Human Resources Department s1

HUMAN RESOURCES DEPARTMENT

City of Burlington ______

131 Church Street, Burlington, VT 05401 Voice (802) 865-7145

Fax (802) 864-1777

TTY (802) 865-7142

WORKERS’ COMPENSATION PROCEDURES

Injury Notification

Any employee injured on the job, however slightly, must report the incident/accident immediately to his/her supervisor. The employee must then complete an internal incident report or a First Report of Injury. All attempts should be made to make sure the incident or accident is reported promptly. If the report is unable to reach Human Resources within 24 hours, the supervisor should contact Lynne Perry by phone or email with specifics so that the City’s Workers’ Compensation carrier, St. Paul Travelers, can be notified.

The supervisor and the employee should discuss the incident or accident. Safety policies and procedures that were or could have been in place to prevent the injury should be reviewed along with the use of safety equipment. The supervisor should complete an incident investigation report and forward or fax to the Human Resources Department within (2) days of the event (Fax -864-1777).

Medical Treatment

Workers’ Compensation law, Administrative Rule #12, allows the City of Burlington to refer an employee to a particular provider (s) for the first visit after an injury. In the case of an emergency, the City may request follow-up treatment with a particular provider. (See Medical Examiners) After the employee's first visit with the City’s designated provider, the employee may choose to treat with his/her own physician once the employee completes the Vermont Department of Labor and Industry FORM-8. The employee must indicate reasons for dissatisfaction and identify the physician or provider with whom they intend to treat. The FORM-8 should be forwarded directly to the insurance company or to Human Resources. The City of Burlington can refuse to reimburse for medical expenses if these guidelines are not followed. (Fire and Police, check policy.)

Absences

Absence following a work-related injury must be documented. If an employee has not completed an incident report or the First Report of Injury, sick time will be used as wages.

An injured employee must inform his/her department immediately if they have been instructed to remain at home by the physician. This notification must be put in writing by the physician and the employee’s department must receive this by the end of the day of the office visit. The department will then notify the Human Resources Department.

If an employee who is released by his/her physician to perform light duty refuses to return to work, payments by the insurance company and payment of the supplement may be suspended. (Police and Fire, check policy.)

Lost time that is due to an accepted work-related injury shall be reported on an employees’ time sheet as “injury leave”. Restricted time and time used for injury-related medical treatment should be coded correctly for inclusion on the OSHA log.

A Wage Statement will be requested by the insurance company for the 12 weeks prior to the week in which the injury occurred for all reported claims.

Wage Replacement

The City of Burlington is not required to reimburse injured employees for the first three days of absence unless the absence is greater than ten days in duration. However, Regular and Limited Service employees will receive pay for those first three days of absence. In addition, because the City does not want employees to go without pay or be required to use sick or annual leave, employees will continue to be paid until the insurance company begins to pay. This practice will be reviewed monthly on an individual case basis.

When St. Paul Travelers begins to pay the employee, they will do so by a check that will be sent to the employee’s home. This check will include compensation for days already paid by the City. When this happens, the employee is required to reimburse the City. He/she should contact Human Resources immediately upon receiving this check.

Failure to reimburse the city will result in deducting sick leave from the employee’s accrued sick time in the amount of any overpayment.

Regular and Limited Service employees are eligible to receive a supplement from the City. The supplement is taxable and will be paid for a period not to exceed a total of twelve months for any one injury. Whether you do or do not receive a supplement is dependent upon the criteria in your Union Agreement or the Personnel Policy Manual. Unless you qualify for this supplement, you will receive your entire pay from the City’s worker’s compensation insurance company.

Because the City will not be paying you, you will be required to pay for your health, dental, supplemental life insurance and retirement as appropriate. If you do not make arrangements to repay these deductions and retirement contributions within three months, it is our standard practice to double up the deductions upon your return until the contribution amount is fully repaid. If your absence is lengthy we may exercise our right to require you to pay your contribution to health insurance monthly to keep the insurance active. Should this be the case, we will notify you in writing of what your obligations are and what the consequences are of failing to make the payments.

Deductions such as Union dues, 457 Plan, credit union, etc. are your responsibility. If you fail to make contributions to Flex and DCAP while you are our and do not catch up upon return, you will be unable to submit expenses for the period of time during which you had no deductions. Please feel free to discuss this with your Payroll Department or Human Resources.

If, after review, the insurance company finds that your injury is not compensable, you will have the right to appeal. Time paid you by the City will be deducted from your accruals. If your appeal is successful, all time will be returned to you.

Light Duty

Employees should be encouraged to notify his/her physician that temporary light duty is

an option. Specific limitations and an anticipated transitional plan for a return to full duty should be noted in any correspondence from an injured employee’s physician.

The employee’s department will review his/her restrictions and transitional plan to determine whether a suitable light duty position is available.

The City makes every effort to provide an employee who is unable to perform the essential functions of his/her position due to a work-related injury with a temporary light duty assignment. However, any light duty assignment will be temporary in nature. An injured employee will fully resume his/her regular position and the temporary position will terminate upon certification from the physician that the essential functions of the position can be performed.

Employees are required to return to work when light duty is available and they have been released by his/her physician. Failure to do so may result in a suspension of certain workers’ compensation benefit payments. (Police and Fire, review policy)

Medical Appointments

Employees who have completed an incident report or First Report of Injury and at a later time see the physician should contact the Human Resources Department immediately so that St. Paul Travelers can be notified.

Medical appointments that can not be scheduled for non-work time can be scheduled during work hours. This time will not be paid on an overtime basis. Employees should attempt to schedule appointments at a non-disruptive time for the department whenever possible. The employee’s department should be notified of all absences for medical appointments.

City’s Approved Providers/Medical Examiners

Concentra Champlain Valley Urgent Care

110 Kimball Avenue, Suite 115 7 Fayette Road

South Burlington, VT 05403 South Burlington, VT 05403

802-658-5756 802-865-3655

For medical treatment after hours or in the case of an emergency:

Fletcher Allen Emergency Room

111 Colchester Avenue

Burlington, VT 05401

802-8472434

If you need additional information or have any questions, please contact Lynne Perry in Human Resources at 865-7148 or .

EMPLOYEES SHOULD:

Immediately notify Supervisor

Complete Incident Report or First Report of Injury

Review Form and accident with supervisor and discuss how the accident could have been avoided

Attend first medical visit with the City’s Provider

Provide supervisor with evidence of restrictions or lost time

Contact Human Resources if medical treatment is sought at any time other that when the accident occurred.

Complete Form 8 if the decision is made to treat with anyone other then the City’s approved Providers.

Forward a copy of the Form 8 and all medical bills to Human Resources

Return to work when released for modified or full duty.

SUPERVISORS SHOULD:

Review and sign the incident or First Report of Injury and forward immediately to Human Resources. Copy the individual responsible for the completion of the OSHA logs.

Perform an accident investigation using the form provided by the City.

Discuss safety equipment, policies and procedures with the employee

Ensure that when an employee requires treatment, he/she goes to the City’s approved providers

Review all restrictions and coordinate light duty as appropriate

Ensure that injured employees follow restrictions

Notify HR if the employee begins to lose time due to a work-related injury or seeks treatment after the initial report of the accident

Forward all restrictions, notifications and bills to HR

Support all efforts to return the injured employee to work as soon and as safely as possible.

CITY’S APPROVED PROVIDERS/MEDICAL EXAMINERS