Workers' Compensation

What to do when an injury occurs

Medical Care – When an employee reports an industrial injury/illness it is important that medical treatment is provided without unnecessary delay. Supervisory staff should refer the employee to a medical facility listed in the Initial Treatment Center directory applicable to their department. That information can be obtained from the department return-to-work unit.

Two exceptions follow:

• If the employee’s need for treatment appears urgent – the employee should be referred to the nearest emergency room or call 911.
• If the employee has predesignated a personal physician to treat an on-the-job injury or illness, and it is not an emergency, the employee should go to this predesignated physician.

Industrial Injury/Illness Reporting Paperwork

An employer must provide an employee a Workers’ Compensation Claim Form (DWC-1) within one working day of receiving notice of an industrial injury/illness. Additional paperwork is required to ensure the full investigation and expeditious delivery of benefits.

* The offer of transitional modified or alternative work is a very important cost saving tool. Departments are encouraged to develop an aggressive early-return-to-work policy that works closely with the injured worker, treating physician, and workers’ compensation third party administrator to return injured employees back to work as soon as practicable. In many cases, the exploration of transitional modified or alternate work should begin upon notification of the industrial injury or illness.

** Use each workers’ compensation injury claim as an opportunity to evaluate your workplace. The Supervisory Investigation Report can be a useful tool in preventing “like type” injuries from occurring in the future. Any ongoing hazard or exposure should be corrected immediately. Reporting supervisors and managers should identify any third party whose actions may have led to the injury/illness. This will assist the County in pursuing subrogation recovery.

Telephonic Reporting

Each and every County department has access to a 24-Hour workers’ compensation injury/illness reporting service. This service is available 24 hours, 7 days per week, and will transmit the information received by the department to the appropriate workers’ compensation third party administrator within one working day.

Work Related Injury/Illness 24-Hour Telephonic Reporting

Department

Telephone Number

Unit 1000 Departments

(888) 419-0585

Unit 2000 Departments

(888) 935-2667

Unit 3000 Departments

(800) 419-0585

Unit 4000/5000 Departments

(866) 291-7121

Medical Care

Injured workers are entitled to receive all medical care reasonably required to cure or relieve the effects of the injury/illness, with no deductible or co-payments by the injured worker. Reasonable medical treatment required to cure or relieve the effects of an industrial injury/illness means treatment that is based upon the guidelines adopted by the administrative director or, prior to the adoption of those guidelines, the update American College of Occupational and Environmental Medicine’s Occupational Medicine Practice Guidelines.

Generally, the employer controls the medical treatment for the first 30 days after the injury is reported, and the employee is then free to select any treating physician or facility. However, if the employee has notified the employer in writing prior to the injury that he or she has a “personal physician” — a physician or surgeon who has previously treated the employee — the employee may be treated by that physician from the date of injury. Choice of treating physician differs; however, if the employer has developed a state certified Medical Provider Network.

Temporary Disability Benefits

Those workers unable to return to work within three days are entitled to temporary disability benefits to partially replace wages lost as a result of the injury. The benefits are generally designed to replace two-thirds of the lost wages, up to a maximum of $840 per week.

Temporary disability benefits are payable every two weeks, on a day designated with the first payment, until the employee is able to return to work or until the employee’s condition becomes permanent and stationary.

Many County employees are entitled to salary continuation benefits that are paid in lieu of state rate temporary disability benefits. Certain classes of County employees are entitled to statutorily derived benefits that exceed the state temporary disability rate.

Permanent Disability Benefits

Injured workers who are permanently disabled – those who have a permanent labor market handicap — are entitled to receive permanent disability benefits. A worker who is determined to have a permanent total disability receives the temporary disability benefit – up to $840 per week – for life. A worker determined to have a permanent partial disability receives weekly benefits for a period which increases with the percentage of disability, from four weeks for a one percent permanent disability up to 694.25 weeks for a 99.75 percent disability. Permanent partial disability benefits are also payable at two-thirds of the injured worker’s average weekly wages, but are subject to a much lower maximum. As of Jan. 1, 2004, the rates are $220 per week for disabilities less than 69.75 percent and $270 per week for disabilities rated at 70 to 99.75 percent. Those with a permanent partial disability of 70 percent or more also receive a small life pension – a maximum of $257.69 per week – following the final payment of permanent partial disability benefits.

The percentage of permanent disability is determined by using the Permanent Disability Rating Schedule and an assessment of the injured worker’s permanent impairment and limitations.

The Permanent Disability Rating Schedule specifies standard percentage ratings for permanent impairments and limitations, and provides for the modification of these standard ratings based on the injured worker’s age, occupation, and considers the employee’s diminished future earning capacity. The standard rating is adjusted for age by lowering the rating for younger workers and increasing it for older workers on the theory that it is easier for younger people to adjust to a permanent handicap. The standard rating is adjusted for occupation by increasing the rating if the permanent impairment or limitation will be more of an impediment in performing the worker’s occupation, and lowering the rating if it will have a lesser impact.

Vocational Rehabilitation Services (for injuries before Jan. 1, 2004)

Injured workers who are unable to return to their former type of work are entitled to vocational rehabilitation services if these services can reasonably be expected to return the worker to suitable gainful employment. This includes the development of a suitable plan, the cost of any training, and a maintenance allowance while participating in rehabilitation.

Once an injured worker is determined unable to return to his or her previous type of work, the employer and worker jointly select a rehabilitation counselor who will determine whether vocational rehabilitation is feasible, and if appropriate, develop a suitable rehabilitation plan. The goal of a rehabilitation plan is to return the injured worker to “suitable gainful employment” – employment or self-employment that is reasonably attainable and which offers an opportunity to restore the injured worker as soon as practicable and as near as possible to maximum self-support.

The maintenance allowance payable to an injured worker while in rehabilitation is, like temporary disability benefits, designed to replace two-thirds of lost earnings, but the maximum weekly amount is lower – $246 per week. The worker may, however, supplement the maintenance allowance with advances of permanent disability benefits up to the point where the worker is receiving the same weekly amount as he or she received in temporary disability benefits. Total costs for rehabilitation are now limited to $16,000 for workers injured on or after Jan. 1, 1994.

For dates of injury on or after Jan. 1, 2003, injured workers who have legal representation may settle vocational rehabilitation for a lump sum. Vocational rehabilitation does not apply for dates of injury after Jan. 1, 2004.

Supplemental Job Displacement Benefit (for injuries on or after Jan. 1, 2004)

This is a nontransferable voucher for education-related retraining or skill enhancement, or both, payable to a state approved or accredited school if the worker is injured on or after Jan. 1, 2004. To qualify for this benefit, the injury must result in a permanent disability, the injured employee does not return to work within 60 days after temporary disability ends, and the employer does not offer modified or alternative work. The maximum voucher amount is $10,000.

Death Benefits

In the event a worker is fatally injured, reasonable burial expenses, up to $5,000, are paid. In addition, the worker’s dependents may receive support payments for a period of time. These payments are generally payable in the same manner and amount as temporary disability benefits, but the minimum rate of payment is $224 per week. The total aggregate amount of support payments depends on the number of dependents and the extent of their dependency. Generally, the maximum (where three or more total dependents are eligible) is $160,000, though additional benefits are payable if there continues to be any dependent children after the basic death benefit has been paid.

* Increased thereafter by the percentage increase in the State Average Weekly Wage [LC 4453 (a) (10)]

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