Transcript Slide 1

WORKERS COMPENSATION
Objectives
• Explain
–Purpose
–Employee responsibility
–Supervisor responsibility
–Procedure
What Is Workers’ Comp?
• Accident insurance program outlined in Florida
Statutes (F.S. 440)
• State of Florida is self insured
• Division of Risk Management administers WC
program
• OptaComp– Medical Case Management (2009)
Purpose
• Provide medical treatment/benefits to employees for
work related injuries to facilitate return to gainful
employment
• Provide, if appropriate
– Medical treatment/prescriptions
– Supplement wages
– Requirement of Light duty
– Reasonable travel costs for medical treatment
– Possible rehabilitation services (not required)
• USF provides 40 hrs. of disability leave (leave eligible
employees)
Who is Covered?
• Employees
– From 1st day of work
– Part time, temporary, student workers
• Volunteers providing services to
University
– Medical benefits only
What is Covered?
• Accidental work injuries
• Occupational diseases arising out of
employment
• Injuries that occur as a result of a new
accident while traveling to/from health care
provider for the purpose of treatment
• WC may be reduced by 25% if injury caused
by the knowing refusal to use safety gear or
observe safety rules
What is Not Covered?
• Employees engaging in social/recreational
events
• Employees coming to work or going home
(unless performing special duties required by
employer)
• Injury cased primarily by employee’s intoxication
or influence of non-prescribed drugs
• Employees hired as independent contractors
Employee Responsibilities
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Reports injury to supervisor immediately
Provide needed information
Follow OptaComp instructions
Sign/acknowledge forms from
OptaComp
Employee Responsibilities
• Follow treatment guidelines
– Go to doctor appointments/rehab
• Provide department/supervisor
documentation from doctor’s office
confirming visit or next appointment
• Inform department of any work restrictions
or when restrictions have been lifted
(reached MMI)
Employee Responsibilities
• Request Leave appropriate
• 40 hours of disability leave is
granted for leave eligible positions
• Leave can be used when going to
medical appointments/rehab
• Keep supervisor/department informed
Consequences
• Late Reporting
– May deny Workers Comp Case
• Knowingly file a false claim
– Punishable (Felony)
– Repayment
• Investigation – DSR routinely reviews cases
where it is not obvious the injury is job-related
Supervisor Responsibilities
• Call OptaComp and complete Supervisor’s
Accident & Investigation Form
• Oversee recovery of injured employee
– Approve leave
– Ensure employee provides documentation
• Provide a light-duty program, if needed
• Ensure timesheets are completed appropriately
Supervisor Responsibilities
• Coordinate Salary benefits (Pay Certs
notes) if appropriate
– Employee continues to accrue leave at
regular rate prior to injury even if in a cut pay
status
• Do not advise employee that accident is
or is not covered – up to DRM to
determine
• Correct safety hazard(s) if appropriate
Consequences
• Fine Due to Late Reporting
• Employee may be denied WC Benefits
Procedure
– Employee reports Injury to supervisor or
department designee
• If emergency, call 911
– Employee/supervisor calls OptaComp prior
to obtain medical treatment (non-emergency)
• OptaComp will assist in seeking an appropriate
medical provider (24/7, 365 days a year)
• Provide requested information
Procedure
Be prepared to provide following info to
OptaComp:
• Employee name, home address, phone, birth date, class
title, class code, location of accident, date/time and
description of accident, description of injury
• 4-digit location code
– Location code based on funding category of USFSP employee
• E&G - 0283
• Auxiliary - 0297
• Contract/Grants – 0298
• Local funds – 0299
Procedure
• Social Security Number
Required for OptaComp (F.S. 440)
• Submit Supervisor’s Accident Investigation Report to
USFSP HR within 24 hours of accident (USFSP HR will log in
and forward to Tampa HR)
• Forward/copy all incoming documentation to USFSP HR
for monitoring
•
EH&S may visit to review area and/or require safety
improvements
Procedure
• Reminder - Accident/Injury should be reported
immediately
– Employee has two years from date of injury to file a
claim
Wage Loss
• First 7 Calendar days –
– State/University employees receive 40
hours of disability leave
– OPS employees receive disability
payment for first 7 days only after 21
days of disability.
Wage Loss
• If employee has not been able to return to the
workplace (must be certified by physician)
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On 8th day, employee is eligible for Wage Loss
66 2/3 salary of pre-injury wages (up to max)
Based on average of previous 13 weeks
Second job could be counted
Employee may use 2.7 hours of leave to keep them
at 100% pay
– Certify and make note in Pay Certs
Wage Loss
• University will continue payment of employer
premiums
• Employee must continue payment of
employee premiums
– If leave doesn’t cover employee portion, employee
must make other arrangements
Recap
• Workers Comp – State regulated insurance to
provide benefits to employees who sustained a
work related injury/illness
• OptaComp – Medical Case Management
• Employee should document any injury
• Employee should follow all OptaComp
instructions
• Employer needs to provide light duty if at all
possible in order to facilitate back to work