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Work status, work status, work status!
Part One – Temporary Restrictions
Department is responsible for their employee -Employee must provide manager/department with updated medical disability slips
prior to returning to work and throughout the leave.
WHEN THE MEDICAL PROVIDER DETERMINES THAT THE EMPLOYEE
HAS TEMPORARY WORK RESTRICTIONS –
• OHF or Workers’ Compensation Provider gives the employee a work status slip with
any medical restrictions and the approximate duration
• Employee immediately gives work status slip to supervisor
• Supervisor finds temporary transitional modified duty assignment compatible with
medical restrictions for up to 90 calendar days
• Employee should have restrictions updated by OHF or Workers’ Compensation
Provider within 45 calendar days or earlier if appropriate.
• If the department/supervisor does not have modified duties available, supervisor must
contact the Return to Work Coordinators for possible placement elsewhere
• If the employee refuses the assignment all temporary disability payments may cease
If employee feels at any time that he/she cannot work due to the workrelated injury, direct employee back to their Workers’ Comp medical
provider immediately to get medical certification of time off.
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Important Information
Employees should be paid for the time at OHF/EH and/or the
EMC (to complete the work shift.)
Charge hours to Home Cost Center
Employees must use SL for any time at off-site (non-OHF/EH or
EMC) appointments, and for time taken for therapy,
diagnostic appts
Charge hours to Home Cost Center
Employee may return to temporary work on a modified work
schedule or modified duties at any time.
Charge actual Modified duty hours worked as ‘Modified Duty
Workers’ Comp’and to the Return to Work Cost Center.
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Who is eligible to use Cost
Center/Paycode?
Open WC claim
Work restrictions are:
Temporary AND
Restrict one or more regular job duties (performed at least once
weekly) and/or at least one essential function of the job AND
Documented by Medical Provider with a start and end date to
the work restrictions
Employees working in a modified assignment related to a non-work
related injury or illness are not eligible to utilize these cost centers.
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RTW Cost Center/Paycode Procedure
1. Determine if the employee meets criteria. Health System
HR/Return to Work coordinators will provide requesting
manager/supervisor with the cost center number.
2. Record the hours worked by the employee on HBS using pay
code MDH ‘Modified Duty Workers Comp’ when the hours
meet the above criteria for the dates indicated on the work
status note
3. Perform ‘Lookup’ function for the cost center and charge the
hours to the appropriate Modified Duty Cost Center
4. BOTH the pay code and the Cost Center must be used
together
12
Contacts for Return to Work Program
Contact Health System HR Workers’ Compensation/
Return to Work coordinators to confirm employee meets
eligibility criteria
Health System Human Resources WC
310 794 0500
Mark Briskie
[email protected]
310 794 0525
Cynthia Vazquez
[email protected] 310 794 0522
Ingrid Garcia
[email protected]
310 794 3036
Return to Work Coordinators
Mark Briskie
[email protected]
310 794 0525
Suzanne Bleibtreu [email protected]
13
Leave of Absence Procedure – 3 day
Waiting Period
If the employee is taken off work completely by the Workers’ Comp Medical
Provider,
a 3-day waiting period may apply before WC benefits are paid -The employee must use his/her sick leave for first three (3) calendar days of
the leave only.
3-day Waiting Period -For 12-hour employees, up to the first 24 scheduled
work hours within the first 3 calendar days
Employee may request the use of VAC/HOL/COMP if wishes to receive full pay
for the 3-day waiting period.
If the employee does not have enough sick leave to cover the 3-day waiting
period, the employee is entitled to receive 80% of his/her regular salary
through the 80%Extended Sick Leave benefit. Notify Health System HR
WC if the employee does not have enough sick leave and wants to
access this benefit.
Record no sick leave/vacation on timesheet after waiting period.
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Leave of Absence Procedure – Beyond
Waiting Period
If the employee’s leave continues past the 3-day workers’ comp waiting period, direct the
employee to submit an online Leave of Absence Notice at the Health System HR
website http://hr.uclahealth.org/body.cfm?id=145
•
Employee can also find additional information regarding the WC leave of absence.
•
Employee should review the COMPARISON OF PAYMENT OPTIONS and contact Human Resources,
Workers’ Compensation coordinator Cynthia Vazquez/Ingrid Garcia, at (310) 794-0500.
•
WC leave may qualify employee for FMLA leave
•
If the employee is eligible for FMLA, employee will be on a FMLA leave first, then a WC leave if claim was
approved
Online Leave of Absence - Workers’ Compensation Pending
Indicate the last day on pay status using sick leave (or other requested accruals) for the 3-day
Waiting Period only
Email the 4-digit leave code that is generated to the HR Representative to begin the process
Notify EDB preparer as you receive updated work status slips from the Medical Provider throughout
the course of treatment so that HR Representative can update Leave of Absence
Notify EDB preparer when the employee returns from leave so HR Representative can update and
close the Leave of Absence file
15
WC Options – to supplement WC
benefits
This process is manual and handled through the HR Rep, Payroll and Health System
HR offices.
This significantly impacts the employee’s health and welfare benefits.
Please have the employee review and contact HS HR Workers’ Comp
unit to elect a WC Option.
Option 1
Employee elects to receive only the workers’ comp TTD check
Employee will be billed for health and welfare benefits as applicable
Option 2
Employee elects to use sick leave only to supplement the workers’ comp TTD
check
Health and welfare benefits contributions are taken on regular paydays
Option 3
Employee elects to use sick leave and vacation time to supplement the workers’
comp TTD check
Health and welfare benefits contributions are taken on regular paydays
Leaves must be updated regardless of which WC Option is chosen
Work status, work status, work status!
Part Two – Permanent Restrictions
Department is responsible for their employee -Employee must provide manager/department with updated medical disability
slips prior to returning to work and throughout the leave.
WHEN THE TREATING PHYSICIAN DETERMINES THAT THE EMPLOYEE HAS
PERMANENT WORK RESTRICTIONS WHICH MAY AFFECT EMPLOYEE’S
ABILITY TO PERFORM ALL OR PART OF HIS/HER JOB DUTIES –
•
Contact the Employee Disability Manager Mark Briskie immediately to advise of
the permanent work restrictions.
•
Consider whether you can permanently modify the employee’s job duties to
accommodate the restrictions OR
•
If there is permanent alternate work in the department to accommodate the
restrictions
•
Document all discussion with employee regarding accommodation
An offer of medically appropriate work must be sent to the injured employee within 30
days of the termination of TD payments.
Employees may use any available accruals to return to pay status while
accommodations are discussed
17
Injury Prevention resources
Health System Safety
SAFETY INSPECTIONS/TRAINING
ERGONOMIC EVALUATION
ACCIDENT INVESTIGATION COORDINATION
Erik Eggins
[email protected]
310-825-4012 phone
310 794 7956 fax
PAGER 90248
Ergonomic Evaluation Request Form
on HR website
http://hr.uclahealth.org
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Directory
SEDGWICK CMS
P.O. Box 14533
Lexington KY 40512-4533
Mail code 691448
Phone
310 253 7500
Fax
310 253 7569
CAMPUS PAYROLL
UCLA Wilshire Center, Suite 620
MC 141648
Phone
310 794 8706
Fax
310 794 8751
UCLA HEALTHCARE PAYROLL
UCLA Wilshire Center, Suite 1700
MC 167646
Phone
310 794 0127
Fax
310 794 8049
OCCUPATIONAL HEALTH FACILITY
(OHF)
67-120 Center for Health Sciences
Monday through Friday
7:00 a.m. to 4:30 p.m.
Mail Code 172524
Phone
310 825 6771
Fax
310 206 4585
www.ohs.uclahealth.org
EMERGENCY DEPARTMENT
757 Westwood Plaza
(ER entrance Gayley Ave, north of Le
Conte)
Phone 310 267 8406
Open 24 hours a day
SMH Emergency Room
Phone
310 319 4765
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Other Information
Health System Policy
HS 7318
EMPLOYEE WORK-RELATED ILLNESS AND/OR INJURY
http://www.mednet.ucla.edu/Policies/pdf/enterprise/HS7318.pdf
Required WorkPlace posting DWC 7
Notice to Employees – Injuries Caused By Work
HR Website http://hr.uclahealth.org
New Employee Pamphlet
Distributed at time of Hire by HR Rep
Pre-designation of Physician form
HR Website http://hr.uclahealth.org
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Health and Welfare, Other benefits
Sick leave and vacation accruals
Retirement Accruals
• WC Options
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OPTION 1
If FMLA eligible, the employee will be on a FMLA Leave Without Pay
If not eligible for FMLA, the employee will be on Workers’ Comp Leave
Without Pay
Employee is fully responsible for insurance contributions according to the
FMLA guidelines.
Employee must make employee contribution for health.
Benefits Office will notify the employee directly regarding all benefits which are
not paid for by FMLA.
Employee will also need to pay directly for health, dental, and vision once the
12 weeks of FMLA exhaust.
Employee is eligible to accrue full sick leave and vacation while on Option 1
but accruals are awarded only upon Return to Work.
Employee does not earn service credit while on Option 1.
Upon return to work, should contact Benefits Office to initiate service-credit buy-back if
applicable
OPTION 2
If FMLA eligible, the employee will be on FMLA Leave With Pay
If not eligible for FMLA, the employee will be on Workers’ Comp Leave With Pay
Employee’s regular contributions for insurances, parking, 403(b), and other voluntary
deductions are taken from supplemental pay.
Employee’s own contribution for health and other insurances is deducted following
normal payroll process.
All contributions remain the same unless employee elects to make a change, e.g. cancels
Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes
insurances or covered members.
Employee is eligible to accrue full sick leave and vacation while on Option 2 AND sick
leave accruals are used as accrued
Once the employee’s own sick leave exhausts, the employee is eligible to receive
80% Extended Sick Leave benefit.
Employee earns service credit at 100% of % appointment while on Option 2.
OPTION 3
If FMLA eligible, the employee will be on FMLA Leave With Pay
If not eligible for FMLA, the employee will be on Workers’ Comp Leave With Pay
Employee’s regular contributions for insurances, parking, 403(b), and other voluntary
deductions are taken from supplemental pay.
Employee’s own contribution for health and other insurances is deducted following
normal payroll process.
All contributions remain the same unless employee elects to make a change, e.g. cancels
Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes
insurances or covered members.
Employee is eligible to accrue full sick leave and vacation while on Option 3 AND sick
leave and vacation accruals are used as accrued
Once the employee’s own sick leave and vacation exhausts, the employee is eligible
to receive 80% Extended Sick Leave benefit.
Employee earns service credit at 100% of % appointment while on Option 3.
80% Extended Sick Leave
If FMLA eligible, the employee will be on a FMLA Leave With Pay
If not eligible for FMLA, the employee will be on Workers’ Comp Leave With Pay
Employee’s regular contributions for insurances, parking, 403(b), and other voluntary
deductions are taken from supplemental pay.
Employee’s own contribution for health and other insurances is deducted following
normal payroll process.
All contributions remain the same unless employee elects to make a change, e.g. cancels
Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes
insurances or covered members.
Employee is eligible to accrue full sick leave and vacation while on 80%Extended Sick
Leave but accruals are awarded only upon Return to Work
Employee earns service credit at 80% of % appointment while on 80% Extended Sick
Leave.
Upon return to work, should contact Benefits Office to initiate service-credit buy-back if applicable
After 80% Extended Sick Leave
Employee will be on a WC Leave Without Pay until Return to Work with or without
given Permanent Restrictions
Employee may apply to Liberty Mutual for the Employee-Paid Supplemental Disability
to supplement the WC checks.
Health Insurance coverage may continue -UC Regents will continue to pay the employee’s full health benefits (Employee and University
contribution) via the Health Contingency Fund while the employee continues to receive temporary
disability payments AND has not been separated.
Employee is eligible to accrue full sick leave and vacation while on receiving WC TTD checks but
accruals are awarded only upon Return to Work
Employee must make payment for all other insurances and Benefits that he/she
wishes to keep current
Benefits will coordinate direct payment of premiums for all other benefits with employee.