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TOP TEN THINGS MEMBERS NEED TO KNOW ABOUT WORKERS' COMPENSATION

Posted by sendmail156 on October 29, 2013 at 6:15 AM

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NYC Transit is self insured and pays both Compensation and differential.



 1.    REPORT the injury to SUPERVISION as soon as possible.

   

The Workers’ Compensation Law gives you 30 days, but if you don’t report the Accident within the tour of duty in which the accident occurred, you will probably lose differential pay. COMPLETE THE INJURY ON DUTY REPORT WITH DIFFERENTIAL APPLICATION IMMEDIATELY Late filing may result in a DELAY in COMPENSATION PAYMENTS AND DENIAL of DIFFERENTIAL PAY. YOU MUST SIGN THE DIFFERENTIAL APPLICATION IMMEDIATELY.


You may report an injury no matter how slight. You may fill out Injury On Duty (IOD) papers for the record only. It is up to you ONLY if you fill out IOD papers. You do not have to go out on compensation because you fill out IOD papers. You may fill out IOD papers for medical benefits only and still work. 


If you need to file for a NYCERS disability pension, you MUST do so before you are terminated (after one year cumulatively on compensation for the same injury.


2.    See a Doctor that handles Workers’ Compensation cases.


The entire Workers’ Compensation System runs on medical reports.  The hospital, your family doctor, and other doctors who are not coded by the Workers’ Compensation Board will probably not file the C-4 reports you need to win your case. 


You must see the doctor at least once every six weeks as long as you are out of work.  If you don’t, the T.A. doesn’t have to pay you compensation. A doctor must cover you for every day of your compensation absence. Make sure to bring the C4/48 form to the depot and have it signed by a dispatcher. Always get a copy of the signed C4/48.


3.    File a C-3 Form with the New York State Workers’ Compensation Board.


You should receive a C-3 form as part of the incident report package.  They are also available at all locations of the Workers’ Compensation Board, online at www.wcb.state.ny.us (common forms), and also, contact a Lawyer.


4.    Get Legal Representation.


Neither the Transit Authority nor the Workers’ Compensation Board will make certain that you get the proper benefits.  It is likely that they will try to close your case without holding a hearing, and if there is a hearing the T.A. will have a lawyer there to represent the T.A.  You will probably need a lawyer and should have one sooner rather than later.


5.    Attend “I.M.E.” Exams.


YOU MUST ATTEND AND BE ON TIME FOR ALL IME APPOINTS.


There’s nothing “independent” about the “Independent Medical Examiners” (I.M.E.s) -- they work for the T.A. However, you still have to go to the exams.  If the I.M.E. gives you restricted or full work, you must report immediately. VERY IMPORTANT: You must go directly to the MAC and give a urine sample if given full work by the IME. (Always read the IME report).


When filling out questionnaires at the I.M.E. appointments, be truthful.  If you answer a question incorrectly, you may be accused of fraud, and if the board finds against you, you can lose all of your workers’ compensation benefits, be terminated, and prosecuted criminally.  Do not answer the question on the I.M.E. form that asks about prior illnesses, injuries, or limitations.  Just leave it blank and let the doctor ask you whatever specific questions he or she wants.  The question is too general and has caused problems for a number of Transit Workers.


BY Donald Yates Oa1: As of lately the Transit Authority has been investigating our members who are out on workers compensation. Unfortunately some of our members are being charged with comp fraud.

Workers compensation fraud will lead to the MTA bringing charges of dismissal.

Here's what you need to know:


1) when filling out the IOD form's read what you're answering carefully, and make sure the information is truthful.


2) when you are scheduled for the independent medical examiner better known as the IME, there will be forms you are required to fill out before each examination. Specifically what you can and cannot do. If you checked that you can't do certain things, don't do them. Example if you can't lift more than 5 pounds, be mindful of carrying groceries. Also on these forms the question is asked do you work, have you worked for the company or any other employer including self employment, if you answer no, it better be so!!!!

You can't even do your Avon business. Failure to answer these questioners truthfully can. And most certainly will get you terminated.


P.S. I almost forgot to mention that social media conduct is being checked especially when the MTA is investigating fraud, or conduct that in there view embarrasses the company. In other words, watch your off duty conduct!!!!!!


 

Compensation or Sick 60 days and/or 10 month letter:

 

While continuously out sick or cumulatively out on compensation for 60 days and/or 10 months, you will receive a standard Civil Service about being reclassified or you will be terminated. The only letter to be concerned about is the 10 month letter which states you may request to be reclassified or you will be terminated at your 12 month not at work anniversary (12 months continuously out sick or 12 months of cumulatively out on compensation). If terminated, you can ONLY be reinstated to the civil service title you held before you were terminated. If you are reclassified and accept a new civil service title, it is VERY difficult to return to your previous civil service title. If the TA does not find a new job for you in the six 6 months reclassification period, you will be terminated.




6.    Keep Track of Out-of-Pocket Expenses.


You are entitled to be reimbursed for travel to and from your doctors and the I.M.E. (if not using T.A. Metrocard), prescriptions, bandages, canes, crutches, etc.  Keep track of the expenses on a piece of paper, keep the receipts together, and give them to your attorney (with the total) at a hearing for submission to T.A. for reimbursement.


7.    Attend Hearings.


Be on time (early if possible).  Some judges will call your case precisely at the scheduled time and hold the hearing without you; other times, you will have to wait to be called.  It’s safer for you to be early than late.


 Bring your most recent medical report with you.


8.    Keep Track of Workers’ Compensation and Differential Payments.


Your Workers’ Compensation checks and differential checks are supposed to add up to your net pay in a base week.  If your workers’ compensation goes down, differential should go up to make up the difference.  Keep track of what you receive to make sure the T.A. is not cheating you.


9.    Keep Track of Your Earnings on Return to Work.


If you are making less money when you return to work, including loss of overtime due to injury, keep copies of your pay stubs.  If it can be shown that you are making less money because of your injury, you may be entitled to Workers’ Compensation for the loss of income.


10.    BE AWARE OF ALL OF YOUR RIGHTS.


Unemployment Insurance:  If your status is “restricted work, no work available,” you may be eligible for unemployment in addition to Workers’ Compensation.  You will have to tell unemployment that you have Workers’ a Compensation claim and that you are restricted.



Social Security Disability:  If you are out of work for six months and it appears that you will be out for over a year, you may be eligible for Social Security Disability.  However, unless the injury was the result of an assault, if you are out for one year you will be terminated under Article 71.



Crime Victims Compensation:  If the injury was the result of an assault, you may be eligible for Crime Victims Compensation Benefits.  Go to http://www.ovs.ny.gov for information and forms.


No-Fault: 

If you are injured while using or operating a motor vehicle, you may be eligible for No-Fault benefits additional to Workers’ Compensation benefits.  However, a No-Fault application must be filed within 30 days of the accident date.  If you were using or occupying a T.A. vehicle, the MTA is No-Fault insurer.  No-Fault applications are available.

Pension:  Application can be made to NYCERS for service or disability pension.

Long Term Disability: 

Many Workers have private disability insurance policies that pay for time out of work.  These policies are all different so you have to read your policy to find out if you are eligible, what the benefits are, and whether they are reduced (offset) by Workers’ Compensation payments.

Third Party Action: 

You cannot sue your employer or your co-workers (including supervisors) for negligence.  However, if you are injured because of the negligence of someone who does not work for the T.A. (an outside contractor, someone driving a private vehicle, etc.) you may be able to bring a lawsuit in addition to your Workers’ Compensation claim. Contact a lawyer if you think you may have a case.


Pay Problem: 

 

If you have issues with your compensation pay, you may consult your TA caseworker. If you do not know who they are, please contact your depot Safety Officer or Union Representative for the TA caseworker contact information. Your TA caseworker works for the TA.

 

 

 

While on compensation, you should receive two (2) checks which should add up to, less taxes, a forty hour 40 work week or run pay on assault. One check from TA/OA comp differential which deductions are taken & one TA/OA Workers Compensation which no deductions are made, thus causing you to have a a short fall in your pension contributions. To correct this deficiency you must get a letter from the Workers' Compensation Board of the time spent on IOD. Then take that letter to NYCERS (TA employees) (347) 643 3000 or pension (OA employees) (347) 643 8550. Then repay the pension deficiency.

 

 

 

Payments are not paid for the first seven days of your compensation disability, unless it extends beyond fourteen days. In that case, the worker may receive payments from the first work day off the job. At NYCT/OA, we receive differential payments which covers up to the first seven days. Please note that you will ONLY receive compensation payments from day 8 thru day 14 if your compensation disability does not go beyond 14 days.

 

1. Day 1 thru day 7 no compensation payments. You can receive differential payments.

 

2. Day 8 thru day 14 you receive compensation payments from day 8 to 14 only.

 

3. Day 1 thru day 15 you will be paid for all compensation days.

 

 

 

You may use up to 20 of your sick days to receive a pay check until compensation payments begin. The TA may controvert your compensation case if they have any issues with your compensation claim. In that scenario, your compensation payments maybe withheld until you have a compensation hearing to determine if your case is valid.

 

 

 

If you do not receive differential payments, please contact your case worker. If your differential are denied, you must ask you case worker for a denial of differential letter.

 

 


Keep Records: Keep detailed records of EVERYTHING compensation related.  


Cash benefits are not paid for the first seven days of the disability, unless it extends beyond fourteen days. In that case, the worker may receive cash benefits from the first work day off the job. Necessary medical care is provided no matter how short or how long the length of the disability.


Occupational Disease


An occupational disease arises from the conditions to which a specific type of worker is exposed. The disease must be produced as a natural incident of a particular occupation, such as asbestosis from asbestos removal.

A person disabled by a work-related occupational disease receives the same benefits as for an on-the job injury. However, the time limit for filing a claim is the later of two dates:

Two years from the date of the disabled worker's disability; or

Two years from the time the disabled worker knew or should have known that the disease was due to the nature of employment.

(In the case of death, the dependents must file within the stated time limits).

When a worker becomes ill from an occupational disease, he/she may be disabled even if there is no lost time from work. For purposes of determining the employee's right to benefits, the date of disablement is determined by a Workers' Compensation Law Judge.


Occupational Hearing Loss


In the event of occupational loss of hearing, other time limits apply. The waiting period for a worker to file a claim is his/her choice of:

  • Three months from the date the worker is removed from the harmful noise in the workplace; or
  • Three months after leaving the employment in which the exposure to the harmful noise occurred.
  • The last day of either 3-month period is considered the date the disability began. The worker may file beyond the two-year limit, if it is done within ninety days of knowledge that the hearing loss is related to his/her employment.

      

 Q. Are all disabilities covered under Workers' Compensation Law?

      

 A. No. Only those disabilities that are causally related to an accidental injury "arising out of and in the course of the employment" or to occupational disease, are compensable.

      

 Q. What if the worker fails to file a claim for workers' compensation?

      

 A. The worker may lose his/her right to benefits and medical care.

      

 Q. Is it necessary for the worker to retain an attorney?

        

A. No. W.C. Law Judges may assist a worker not represented by an attorney. An attorney's assistance may be desirable if the issues are complicated. Attorney's fees are deducted from the claimant's award, as determined by a Workers' Compensation Law Judge. A claimant must not pay an attorney directly.

        

Q. How is the weekly cash benefit for temporary total disability determined?

        

A. The weekly cash benefit for temporary total disability is computed by taking two-thirds of the workers' average weekly wage for one year immediately preceding the accident. It may not, however, exceed the legal maximum in effect on the date of the injury.

        

Q. Is medical care provided in the case of an accidental injury even when no claim is made for weekly cash benefits?

        

A. Yes. If medical care is necessary, it will be provided even though there has been no lost time from work (or less than eight days lost time) and no cash benefits paid.

        

Q. When must a physician request advance authorization for medical care?

        

A. The law requires a physician to request prior authorization for specialist consultations, surgical procedures, physiotherapeutic procedures, X-rays or special diagnostic laboratory tests costing more than $500 until July 10, 2007. As of July 11, 2007, the special services must cost more than $1,000 before authorization must be requested. However, as of March 13, 2007, insurance carriers are authorized to require claimants to obtain X-rays, CT Scans, MRIs and other diagnostic tests from a provider or facility within the network it has contracted with for such tests. If the insurance carrier has notified the claimant of this requirement, then the claimant must obtain diagnostic tests from a network facility or provider unless it is an emergency or there is no location within a reasonable distance from the claimant.

      

 Q. Are prescription drugs and medications covered under the law?

        

A. Yes. The claimant should send a receipted bill and letter from the attending physician to the insurance carrier, stating that the purchase was necessary and in accordance with the physician's direction. As of July 11, 2007, the law specifically authorizes pharmacies to direct bill the insurance carrier and requires the insurance carrier to pay for the prescription or reimburse the employee within 45 days of receipt of the claim for payment or reimbursement. It also allows the insurance carrier to contract with a pharmacy or pharmacies and require claimants to use the pharmacy or pharmacies to obtain their prescriptions. The only exceptions are when a medical emergency occurs and it is not reasonably possible to obtain immediately required prescribed medicines from such pharmacy or pharmacies or the pharmacy or pharmacies do not offer mail order service and do not have a physical location within a reasonable distance from the claimant.

        

Q. May a doctor proceed with care if the insurance carrier withholds authorization without reason?

        

A. Yes. When the authorization has been requested and withheld without reason for more than 30 days, the doctor may proceed to render the services required for the claimant's welfare. If the authorization is for a diagnostic test and the carrier has contracted with a network and requires claimants to use the network, the diagnostic test must be obtained from a provider or facility within the network.

        

Q. Must an injured worker submit to a medical examination when requested to do so by the employer or insurance carrier?

        

A. Yes. The employer or insurance carrier is entitled to have the worker examined by a qualified physician. Refusal to submit to an exam may affect the worker's claim.

        

Q. What happens when a claim is contested by the insurance carrier?

        

A. The insurance carrier contesting a claim must file a notice of controversy with the Board within eighteen days after the disability begins or within ten days of learning of the accident, whichever is greater. The carrier must give the reasons why the claim is not being paid. The issue is resolved by a W.C. Law Judge at a pre-hearing conference or a hearing.

      

 Q. May an insurance carrier suspend or modify the cash benefits?

        

A. In a case where the carrier has made payment without waiting for a Judge's decision, it may suspend or modify the payment based on payroll or medical evidence submitted to the Board.

        

Q. What can a worker do if he/she is not satisfied with the Judge's decision?

        

A. The worker may file with the Board a written application for review within thirty days of the filing of the notice of the Judge's decision. The application must specify why the claimant disagrees with the decision.

        

Q. What can a worker do if he/she is not satisfied with the Board's decision after an application for review?

      

 A. The worker may appeal to the Appellate Division, Third Department, within thirty days after the decision has been served upon the parties.

        

Q. What is the penalty for making a false claim?

      

 A. A person who willfully misrepresents the circumstances surrounding his or her case in order to obtain benefits is guilty of a felony.

        

Q. What do I need to do if my spouse/parent/child/grandchild(ren)'s has passed away while collecting workers' comp benefits?

        

A. Notify the Board and Insurance Carrier¹ immediately and submit (when available) a copy of the Death Certificate.

        

Q. As a widow/widower, will his/her compensation benefits continue coming to me once they passed?

        

A. In most cases benefits may stop. The widow/widower must file for a Workers' Compensation Death claim showing medical proof that the claimants death was related to the established work injury. If the death claim is found compensable, payments may resume retroactive back to the date of death.

        

Q. What do I need to do if my spouse/parent/child/grandchild(ren)'s death was because of his/her work injury?

        

A. File for a Workers' Compensation Death claim by completing and filing a C-62 with the appropriate documentation. You will also need to file the C-64 and, If you have it, file medical evidence from the last treating physician stating how the death is causally related to the original work injury/illness.

        

Q. What if my Child was killed at work and has no dependents; are there benefits payable for at least funeral expenses?

        

A. Parents who were not dependent on the deceased would be eligible for a no-dependency award if there were no spouse, children, or other dependent family members. They would also be eligible for up to the maximum allowed under Workers' Compensation for funeral expenses paid.

        

Q. I have been approached to consider settling my claim, what do I do?

        

A. Under the Workers' Compensation Law, any settlement, whether a stipulation agreement or a Section 32 Waiver Agreement, is a negotiation between you and the Carrier¹. The main difference is that a Stipulation is always subject to modification, with proof and the Boards consent, whereas a Section 32 can never be changed once approved by the Board (see Workers' Compensation law section 32).

      

 Q. What is a stipulation agreement?

      

 A. This is an agreement between the carrier¹ and claimant which is memorialized in writing on a Board-prescribed form, and placed on the record by the Judge. This agreement is usually to agree on a percentage of a schedule loss of use, level of disability, reimbursements to the employer, and/or what your weekly indemnity benefits will be.
For more information on stipulations, see Board rule 12 NYCRR 300.5.

        

Q. What is a Schedule Loss of Use Award?

        

A. This is an award that is issued by the Judge that determines the amount of loss of use you have to the injured body part (Usually limbs/digits). This percentage is determined by medical evidence such as treating doctors' report and the Independent Medical Examiners report, if any. This award is paid at your total disability rate as applied. This award is set forth in a Board decision, listing amounts as if they were lost wages, whether you have actually lost time or not. However, once an award is paid, if you have not been out of work for that amount of weeks, it is then considered an advance payment and if you go out of work due to this injury later on, you will not be paid for lost wages until the number of weeks is used up. If you have already been out of work for the amount of weeks of the schedule loss, you will not receive any further payments. But if you are out of work down the road, and used up the weeks of the schedule loss, you may be eligible for further monies.

        

Q. If I had a Schedule Loss of Use Award can I still treat with my doctor?

        

A. Yes

        

Q. What can I include in the Section 32 agreement?

      

 A. The Section 32 agreement is a negotiation; therefore you can include what you feel is in your best interest. There are times when medical is left in and just the monetary value is what is finalized. While many cases are based upon approximately (5) years of payments, remember it is a negotiation. Both parties have to be in agreement before it can be presented to the Board.

        

Q. What if I settled on a Section 32 and my condition gets worse?

        

A. You will be responsible for anything related to this injury, no one else.

      

 Q. What if I have extreme financial hardship or need surgery down the road due to the injury I settled with a Section 32?

      

 A. You are solely responsible for any bills related to this injury.

        

Q. Can I sue someone for my injuries since I settled my case?

        

A. No

        

Q. What if I have settled my case, but then reinsure myself at work again to the same thing and it is made worse?

      

 A. If this were to happen, you could then file a new claim. If the Judge were to determine that there would be an apportionment between the first injury and the new one, you would only get paid the apportionment amount from the new injury as the first injury case was settled.

        

Q. Can I file for a Death Claim if my spouse settled his/her case on a section 32 and has since passed away due to the injury/illness?

      

 A. Yes, only if the persons death was related to the actual injury/illness. ( Please see under the Workers' section on how to file a Death claim).

      

 Q. What can I do if I disagree with an MOD issued and the Full Board Review is denied?

      

 A. You have thirty days from the denial of the Full Board Review notice in which to file with the Appellate Division, Third Department, of the Supreme Court. This step is outside the Workers' Compensation System and there could possibly be a fee for filing the appeal. The Supreme Court does have programs in which to file as a poor person. Again, you would need to contact them.


What is the Advocate for Injured Workers?


The Advocate for Injured Workers accepts complaints concerning matters related to workers' compensation, investigates and attempts to resolve them. In addition, the Advocate provides information to injured workers to enable them to protect their rights in the workers' compensation system.

When calling the Advocate for Injured Workers, please have the following information available:

CLAIMANT'S NAME

CLAIMANT'S WCB NUMBER

TELEPHONE NUMBER, WITH AREA CODE

BRIEF DESCRIPTION OF THE PROBLEM AND ANY CORRESPONDENCE RECEIVED

For more information about your workers' compensation claim, please contact the:

Advocate for Injured Workers
1-800-580-6665
20 Park Street, Albany, NY 12207




 

 

COMP INFO FROM THE TA

 

 

 

1. COMPLETE THE INJURY ON DUTY REPORT WITH DIFFERENTIAL APPLICATION IMMEDIATELY Late filing may result in a DELAY in COMPENSATION PAYMENTS AND DENIAL of DIFFERENTIAL PAY.

 

 

 

2. READ THOROUGHLY STATEMENT OF RIGHTS published by the New York State Workers’ Compensation Board.

 

 

 

3. REQUEST FOR PAYMENT WHILE ABSENT DUE TO CLAIMED SERVICE-CONNECTED DISABILITY If provided for in the relevant collective bargaining agreement, NYC Transit Authority employees, who are not receiving workers’ compensation payments, may request to use his/her sick leave and/or vacation time beginning with the 11th day of absence by submitting the appropriate form. You should contact your supervisor and/or union representative if you have any questions about this process.

 

 

4. YOUR OWN PRIVATE PHYSICIAN'S CARE: Your physician must file a C-4 OR C-48 form with the Authority's Workers' Compensation Division and the Workers' Compensation Board as soon as possible. Absent receipt of the C-4 or requisite, acceptable medical lines (these must include diagnosis, medical findings, not solely conclusions, and a work status – see form supplied by Supervisor) from your treating physician by the Workers’ Compensation Division, your workers’ compensation* and differential benefits will not commence. Failure to submit medical documentation may result in your being considered absent without leave. Additional medical lines may be requested by the Workers’ Compensation Division. All physician medical invoices are to be mailed to the Workers' Compensation address listed below.

 

 

5. INDEPENDENT MEDICAL EXAMINATION (IME)

 

 

· REPORT TO AUTHORITY IME PHYSICIAN AS DIRECTED BY the mail notice you receive (by express and/or regular mail and possibly by hand). The notice will be received at least seven business days (excluding Saturday and Sunday) before the scheduled examination.

 

 

· A FAILURE TO REPORT TO THE MEDICAL IME EVALUATION may result in a denial of workers’ compensation* or differential benefits. If you have returned to work prior to the scheduled IME examination, you should check to determine whether the examination is still required.

 

 

· IF UNABLE TO TRAVEL TO THE IME EVALUATION: You must give your department and the Workers’ Compensation Division at least two business days advance notice if you cannot go to the consultant physician on the scheduled date. If unable to attend the Medical IME Evaluation, you must call/fax the Medical Consultant Unit listed below for notification. You will be required to prove your inability to attend. Ask your physician to provide his/her written opinion of your inability to travel. Absent such proof, your differential benefits may be jeopardized and you may be considered AWOL. If requested by the employee, the Authority may, based upon the circumstances, arrange for a home or hospital visit for evaluation of your medical condition.

 

 

* Subject to review by the Workers’ Compensation Board.

 

 

· OBTAIN WORK STATUS FROM MEDICAL IME AND RETURN TO YOUR DEPARTMENT. The IME Physician will give you a Medical IME Evaluation Form which will indicate your work status - Full Work, Restricted Duty or No Work. Unless you receive directions otherwise from your department, after you receive the Medical IME Evaluation Form return to your Department with the Form. Your department will determine whether work is available within the restrictions indicated by the Independent Medical Examination.

 

 

· IF YOU DISAGREE WITH THE WORK STATUS DETERMINATION: Contact your Department for instructions. If your physician's opinion regarding your work status differs from the Authority's IME physician, medical evidence (with objective findings) should be submitted in writing for review to the Injury Reporting Unit of your department and the Workers' Compensation Division at the address stated below. If you dispute a full or restricted work status give by the IME and do not return to work, you may be denied workers compensation benefits and or differential benefits. If you are uncertain about how to proceed you are to contact your supervisor and/or Union Representative for clarification.

 

 

· A COPY OF THE IME/MEDICAL REPORT will be forwarded to you.

 

 

· RE-EXAMINATIONS: You must continue to report to the Authority's IME physician as noticed in subsequent mailed notification, as well as by hand delivery at the current medical examination. You are required to bring current reports from your doctor concerning your medical status.

 

 

 

6. DIFFERENTIAL/ASSAULT PAY: Speak to your department supervisor and union representatives for forms and information regarding differential or assault pay.

 

 

 

Completion of Accident Report - The employee shall as soon as possible, complete and sign the Accident Report and give the signed Accident Report to his/her Supervisor. If an employee who is physically unable or otherwise fails to complete and/or sign the Accident Report with in his/her tour of duty, It shall then become the responsibility of the supervisor to complete and/or sign his/her name to the form in the place Identified for the Supervisor. The supervisor shall include the source of the information used to fill in the employee’s and his/her sections of the form. Notwithstanding prior completion and/or signing by a Supervisor, the employee shall complete and sign an Accident Report as soon as he/she is able to do so. Use of a local log or “first aid book” does not replace the requirement for an Accident Report.

 

 

 

Recurrence - A Recurrence takes place when an employee suffers disability as the result of a previously reported injury or illness “arising out of and in the course of employment” after a return to work from the original injury or illness.

 

 

 

A. For reporting purposes, notification of a Recurrence shall be treated the same as a new accident (See 11a 1-5). Anew Accident Report form shall be completed in which the employee sets forth how the alleged Recurrence took place and how the alleged recurrence relates to a previously reported occurrence. The Supervisor shall be required to complete the Supervisor’s section of the Accident Report.

 

 

 

B. If the employee IS not at work when reporting a Recurrence, He/she must contact his/her Department for instructions. The Department should obtain information as to the Recurrence to be set forth in the Accident Report including the source of the information. The Department shall fill out the employee’s section of the Accident Report and forward it in accordance with the instructions set forth in 11a, 5. Workers’ Compensation Lost Wage Claim Review

 

 

 

1. Lost Wage Claim - A Workers’ Compensation Claim exists whenever there is an accidental injury or disease arising out of and in the course of

 

 

employment, resulting in medical treatment and/or lost time from work. There are no Workers’ Compensation lost wages due for the first five (5) work days of disability unless the disability is more than ten (10) work days.

 

 

 

2. Timeliness of Payments - The first payment to an employee is required within eighteen (18) days after the ‘first day of disability,” defined as the first day of regularly scheduled work after the day an employee is unable to work due to a work-related injury/illness. Subsequent payments are required to be made hi-weekly thereafter. To review, adjust, and process Lost Wage claims in a timely manner, the Worker’s Compensation Subdivision must promptly receive, as set forth in this Policy/Instruction, the Accident Report and Lost-Time Report, both from the employee’s Department, and the Medical Report from the Medical Services Division and/or the consulting physician’s report.

 

 

 

Processing of Checks

 

 

A. For Compensation Lost Wage payments for temporary disability cases, the Workers’ Compensation Subdivision shall draft the checks and prepare a summary listing the names and addresses of the employees entitled to checks. The Treasury Department shall, within one business day of receipt of the checks and accompanying transmittal summary, Issue and mail the checks to the named payees.

 

 

 

B. For Compensation payments for permanent disabilities, the Workers’ Compensation Subdivision shall provide vouchers Bi-weekly, together with a listing of the employees’ names and addresses to the Disbursements Department. The Controller’s Department shall issue and mail the checks to the named payees in accordance with the payment schedule submitted by the Workers’ Compensation Subdivision.

 

 

 

 


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