§65.2-603 Duty to Furnish Medical Attention Offer a panel of three physicians– http://www.covwc.comhttp://www.covwc.com It is important to offer a panel Send in documentation of panel offering Referrals to other doctors must come from panel Injured workers cannot change physician without authorization
What Constitutes a Proper Panel? Three physicians who do not share a community interest in a joint practice Not valid if includes a physician unwilling to see new patients or take WC patients May not be valid if travel of 50 miles each way Specialty Panels—eye injuries, etc... Medical clinics do not meet panel requirements as physicians must be listed by name Avoid chiropractors, orthopedics are preferred
Where Can an Agency Locate a Panel? Online at http://www.covwc.comhttp://www.covwc.com Contact: Chad Smith or LaTarsha McMahand Return to Work Specialists Chad.Smith@dhrm.virginia.gov or 804-786-2311 Chad.Smith@dhrm.virginia.gov LaTarsha.McMahand@dhrm.virginia.gov or 804-786-2310 LaTarsha.McMahand@dhrm.virginia.gov
What Documents Do I Submit? First Report of Injury via Visual Liquid Web (VLW) Anything Signed by the Employee Supervisor’s/Safety Officer’s Investigative Report/Photos Written Witness Statements Medical Reports Any Police Reports
First Report of Injury Submit the claim electronically via Visual Liquid Web Visual Liquid Web claim entry is https://apps.frankgates.com/vaear-hr https://apps.frankgates.com/vaear-hr Mail supporting documentation to: Managed Care Innovations P.O. Box 1140 Richmond, VA 23218 Electronically submit scanned documents: firstname.lastname@example.org
Identification of AmeriCorps in VLW Employer Section Agency AmeriCorps c/o DSS-OVC, Richmond, Va Agency 998 If there is an additional employer or location utilize the Employer case number and location fields in the Employer section
Claims Handling Procedures If claim cannot be immediately determined to be covered, the following activities may occur: Investigations/Recorded Statements Agency Internal Investigations or Photos Written Request for Information from Employer and Medical Provider 30 Day Letter will be sent if no decision can be made
Coverage for Injuries Under the Act Employees are entitled to receive compensation benefits for an “Injury by accident, arising out of and in the course and scope of employment” or and “Occupational Disease” Benefits include medical bill payment, mileage reimbursement, and prescription reimbursement
Coverage for Going and Coming to Work Where transportation is provided by the employer, transportation cost reimbursed, or transportation time paid Where the way used is the sole and exclusive way of ingress or egress or employer constructed Where the employee is charged with some duty or task in connection with their employment Exceptions to the going to or from work rule:
Cases Where Coverage May or May Not Apply Voluntary Actions Horseplay Assault/Murder/Robbery Stress/PTSD Idiopathic/Unexplained Falls Heart Attacks Going to or Coming from Work Pre-Existing Conditions Suicide Steps/Stairs
“Willful Misconduct” Defined The Safety Rule was Reasonable The Rule was Known to the Employee The Rule was for the Employee’s Benefit The Employee Intentionally Undertook the Forbidden Act Employer Must Establish:
§65.2-603 Eyeglasses (Prosthesis) Duty to provide only in cases of injury by accident, arising out of and in the course of employment.
Greater Risk and Work Related Risk To be compensable, an injury must grow out of risks particular to the nature of the work. Risks to which all persons similarly situated are equally exposed and not traceable to some special degree to the particular employment are excluded. The mere happening of an accident at the workplace, not caused by any work-related risk or significant work-related exertion, is not compensable.
Injury by Accident, Arising Out of and in the Course of Employment Occur at work or during a work-related function Be caused by a specific work activity Happen suddenly at a specified time Not incurred gradually or as a result of repetitive trauma Notice must be given to their Supervisor/Manager within 30 days of the injury In order to be covered, an “Accident” must:
Your Requirements When a Claim Occurs Submit the claim via Visual Liquid Web (VLW) within 10 days of the injury Evaluate work-related injuries and illnesses to prevent them Establish goals to reduce serious occupational injuries and illnesses and to enhance workplace safety Include in managers’ performance expectations, when appropriate, goals to encourage a safer work environment and reduce injuries and illnesses
Websites to Visit for Phone Numbers, E-mail Addresses, or Answers to Your Questions For the Virginia Workers’ Compensation Commission: http://www.vwc.state.va.us http://www.vwc.state.va.us For the Dept. of Human Resource Management http://www.dhrm.virginia.gov http://www.dhrm.virginia.gov For the Managed Care Innovations Workers’ Compensation Program http://www.covwc.com http://www.covwc.com