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DANNA CORBELL PROGRAM ANALYST (VACO) MARK BAUMANN WC SPECIALIST VISN 9 My Employee is Injured..Now What?

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Presentation on theme: "DANNA CORBELL PROGRAM ANALYST (VACO) MARK BAUMANN WC SPECIALIST VISN 9 My Employee is Injured..Now What?"— Presentation transcript:

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2 DANNA CORBELL PROGRAM ANALYST (VACO) MARK BAUMANN WC SPECIALIST VISN 9 My Employee is Injured..Now What?

3 Course Description Provide an overview of the fundamentals involved in the initial management of a workers’ compensation claim. Clearly define the roles and responsibilities of the supervisor and the employee when an injury occurs. Specifically address the actions required to ensure injured workers receive all benefits to which they are entitled and concurrently protect the interests of the agency. 3

4 Objectives Identify the appropriate response and action to be taken by a supervisor when an employee is injured on the job Understand the importance of timely filing of claims Understand how to determine the employee’s duty status and appropriate leave status Understand the importance of accident investigation Understand the involvement of other parties in responding to the injury 4

5 Injury Reporting Flowchart My Employee has been Injured… Now What? 5

6 Injury Reporting Flowchart During Normal Working Hours Employee experiences an occupational injury or illness- What is the difference between an injury and an illness? Employee immediately reports injury or illness to supervisor Does employee require emergency treatment? Yes or No? 6

7 Employee Requires Emergency Treatment Employee and supervisor reports immediately to Emergency Department for medical evaluation and/or treatment, for an injury only. Supervisor creates Incident Report and completes the Incident Report based on supervisor’s investigation of the accident. If employee elects to file for Workers Compensation, employee completes the CA-1 or CA-2 with supervisor assistance. Then supervisor completes the supervisor section of the CA-1 or CA-2. 7

8 Employee Does Not Require Emergency Treatment Supervisor creates Incident Report and completes the Incident Report based on supervisor’s investigation of the accident. Employee and supervisor report to Occupational Health Section for medical evaluation and/or treatment if the employee requests treatment, for an injury only. If employee elects to file for Workers Compensation, employee completes the CA-1 or CA-2 with supervisor assistance. Then supervisor completes the supervisor section of the CA-1 or CA-2. 8

9 Injury Reporting Flowchart After Normal Working Hours, Weekends and Holidays Employee experiences an occupational injury or illness Employee immediately reports injury or illness to supervisor 9

10 Injury Reporting Flowchart Employee and supervisor report to the Emergency Department for medical evaluation and/or treatment if the employee requests treatment, for an injury only. Supervisor creates Incident Report and completes the Incident Report based on supervisor’s investigation of the accident. 10

11 Injury Reporting Flowchart If employee elects to file for Workers Compensation, employee completes the CA- 1 or CA-2 with supervisor assistance. Then supervisor completes the supervisor section of the CA-1 or CA-2. Can the supervisor direct the employee to file a claim? 11

12 Scenario Your employee is walking into work at 6:50 am. The employee’s shift doesn’t start until 7:15 am. While walking across the grass, the employee steps in a hole, twist their ankle and can barely make it into work. They report to your office and inform you of what happened. What are the steps that you will take in order to assist your employee with their injury? 12

13 GROUP EXERCISE 13

14 Medical Care Your employee reports an injury today that he alleges occurred 3 days ago. This employee has filed multiple claims with lost time. The employee requests leave to seek medical care. As the supervisor you instruct the employee to report to Occupational Health for examination by the OH physician prior to leaving the facility. Is this action appropriate? Why? Should a CA-16 be issued? 14

15 Timely Filing Your employee reports an injury at the end of tour prior to the start of your AL the next day (of course!). You realize that your leave will only last for 10 workdays, so you put in a call up to complete the CA-1 or CA-2 on the morning of your return from leave. Will the CA form be submitted timely to OWCP? 15

16 CA-1 or CA-2? Your employee states that an injury occurred due to lifting boxes over a few days last week. When informed that COP is not payable for occupational disease, the employee states that the pain began at 10:00 on Tuesday (last week) after lifting boxes. The employee requests a CA-1. Should a CA-1 or a CA-2 be filed? 16

17 Continuation of Pay (COP) Your employee files a CA-1 today, for an injury that occurred 30 days ago. Has the employee met the burden of Time? Is the employee entitled to COP? 17

18 Continuation of Pay (COP) If there is immediate time loss on the DOI and if the employee was injured during official work hours, time lost on DOI is charged to ???. If employee is injured before work hours and there is immediate time loss, the first day of COP is the ???. 18

19 Light Duty and Continuation of Pay (COP) An employee's regular pay includes night or shift differential and various kinds of premium pay including Sunday pay. True or False? Is your employee entitled to ND if placed on the day shift during the COP period and the regular tour is the night shift? Yes or No? 19

20 Continuation of Pay (COP) Your employee has a medical appointment at 10:00 AM. The employee’s tour begins at 8:00 AM. The employee calls to say that it does not make sense to come all the way to the VAMC for just 2 hours of work so the employee suggests that s/he will report to work after the appointment and requests COP from 8:00 to 12:00. Should the COP be approved? 20

21 Alternate Work Assignment Your employee has provided you with a CA-17 that indicates no lifting greater than 10 lbs. Initially you cannot identify alternate work. However, after consulting with the WC Specialist who informs you that you must justify your inability to provide alternate work to the Director; you realize that there are some tasks the employee can perform. Can you inform the employee verbally of the availability of light duty? Is a written job offer necessary? 21

22 CA-17 (Duty Status Report) Your employee is working an alternate work assignment due to an accepted injury. The last medical documentation the employee provided is 30 days old. Two weeks ago, you verbally requested that the employee provide you with updated medical restrictions, but the employee has not complied. You are aware that the employee has had a medical appointment in the interim. What should you do now? 22

23 Performance of Duty Your employee reported an injury that s/he alleges occurred at 8AM. The employee’s tour begins at 9AM. On the CA-1 the employee states s/he comes early to prepare for the day, read memos that may have been issued, get coffee and/or read the paper. Is this injury considered to be in the POD? 23

24 Challenging Questionable Claims Which of the following is not the responsibility of the Supervisor when challenging the validity of a claim? a. Fully investigate the circumstances of the injury b. Conduct a fact finding c. Provide factual evidence in support of the agency’s position such as time cards and witness statements. d. Promptly respond to questions posed by OWCP e. Delay the questionable claim until the investigation is complete or ask the employee to withdraw it. 24

25 In Case You Missed It 25

26 Supervisor’s Role/Responsibilities Offer immediate medical care Timely completion of CA-1/CA-2 (must submit to OWCP within 10 workdays) Pay COP to eligible Injured Worker Assist employee in returning to work/provide light duty Request duty status update/CA-17 Fully investigate injuries and document findings Challenge questionable claims Cooperate with Workers’ Compensation Specialist/OWCP inquires 26

27 Alternate Work Assignment/Light Duty CA-17 Duty Status Report or OWCP-5 Identify alternate work  Recovery job offer Offer Light Duty in writing  Include physical description of the job/physical demands/location/salary  Date job available and response date Modify assignment as restrictions change COP terminates on the date of refusal  Notify OWCP 27

28 FECA /Reasonable Accommodation FECA and Reasonable Accommodation (RA) are two separate and distinct statutes. Each has their own regulatory criteria to apply. FECA is for work-related medical conditions and the ADA is to address non- work-related medical conditions. In cases where OWCP has not yet accepted a claim as work-related, a medical condition may still exist and the law requires agencies to provide RA for those who meet the established criteria. See 29 CFR

29 Identify and Challenge Questionable Claims Differing versions of injury  witness statements  medical documentation Previous injury  reports to work with appearance of an injury Time lags  delayed report of injury  delay in seeking medical care Other employment 29

30 Employee’s Responsibilities Report all injuries immediately Provide prima facie medical evidence of disability within 10 workdays Communicate with supervisor regarding duty status Request leave in accordance with procedures Cooperate with Second Opinion or Agency Medical Exam Inform physician of the availability of alternate work Accept suitable alternate work 30

31 References 5 U.S.C Code of Federal Regulations, 20 CFR part 10 FECA Procedure Manual Part 2 Agency Handbook CA-810 OWCP Directives ECAB Decisions 31

32 Questions???


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