Caldwell County Government Workers’ Comp Handbook Questions, Answers, General Information and Guidelines 8 What is the Safety Coordinator’s Role? The Safety Coordinator’s role is to initiate contact and follow through with the injured employee immediately after an accident to ensure the employee receives all workers compensation benefits provided to them. Introduction Based on the incident report completed by the employee or the employee’s supervisor, the Safety Coordinator will file the claim with Sedgwick Claims Management Services through the NC Association of County Commissioners. From this step the Safety Coordinator will facilitate communication between the employee, Sedgwick, the employee’s supervisor and treating physician as necessary until the claim is closed. When an employee misses work due to a workers comp injury, the Safety Coordinator will facilitate a return to work program with the employee. Our returnto-work program is based on a balanced employer-employee model that fosters compliance with the American Disabilities Act and related guidelines. The most important step of Caldwell County’s Workers’ Compensation process is direct and frequent communication about your workers’ comp injury or illness with the Safety Coordinator and your supervisor. It is important that you communicate with the County the status of your condition as it relates to your ability to work. It is also important for you to understand that you will be contacted as necessary by the Safety Coordinator about your workers’ comp injury/illness and claims status. The NC Workers’ Compensation Act (General Statue 97) section 25.6 dictates an employer is afforded reasonable access to medical information pertaining to an employee’s specific workers’ comp case. This is not meant as an invasion of privacy. Rather, this allows for better facilitation and understanding of each employee’s workers comp case. For Caldwell County, returning an employee to full duty work is an end goal of the overall Workers’ Compensation Process. Along with the County’s management strategies of each employee’s workers’ comp claim are the management strategies of our third party workers’ comp insurance service, Sedgwick Claims Management Services out of Charlotte. Information on Sedgwick and what to expect from them is provided later in this booklet. 2 7 What is the role of Sedgwick Claims Management Services? When an employee notifies the county of a workers’ comp injury or illness, we are required to report this claim to the NC Industrial Commission. This is done by submitting the claim through the NC Association of County Commissioners who then immediately transfer the claim information to Sedgwick. Sedgwick then assigns the claim to an adjuster. The adjuster assesses the claim and will contact the employee within 48 hours for further information and to begin the claims management procedure. Employees should expect frequent contact from their claims examiner. In addition to the claims examiner, some cases are assigned a Telephonic Nurse Case Manager and/or an On-site medical and vocational case manager. Workers’ Compensation: Caldwell County Employee Information It's important to know that not all injuries and illnesses that happen at work are covered under workers' compensation. Determination is based on injuries and illnesses that arise out of and in the course of the employment. This includes what precipitated the accident and the time, place and circumstances of the accident. This evaluation is completed by a Claims Adjuster with Sedgwick Claims Management Services, Caldwell County’s third party Workers' Compensation company. The information below is applicable when the injury is one that is covered under workers' compensation. _____________________________________________________________________ Common Questions and Answers about your Workers’ Compensation Coverage The following information was retrieved from http://www.ncacc.org/workerscomp.htm ______________________________________________________________ When a workers’ comp accident occurs that results in lost time, and once the accident is reported to Sedgwick, the case is automatically referred to a Telephonic Nurse Case Manager. The nurse will work closely with the injured employee and the treating physician to ensure that the employee is receiving the appropriate medical treatment to return to gainful employment as soon as possible. May I go to any doctor I choose? For more complicated and/or serious injuries, the case will be automatically assigned to an on-site nurse case manager once the case has been reported to Sedgwick. The on-site nurse will work with the employer, the treating physician, and one-on-one with the injured employee. If for any reason the injured employee is unable to return to their current job and responsibilities, a Vocational Specialist will be referred to the case. The Vocational Specialist will work with the injured employee to identify and locate what jobs are available within their limitations. For an initial non-emergency workers’ comp medical visit, the County has an agreement with Caldwell Industrial Medicine (828-754-8482) to see our non-emergency workers’ comp cases that occur during normal business hours. Our alternate workers’ comp facility is Hudson Primary Care (828-728-0900). Emergency situations should be treated at the nearest emergency medical facility. Depending on the nature of the injury, further treatment may be referred to other medical professionals. Similar to the County’s health care coverage through Cigna, Sedgwick recognizes a wide network of physicians and other allied medical providers. According to the NC Industrial Commission: The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The Commission may permit the employee to change physicians or approve a physician of employee's selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered Will I have to pay for the visits to the doctor? No, workers’ comp claims are covered by the County’s workers compensation insurance through the NC Association of County Commissions Risk Management Pool. Workers’ Comp insurance is separate from employee health insurance. Please do not use your Cigna health insurance card for a workers’ comp claim, and please inform the medical provider that the visit is a workers’ comp visit and covered by the County’s workers comp insurance (Sedgwick Claim Management Services). How will I be compensated for workers' comp time? In accordance with the North Carolina Workers Compensation Act, compensation will be calculated at a fixed rate of two-thirds (2/3) of the employee’s average weekly wage. Income tax is not taken from WC checks. When does an employee become eligible for lost wage compensation? Caldwell County’s Personnel Manual states: Any employee who is absent from work due to sickness or disability covered under the North Carolina Workers’ Compensation Act is subject to the following leave provisions (a) An employee may take leave without pay for the entire period of disability, and 6 3 receive any workers’ compensation benefits to which they are entitled. If the absence is expected to extend beyond twenty-one (21) calendar days, the employee must go immediately into a leave without pay status and begin receiving workers’ compensation benefits on day one (1): (b) An employee with a workers’ compensation injury/illness that is not expected to extend beyond twenty-one (21) calendar days shall be permitted to use available paid sick and/or vacation leave for the first seven (7) calendar days of the workers compensation leave. The employee will not be required to reimburse the County for this paid leave in the event the absence extends beyond twenty-one (21) calendar days. When should I receive the first payment? After you have been out of work for the waiting period (i.e. seven calendar days), you should anticipate your first check being sent the following week. Payments are sent weekly from Sedgwick Claims Management Services. State law dictates that WC checks be distributed weekly. How do I complete my time sheet when I’m out on workers’ comp? It is the responsibility of the employee’s supervisor to complete and process time sheets for each pay roll cycle during the time an employee is out on Workers Comp leave. Supervisors will complete a change sheet and these change sheets are due to Human Resources by the 20th of each month. Who determines when I am medically ready to return to work? Your treating physician is responsible for providing your medical treatment and keeping you informed about how soon he or she anticipates you will be medically able to return to full time work or a modified duty work assignment. You are encouraged to regularly communicate with the Safety Coordinator and your supervisor about your medical progress in order to plan for your return to work. Following the treating physician’s recommendations, for many employees, a modified/light duty work assignment is appropriate. For more information please see Caldwell County’s Return to Work Program description on our website: http://www2.caldwellcountync.org/safety/pdfs/returntowork.pdf Please keep in mind that immediate reporting of the workplace injury/illness allows for this process to be as timely as possible. Delayed reporting delays WC payments. Does receiving Workers Compensation affect my retirement or other accruals? What if my doctor’s office is in another city, am I expected to pay for mileage? In accordance with NC General Statues governing the NC retirement systems, you will not receive retirement system credit for any month in which you receive workers comp payments. However, there are provisions which allow the purchase of this lost time. No. You are reimbursed at the current IRS rate per mile for any trip you make to the doctor, physical therapy or hospital that is more than 10 miles one way. To be considered for mileage, please submit the NC Industrial Commission’s Form 25T. The Safety Coordinator can give you this form if you need it. What about pharmacy prescriptions I need, how do I get them? Our Workers’ Comp insurance carrier facilitates a pharmacy program. On their initial visit employees may take a form (see Safety Coordinator for appropriate form) to an approved pharmacy. Once a claim is submitted to Sedgwick, employees will receive a pharmacy card for future pharmacy visits. An employee’s vacation and sick leave is not affected by workers compensation. Employees continue earning this leave as normal. How do I find out more info about Workers Compensation? You may access information through the NC Industrial Commission at http:// www.comp.state.nc.us or call the Ombudsmen section at (800) 688-8349. How do I arrange to continue paying for health insurance and other benefits when I’m receiving workers’ compensation? If an employee is in a pay status of 50% or more full time, the County will continue contributing the employee health insurance coverage as normal. Should the employee carry a spouse, children or family, however, then in the first week of each month the employee should submit payment to the Caldwell County Employee Health Insurance fund which is received by Finance. When an employee is in a pay status of less than 50% full time, the employee is responsible for contributing the required amount to continue health insurance coverage. How long is an employee eligible to receive lost-time weekly benefits? Until the employee is able to return to work. 4 5