Workers’ Compensation for State Agencies. Office of Risk Management Karen C. Jackson, Facilitator. Expected Workshop Goals. Develop a better understanding of the workers’ compensation process. Expected Workshop Goals. Save
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Karen C. Jackson,
Develop a better understanding of the workers’ compensation process.
5500 active workers’ compensation claims.
Approximately 1200 of these paid lost time benefits on regular basis.
$48 million spent on
Title 23 Louisiana Revised Statutes requires all employers to provide workers’ compensation coverage for their employees.
IW have the RIGHT to file a claim.
Let us decide if it’s a claim.
Anyone employed in the State
of Louisiana who is injured on
Coverage begins immediately.
Covered accidents must arise
out of employment and occur
during course and scope of
Anything required by
the statute is subject
to a penalty if
IW may be entitled to medical and/or indemnity benefits at the expense of his employer.
surviving parents in the event of work - related death.
Injured workers must notify supervisor as soon as an accident occurs.
Supervisor immediately initiates paperwork for
the Employers’ First Report of Injury (E-1) claim to be sent to ORM electronically via STARS.
Report all incidents and near-misses in STARS even if the incident does not result in lost time or incur medical expenses.
To request access to STARS online reporting:
Quick Links section
ORM Data Liaison Application/change form
Please notify ORM
Benefits due 14 days from
the date employer aware
11.21 Workers’ Compensation Payments
When an employee is absent from work due to disabilities for which he is entitled to workers’ compensation he
(a) shall, to the extent of the amount accrued to his credit, be granted sick leave not to exceed the amount necessary to receive total payments for leave and workers’ compensation equal to his regular salary.
(b) may, to the extent of the amount accrued to his credit, be granted annual leave or a combination of annual and sick leave not to exceed the amount necessary to receive total payments for leave and workers’ compensation equal to his regular salary.
(c) may be granted leave without pay.
Covered for medical
Insure contractor carries
WC coverage for its
If coverage lapses the
State pays WC benefits
–check solvency of
ORM maintains all closed files for two (2) years on-site.
Files are archived for three (3) years then destroyed.
IW intentionally injures himself.
IW intoxicated at the time of the accident.
Employers can deny WC claims
that result from intoxication if
-have a written policy
-notify employees of intent to
perform post accident drug
Intoxication can be due to
alcohol, Rx, OTC medication or
Post-accident drug screening paid in conjunction with the workers’ compensation claim.
IW who is proven to be the aggressor in an
Injuries resulting from horseplay.
Incidents which arise out of purely personal matters.
Benefits are not payable when an IW is
incarcerated unless the IW can prove he has
family who is dependant on the comp check
Personal items damaged in work-related accidents.
Clear and convincing
evidence that these are
Cannot be related to
Accidents which occur when the employee is
waiting until a new task is given or unfavorable conditions change before the work can be resumed; i.e. rain.
Accidents that occur while responding to an
on call incident as well as traveling to and
from the call are usually covered under workers’ compensation.
Injuries that occur at the employer’s place of business during lunch or rest are usually covered under workers’ compensation.
Employees who arrive early or remain at the
place of work after hours are covered under
workers’ compensation if the period of time is reasonable.
Accidents to and from work are not covered unless:
1) Employer asks employee to perform a task on the way to or from work.
2) If the employer furnishes the transportation.
Employees on a special mission are within the course of
employment from “portal-to-portal” or from home to the
location of the mission or from the location of the mission to home.
Accidents which occur while an employee is
traveling on behalf of the employer are
covered under workers’ compensation.
Out of town
At the hotel
At the restaurant
… if there is no deviation.
There are special circumstances in which the
employer’s premises is immediately
adjacent to an unusually hazardous area of
travel. The unusual risk is at the threshold
of the employer’s premises.
--designated parking areas
Pre-existing disabilities or degenerative conditions (whether known or not) that are aggravated or accelerated by physical exertion or extraordinary mental stress may be eligible for workers’ compensation benefits.
$750 of non-emergency
Failure to obtain approval may
result in non-payment of bills in
excess of $750.
Employer or insurer has right to have IW
examined from time to time during the course
of the claim.
Employer can give verification of initial medical
treatment up to $750 of non-emergency care.
IW should NEVER pay out-of-pocket for
medical services or use personal insurance to
pay for covered medical expenses that result
from a work related accident.
Injury prevents IW from RTW
for more than 7 days.
7 day waiting period
unless IW loses more than 41 calendar days.
Benefits payable on 8th day.
Comp checks are due 14 days after
Based on 66 2/3 % of average weekly wageup
(maximum is $522)
If a worker earns less than
the minimum his actual
wage is his comp rate.
Wages locked according
to date of accident
-in most cases.
Maximum and minimum
change September 1st.
To initiate benefits adjuster enters benefit record upon claim setup or when lost time begins.
Usually mailed to agency of employment to buy back leave.
Must be mailed directly to injured worker if
Workers’ compensation payments, at the option of
the employee, shall be mailed to the employee at the
address designated by him.
Every other Tuesday
Checks expire 180 days from issue date.
Workers’ compensation is a non-taxable income.
The Office of Risk Management has established a
leave buy back report which agencies can run to aid
in re-crediting leave.
The report identifies:
name of injured worker
agency of employment
amount of comp check
average weekly waged used to determine comp rate
payment period for the check
Comp check incorrect
Notify the adjuster of
Name and phone
number on check
When agency personnel changes.
Copy of pay stubs for four weeks prior to date
This does not include the week of injury.
Copy of IW job description.
Notify ORM of changes
in claim status
Employer’s Certificate of Compliance
Certifies employer provides WC insurance.
Certifies employer will not intentionally
defeat IW WC claim.
DO NOT RESPOND
EITHER OF THESE!
ORM will secure
representation from the
attorney general’s office
to respond on you behalf.
R. S. 39:1533b
The representation of the state and state agencies
in all claims covered by the Self-Insurance Fund,
and in all tort claims whether or not covered by
the Self-Insurance Fund, shall be provided by the
attorney general or by private legal counsel
appointed by the attorney general…,
Employee can be on
and family medical
leave at the same time.
These run concurrently.
Some workers’ compensation injuries may qualify for accommodations under the Americans with Disabilities Act.
Entitlement to SEB begins
when an IW is unable to earn
wages = 90% or > of pre-injury
SEB based on 66 2/3 of
difference between pre-injury
wage and what employee is
now capable of earning.
Once WC benefits are started they continue until
IW returns to work or is released to RTW, regular
duties by treating physician.
Only way to stop workers’ compensation payments altogether …
Enables IW to go from here…
… to here.
Would you like for your employee to sit here?
Should be done when
IW unable to return to
his previous work
unable to earn wages
equal to his pre-injury
R. S. 23:1226 rehabilitative services.
Job placement Retraining
Make every effort to return IW back to work
even if IW cannot return to work full duties.
When an employee is sitting home collecting a
comp check -
The work piles up !!!
Transitional Duty is
feasible when the IW
released to some form
of employment by
Agency involvement is
Employers should exercise discretion and caution in
determining the transitional duties to be assigned.
Transitional duty must not lower the performance
standards and expectations of the job as a whole.
Transitional duty should not establish a precedent for a
lower level of duties and performance that other
employees might then expect to be applied to them.
Transitional duty should not have the effect of
permanently lowering the employee’s civil service job title.
Department of Civil
can give guidance in
evaluating transitional duty
ORM must be notified
Can’t get both workers’
Notify the handling
Reviewing the Claim Form
Employee social security number
More than seven (7) days lost time
Amputation / Disfigurement
10) Employee Name - injured worker's first, middle, last
11) Male, female - gender of the injured worker.
12) Employee telephone number – IW home telephone
13) Employee’s most current residential address -
Street address, city, parish, state, zip code.
14) Parish of injury - Name of the parish where
injury / illness occurred.
15) Date of hire - date injured worker began working with agency.
16) Date of birth - injured worker's date of birth.
17) Occupation - Employee's occupation. Example: Gardner.
18) Department or division regularly employed .
19) Employer’s premises: YES or NO – If the injury did not occur on
the employer's premises, coverage may be affected.
20) If "NO"- give the location of the injury including city and state.
21) What was the IW doing when the accident
Example - Employee injured while lifting numerous 30 lb. boxes into truck at loading dock. Dollies are provided for this task but employee refused to use them.
Course and scope of employment
Arising out of the employment
22) The events which resulted in injury or disease.
What happened and how it happened.
Full details on all factors which led or contributed to
injury or illness.
Example: Employee complained of back pain after
lifting boxes for 1 week (approximately 50
boxes per day).
Accidents due to mechanical defects or
unsafe acts should have a safety review.
If incident is result of MVA, who’s at fault
(who hit whom)?
Retain damaged property
23) Identify part(s) of body involved and the nature of
the injury and illness to that body part(s).
May include more than one part of body.
Example: Sprain to upper and lower back.
24) If occupational disease – Date doctor diagnosed
disease / illness as occupational.
If leg, arm, eye, ear, fingers or toes are hurt:
25) Physician and address - Doctor
who treated the employee for injury.
26) Hospital name and address.
27) Name of the agency injured worker
28) Person completing this report.
29) Employer address - Include street address,
city, state and zip.
30) Employer’s telephone - Phone number
of person completing the form.
31) Employer’s mailing address – if different
from address in Item 29.
32) Nature of business - Nature of employer’s
business. Be specific.
33) Always report wage even if IW does not
Report wage on WEEKLY basis.
Overtime earned in the four
(4) weeks prior to date of
Premium or differential pay
Income that is taxable to
Part-time employment or
Share information with adjuster that will be
helpful in making a determination on the claim.
This can be done at any time during the claims
Log on Web
Go to Reports
Report Group > AGENCY REP> Filter
FILTER > Leave Buy Back Report> Run
Karen C. Jackson
State Risk Claims Manager
P. O. Box 91106
Baton Rouge, LA 70821-9106
LOUISIANA R. S. TITLE 23
LABI WORKERS’ COMPENSATION DESK
MALONE AND JOHNSON TREATISE ON
Are there any