Return to work 101 injury reporting
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RETURN TO WORK 101 INJURY REPORTING . Chief Executive Office Risk Management RETURN TO WORK Unit. Workers’ Compensation/Return-To-Work (RTW) Forms/Process Completing Forms Seeking medical treatment via Pre-designation or Initial Treatment Center (ITC) Work Hardening (WHTAA)

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Chief Executive Office Risk Management RETURN TO WORK Unit

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RETURN TO WORK 101INJURY REPORTING

Chief Executive OfficeRisk Management RETURN TO WORK Unit


  • Workers’ Compensation/Return-To-Work (RTW)

  • Forms/Process

    • Completing Forms

    • Seeking medical treatment via Pre-designation or Initial Treatment Center (ITC)

  • Work Hardening (WHTAA)

  • Maintaining File/Contact with Employee

Topics Covered


  • Injury definition: Any injury or disease arising in the course and scope of employment

  • Applicable labor code section;

    “…shall be liberally construed by the courts with the purpose of extending their benefit for the protection of persons injured in the course of their employment.” (LC3202)

Workers’ compensation overview


  • Third Party Administrator (TPA):

    • Contractor hired by County of Los Angeles to administer workers’ compensation benefits for County employees

    • Decides whether workers’ compensation claims are compensable (work-related)

    • Decision must be made within 90 days of receiving claim form

Workers’ compensation overview cont…


  • Definition

    • Program designed to return employees to work in a productive capacity as quickly as possible after an injury or illness.

  • Purpose

    • Minimize the costs of injuries and illness while maintaining an inclusive work environment.

Return to work overview


  • Emergency Injury Reporting

  • Non-Emergency Injury Reporting

  • Employee Seeks Treatment

  • Employee Injury/Illness File

  • Employee on Temporary Total Disability

  • Employee Released to Full Duties

  • Employee Release to Modified or Alternative Work

  • Required Forms

Breakdown of injury reporting PROCESS


Emergency injury reported

CALL 911


  • Once the situation is stable, you should:

    • Complete the DWC1 Claim Form, and the Employer’s Report of Injury (5020) and call into the Toll-Free number within 24 hours.

    • Complete the Job Description form.

Emergency injury reported


WORKERS’ COMPENSATION CLAIM FORM (DWC 1)


EMPLOYER’S REPORT OF OCCUPATIONAL INJURY/ILLNESS (5020 FORM)


JOB DESCRIPTION FORM


JOB DESCRIPTION FORM


FIRST ALERT FORM


  • If Employee Declines Treatment:

    • Employee must complete the Employee’s Statement Declining Treatment form. A copy of the form must be sent to the RTW Coordinator or Personnel.

    • Employee must sign Receipt of Employee Packet, and be given the packet.

NON-EMERGENCY INJURY REPORTED


Employee’s declining medical treatment FORM


Receipt of employee packet


  • Review the Employee’s Guide for Injury Reporting with the employee.

  • Complete the Injury Reporting forms with the employee. The packet must contain the four forms below:

    • The completed Treatment Referral Slip

    • The completed Treating Physician’s letter (for physical injuries only)

    • A copy of the blank Patient Status Report

    • A copy of the completed Job Description should be included in the Medical Provider Packet.

      Send the four documents with the employee to the

      Pre-designated physician OR ITC, as applicable.

Employee seeks treatment


Treatment referral slip FORM


Treating physician’s letter (Physical injuries only)


Patient status report FORM(Physical injuries only)


EMPLOYEE’S REPORT OF ACCIDENT FORM


  • Ask the employee if they have Pre-designated a treating physician.

  • If they have not, send them to the Medical Provider Network (MPN) Initial Treatment Center (ITC).

    A list of those centers can be obtained on the County’s MPN website at:

    http://ceo.lacounty.gov/mpn

EMPLOYEE SEEKS TREATMENT CONT…


PREDESIGNATION OF PERSONAL PHYSICIAN FORM


Fill out the DWC1 Claim Form, and Employer’s Report (5020) form. The injury must be called into the Toll-Free number within 24 hours upon notice of the injury.

Call the Toll-Free number and report the injury.

In some departments, the RTW Unit staff calls in the injury, in others the supervisor or location designee calls it in.

EMPLOYEE SEEKS TREATMENT CONT…


If Employee has not Pre-designated their personal treating physician, the work location Supervisor or designee must direct them into the County’s Medical Provider Network (MPNs), via an Initial Treatment Center (ITC).

mpn initial treatment centers (itc)


  • Location Supervisor should fax a copy of the Patient Status Report to the RTW Unit/Personnel.

  • Make sure that the time card is coded appropriately.

  • Call the employee for status. The employee should be called on a weekly basis to determine their status, follow-up on their recovery, and answer any questions they may have regarding the process.

Employee on temporary total disability(EMPLOYEE IS TAKEN OFF WORK BY PHYSICIAN AFTER INJURY)


  • Return the employee to work.

  • Communicate with the employee to make sure they are able to continue working their Usual and Customary (U&C) duties.

  • The department RTW Unit should be informed of status in writing, and of any problems or concerns.

  • Close the employee injury/illness file in 45 days from the date of injury if the employee continues to work their U&C job.

Employee release to full duties


  • If a Physician has provided restrictions that prevent employee from immediately returning to their Usual and Customary (U&C) job, proceed with the following:

    • Review the work restrictions to make sure they are compatible with the duties listed in the job description.

    • If the work restrictions are compatible, return the employee to work.

Employee release to modified or alternative work


  • If the modification of the job duties is required, make the necessary modifications.

  • Communicate those temporary modifications and time limits to the employee.

Employee release to modified or alternative work cont…


If modification of the job is done, a Work Hardening Transitional Assignment Agreement (WHTAA) must be completed with the employee. (This should be done during the Interactive meeting and by either or both the RTW Unit staff or the location Supervisor or designee along with the employee.)

Location Supervisor/designated staff and department RTW Unit staff should both have a signed copy of the WHTAA, along with the employee.

Employee release to modified or alternative work cont…(using whtaa form)


Retain a copy of the WHTAA in the employee’s injury/illness file.

If modification of the job is not possible, explore available job tasks within the work unit.

If the location is able to provide alternative work, a WHTAA must be completed with the employee.

Employee release to modified or alternative work (WHTAA) cont…


Work hardening transitional assignment agreement (whtaa) form


Work hardening transitional assignment agreement (whtaa) form


If no alternative or modified job is available after a thorough and reasonable search is conducted, contact the Supervisor/Management at work location and human resources staff to assist with a plan to monitor situation and expand search for other job placement opportunities within the department.

Catalog a follow-up date with department staff.

Employee release to modified or alternative workcont…


When an assignment is located, complete the WHTAA form with the employee on their first day back to work.

Make sure a signed WHTAA form is obtained and maintained between the department RTW Unit and the work location/supervisor/RTW Coordinator.

Employee release to modified or alternative work cont…


If there is a problem reaching the employee at home, document attempts on the Telephone Log and work with other County TPA staff as appropriate to verify contact information. If necessary you can contact the treating physician to request medical certification reflecting any restrictions or to verify employee is taken off work.

Employee release to modified or alternative work cont…


If you suspect any behavior or receive any information regarding fraudulent activities or abuse, this information should be shared with our TPA staff once their file is set up.

Employee release to modified or alternative work cont…


Weekly telephone call verification sheet


  • Receipt of Employee Packet

  • Employee’s Statement Declining Medical Treatment

  • First Alert or other proof of Fax as appropriate

  • DWC1 Claim Form

  • Employer’s Report (5020) Form

  • Job Description Form

  • Treating Physician’s Letter

  • Treatment Referral Slip

  • Work Hardening Transitional Assignment Agreement

  • Weekly Call Verification Sheet

  • To locate more forms see:

    http://ceo.lacounty.gov/mpn

Review of required forms for reporting an industrial injury


Complete DWC-1 Employee Claim Form

Complete Employee’s Report of Accident

Return the Completed forms to your supervisor/including all Medical Certifications from your treating physician

Review of employee responsibilities


It is important that an injury/illness file be

maintained on employees. The injury/illness

file should contain, at a minimum, the following

documents:

  • A copy of the Claim Form (DWC Form 1)

  • A copy of the Employer’s Report (5020)

  • Copy of the Job Description/Essential Job Functions listing

  • Employee’s Report of Accident

  • Patient Status Reports

  • Work Hardening Agreements

  • Supervisor Weekly Telephone Log Sheet

  • Any other documentation that you may receive on this injury

Employee injury/illness file


Questions???


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