PROTOCAL FOR WORKERS’ COMPENSATION INJURY

REPORT TO BUILDING ADMINISTRATORS AND/OR OFFICE MANAGERS

THEN;

CONTACT RISK MANAGEMENT

DEBBIE FAAST x4203; Fax x4336

IMMEDIATELY AFTER INJURY.

24 HRS / 7 DAYS A WEEK

RISK MANAGEMENT

720-972-4911

DEBBIE FAASTx4203 303-887-1204(24 hrs / 7 days a week)

PHIL PADILLAx4210303-588-3569(24 hrs / 7 days a week)

COMM CENTERx4911720-972-4911(24 hrs / 7 days a week)

ONLY DEB FAAST/PHIL PADILLA;ARE ALLOWED TO AUTHORIZE MEDICAL TREATMENT AND THEY ARE AVAILABLE (24 hrs / 7 days a week)

CLAIMANTS AND SCHOOLS RESPONSIBILITY

(Principal or Office Manager may fill out paperwork for claimant)

Supervisor and/or Principal Signature Mandatory

Provide the following information when calling Risk Management:

  1. Your Name, Your School/Department, Your Phone Number.
  2. The Injured Employees Name, Type of Injury, Date of Injury, Social Security #.

Then;

1.Fill out a Workers’ Compensation Accident Worksheet. All three (3) pages must be completed and signed by claimant. The employee must select a Medical Provider and sign the 3rd page, prior to treatment.

2.Please scan signed document to Debbie Faast, ESC Building or Fax signed worksheet to Risk Management x4336 A.S.A.P. then file in employees file.

3.Risk Management will authorize medical treatment at the appropriate location and file initial claim through the insurance company.

After initial injury;

Employee is responsible for:

  1. Scheduling and attending all Doctor and Physical Therapy Appointments on their own time, but will be reimbursed mileage from the W.C. Insurance Company.
  2. Scheduling all appointments at a time that will not interrupt the work day or interfere with their job responsibilities.
  3. Providing your supervisor with all documentation received from the Doctor the same day.
  4. Informing their supervisor of restrictions and modified duty, if any, and to work within those limitations.
  5. Notify Risk Management if their school cannot accommodate their restrictions or with any other problems or concerns including but not limited to safety issues.
  6. Employee is responsible to report to work when released to modify duty. Any time taken off during this time will be documented as temporary leave, vacation or no pay.
  7. Tracking their workers’ comp hours and submitting them to supervisor by the 15th of the month.

PROTOCAL FOR WORKERS’ COMPENSATION INJURY

REPORT TO BUILDING ADMINISTRATORS AND/OR OFFICE MANAGERS

THEN;

CONTACT RISK MANAGEMENT

DEBBIE FAAST x4203; Fax x4336

IMMEDIATELY AFTER INJURY.

24 HRS / 7 DAYS A WEEK

RISK MANAGEMENT

720-972-4911

DEBBIE FAASTx4203 303-887-1204(24 hrs / 7 days a week)

PHIL PADILLAx4210303-588-3569(24 hrs / 7 days a week)

COMM CENTERx4911 720-972-4911(24 hrs / 7 days a week)

ONLY DEB FAAST/PHIL PADILLA; ARE ALLOWED TO AUTHORIZE MEDICAL TREATMENT

AND THEY ARE AVAILABLE (24 hrs / 7 days a week)

School is responsible for:

  1. Determine the severity of injury, whether an ambulance should be called.
  2. Notifying Risk Management immediately after injury.
  3. Complete Workers’ Compensation Accident Worksheet (3 pages). Please scan signed document to Debbie Faast, ESC Building or Fax signed worksheet to Risk Management x4336 A.S.A.P.
  4. Accommodating restrictions and modified duty of injured employee if possible. If not possible, contact Risk Management to schedule modified duty at the ESCBuilding or work pools throughout the district.
  5. Record and enter hours for the employee when excused under Workers’ Comp. Please work closely with the Risk Management Coordinator x4203; when reporting this time to ensure accuracy. Initial injury time at doctor’s office will be covered; up to 2 hours unless stated by Doctor, any time after that (P.T. and Dr. Appointments) will be on employees’ own time, unless stated from Doctor. Per the Master Agreement, Adams 12 will cover the first 3 days of W.C. time for surgeries or excused absences from the W.C. Doctor only. The insurance company picks up lost time after the first 3 days. The W.C. Insurance Coordinator approves hours through the Payroll system.
  6. Inform Risk Management when employee does not call or show up for work or with any questions or concerns.

Risk Management is responsible for:

  1. Employees’ safetyhealth,is first priority. Verify employee is receiving the best medical treatment available.
  2. Scan/Fax over Medical Authorization and Workers Comp. Accident Report prior to appt. if possible. If urgent, send claimant to appt, and request doctors office to have claimant complete forms (WC Worksheet) then Scan/Fax to Risk Management. x4336
  3. Follow-up with the school on status of injured employee immediately after treatment.
  4. Notify supervisorif employee is not able to return to work, and verify that a sub has been called in.
  5. Verify that modified duty will be available at the school.
  6. Notify school after each doctor’s appointment with verification of next scheduled appointments/physical therapy and restrictions by mail, email or voice mail.
  7. Verify Workers’ Comp hours with Payroll and appropriate schools.
  8. Authorize prescriptions as needed.
  9. Maintain copies of all activities for each claim.
  10. Notify school when claim has reached MMI (Maximum Medical Improvement) and that Workers’ Comp claim is closed or if claim is closed and has permanent restrictions.
  11. Verify with School Representative and Payroll all Workers’ Comp hours, and provide authorization.
  12. If permanent restrictions do not allow employee to return to regular job, a discussion between employee, Risk Management, and Human Resources will take place to determine if and where claimant will be placed.
  13. Possible Fit for Duty may be requested at this time.