LAS VEGAS FIRE & RESCUE
STANDARD OPERATING PROCEDURES
ADMINISTRATION / WORKERS’ COMPENSATIONReviewed Date:
Effective Date: / 04/17/06
Supersedes: / 05/26/97 / SOP / 100.11 / Page 1 of 18
I. INTRODUCTION
A. Purpose: To provide information regarding the correct procedures to initiate a workers’ compensation claim due to a job related illness or injury.
B. Scope: These instructions are to be used by all Department personnel whenever an injury or illness occurs on duty.
C. Author: The Deputy Chief of Administration, through the SOP Coordinator, shall be responsible for the content, revision and review of this instruction.
D. Authority: Nevada Revised Statutes Chapters (NRS) 616, 617, and 618.
E. Objectives:
1. To assure that employees get quality care and the treatment needed for any work-related injuries or diseases that may occur.
2. To assure that employees entitled to workers’ compensation benefits for work-related injuries or diseases are not disqualified for benefits because of a procedural error.
3. To provide step-by-step procedures for completing all necessary paperwork and forms in accordance with the laws of the State of Nevada and City of Las Vegas policy.
F. Definitions:
1. Workers’ Compensation Forms:
a) C-1 - Notice of Injury or Occupational Disease/Incident Report (CLV 7040 6/94). See Appendix I.
b) C-3 -- Employer’s Report of Industrial Injury or Occupational Disease (CLV 7034 6/94) See Appendix II.
c) C-4 - Employee's Claim for Compensation/Report of Initial Treatment (CLV 7041 6/94) See Appendix III.
d) Certificate of Recovery and Fitness (Medical Release) See Appendix IV.
2. Accident: Defined by NRS as an unexpected or unforeseen event happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury.
3. Injury and Personal Injury: Defined by NRS, means a sudden and tangible happening of a traumatic nature, producing an immediate or prompt result which is established by medical evidence, including injuries to prosthetic devices.
II. RESPONSIBILITY
A. All Personnel shall use this instruction for any injury or illness incurred as a result of employment with the Las Vegas Fire Department.
B. All Supervisors shall assist their subordinates in obtaining medical care, if needed, and complete the supervisor’s portion of all workers’ compensation forms. Supervisors shall also be required to submit all paperwork and forms in a timely manner, within in seven (7) calendar days, not shifts.
C. Deputy Chief of Administration shall coordinate the workers’ compensation program with the Workers’ Compensation Administration Division, injured employees and supervisory personnel.
D. Office Specialist II assigned to the workers’ compensation program shall be responsible for auditing the rosters, associated forms and other paperwork for compliance to City policy. This person maintains an employee injury log and processes workers’ compensation forms submitting them to the appropriate person in the Workers’ Compensation Administration Division.
III. POLICY
The following policy is from the Workers’ Compensation Administration Division. Under the PROCEDURES section of this instruction are the specific step-by-step instructions to adhere to this policy.
A. ELIGIBILITY: All classified, appointive, and hourly personnel who are injured or acquire occupational disease out of or in the course of their employment with the City of Las Vegas are eligible for workers’ compensation benefits.
B. REPORTING: Regardless of the degree of severity, each occurrence should be reported as soon as possible by the employee (within seven (7) days) in writing using a C-1 form (Notice of Injury or Occupational Disease/Incident Report) to his or her supervisor.
C. SUDDEN, SEVERE ILLNESS OR INJURY: The Department will transport you immediately to the nearest authorized/appropriate emergency care facility in case of sudden, severe illness or injury.
D. REOCCURRENCE OF A PREVIOUSLY REPORTED INDUSTRIAL INJURY: Advise your supervisor immediately and contact the Workers’ Compensation Administration Division for further instructions in the event of the reoccurrence of a previously reported industrial injury.
E. UNACCEPTED CLAIMS: If a claim is denied, instructions and appeal rights are provided to the employee by the Workers’ Compensation Administration Division.
F. TRANSITIONAL WORK ASSIGNMENTS (LIGHT DUTY): These assignments will be provided to every City employee with a valid Workers’ Compensation claim, if available, and if authorized by the employee’s physician. If your Division has nothing available, the Department will contact the Workers’ Compensation Administration Division for placement. (See SOP 100.12 for Transitional Work Assignments/Light Duty)
G. LOST TIME: To receive benefits, you must provide the Department with a physician's certificate stating you are unable to work for a specific time period. If you are to remain off work at the doctor's instructions after the time written on the certificate, you must have your doctor write a new certificate for you. Certificates statutorily must contain limitations and restrictions.
IV. PROCEDURES
A. The City of Las Vegas maintains a self-insured and self-administered program for industrial claims. This program adheres to all applicable state statutes and regulations.
B. MEDICAL CARE: When an injury or illness results from job related activities the first priority is medical care for the employee.
1. The City of Las Vegas uses a preferred provider organization. This process ensures that City employees will receive the best care as quickly as possible since the City's injured or ill employee will receive priority treatment. The current preferred provider list is attached as Appendix V.
2. In life threatening emergency situations, Las Vegas Fire Department Rescue Units will transport employees to the closest appropriate medical facility.
3. If no medical care is required at the time of injury or illness, this does not diminish a potential claim. Often medical care is required at a later date. Personnel must adhere to this SOP regardless of whether medical care is rendered at time of injury.
C. The initial treating medical facility or physician must complete a C-4 Employee's Claim for Compensation/Report of Initial Treatment. They will send this to the City of Las Vegas. Occasionally the physician/facility will give the completed C-4 to the employee after treatment. If this is the case send the completed form to the Deputy Chief of Administration with the other required forms. It is the employee’s responsibility to make sure this form is submitted. This form initiates the claim.
1. Completing the C-4: The top portion is to be completed and signed by the employee. The bottom portion must be completed by the initial, treating physician.
2. The employee should take the C-4 to the primary care physician/facility, who will complete the form and distribute the copies.
D. WORKERS’ COMPENSATION FORMS REQUIRED FOR OCCUPATIONAL INJURIES/ILLNESS: After the issue of medical treatment has been resolved and a C-4, Employees Claim for Compensation/Report of Initial Treatment form, has been completed the following forms must be completed.
1. C-1 - Notice of Injury or Occupational Disease (Incident Report): This form is completed and signed by the employee and then signed by their supervisor. The C-1 should be completed at the time of injury, unless the injury is an emergency situation. This form also has a block for the name of any witness to the injury or illness. Send this form in with the others to the Deputy Chief of Administration. The Office Specialist II assigned to the workers’ compensation program will distribute the copies of the C-1 as follows:
Original - Workers’ Compensation Administration - within seven (7) calendar days from date of injury
Yellow copy - Department
Pink copy - Employee
NOTE: This form must be submitted to the Workers’ Compensation Administration Division within seven (7) calendar days, not shifts, from the date of injury. The C-1 is the employees responsibility, submission beyond the seven (7) days may result in the claim being denied.
2. C-3 - Employer's Report of Industrial Injury or Occupational Disease: The injured or ill employee's supervisor completes this form and signs it. Once the supervisor is made aware of an injury or disease related to work, the C-3 must be completed and sent in. The form design and information required is mandated by the State of Nevada. Complete as much of the form as possible. The bottom one-third of the form is completed by personnel in Payroll. Supervisors must sign the form in the block entitled "Employers signature and title." The injured employee is also required to sign this form. The Office Specialist II assigned to the workers’ compensation program will distribute the copies of the C-3 as follows:
Original - Workers’ Compensation Administration
Yellow copy - Department
Pink copy - Employee
NOTE: The C-3 is the Employer’s (Supervisor’s) responsibility. Failure to submit the C-3 within seven (7) days of notice may result in the City of Las Vegas being fined by the State of Nevada. It is imperative that supervisors submit the C-3 as soon as possible in order for the Department to comply with the seven (7) day time limit.
3. Place completed forms in an inter-department delivery envelope and route to the Deputy Chief of Administration.
4. The Deputy Chief of Administration will review the forms for completeness and required signatures. The forms will be delivered to the Office Specialist II assigned to the workers’ compensation program who will enter information into the workers’ compensation log and distribute the copies.
NOTE: The Claim will be accepted or denied by the Workers’ Compensation Administration Division. All instructions regarding the claim at this point are provided by the Workers’ Compensation Administration Division.
E. POST INJURY/ILLNESS WORK STATUS: The treating physician will determine if an employee must be:
· off-duty for a disability;
· can return to full duty with no restrictions; or,
· return to duty with restricted activity (transitional work assignments/light duty).
1. CERTIFICATE OF DISABILITY or PHYSICAL CAPACITIES EVALUATION: To receive benefits, the injured employee must provide the Department with a physician's Certificate of Disability or Physical Capacities Evaluation covering the period of disability. When the certificate expires, and additional time off is required, the physician must complete a new Certificate of Disability or Physical Capacities Evaluation. Employees are to provide these certificates to the Office Specialist II in Administration. If this form is not provided, it may effect the employee’s benefits.
2. TIME CARD CODING: If an employee is off-duty due to an occupational injury or illness and has a physician’s Certificate of Disability or Physical Capacities Evaluation, the time off should be coded "Workers’ Compensation Paid" - line 22. If at a later date the claim is denied, adjustments to payroll can be done at a later date.
Paid coverage of 100% is provided to IAFF employees for sixty (60) calendar days, if the claim is accepted. If denied, adjustments will be made changing the lost time to sick leave. After the sixty (60) days has elapsed and if the employee is not able to return to work, the Workers’ Compensation Fund pays approximately 2/3's of their average monthly salary up to the State allowable maximum. After the sixty (60) days of full coverage, the employee has two options for pay.
OPTION #1:
· When full coverage (60 days) expires, the employee may receive a full pay check by using their accrued sick leave or annual leave time to supplement the amount paid from the Workers’ Compensation Fund.
· Record the total number of hours off to the appropriate leave line. As a result, the employee will receive full pay and full benefits. Approximately 2/3 of the average monthly wage will be charged to the Workers’ Compensation Fund and 1/3 to the employee's accrued leave. This option could continue as long as medically approved.
OPTION #2:
· If full coverage (60 days) expires and the employee does not have leave available or elects not to use accrued leave time to receive full pay the following option is to be used. Record the total number of hours off on "Workers’ Compensation WOP" - line 29. As a result, the employee will receive only the amount of money he/she is eligible for under Workers’ Compensation coverage, approximately 2/3 of the average monthly wage, up to the State allowable maximum. The City will not take any deductions from the Workers’ Compensation check and direct deposit is not available with this option. The employee taking this option must realize that deductions for dependent medical coverage and the Public Employees Retirement System (PERS) cannot be taken from the workers’ compensation pay check. Deductions from workers’ compensation checks is disallowed by Nevada statute. Employees taking this option must contact the Benefits Section of Human Resources or the IAFF Insurance Trust representative depending on which insurance they have. The employee will receive their check through his/her department.
3. VACATION USAGE WHILE OFF Taking a vacation during a Workers’ Compensation claim is discouraged, since you must be under a physician's care and able to actively participate in your treatment, to receive benefits. Employees with scheduled vacation during the time they are off due to an occupational injury or illness must have the treating physician's approval in writing. Any time spent on vacation must be coded to the time card as “Vacation Leave” - line 15.
F. FITNESS FOR DUTY EXAMINATIONS If an employee is off-duty for more than thirty calendar (30) days, regardless if the injury occurred on-duty or off-duty, they will be required to submit to an examination to determine their fitness for duty based on the Department's Medical Standards (SOP 100.04). This examination is conducted by the medical advisor to the City of Las Vegas. This physician has been provided with a copy of the Medical Standards and is familiar with the duties of fire department personnel. The fitness for duty status will be recorded on the department's form "Certificate of Recovery and Fitness" (Medical Release). See Appendix IV.
G. TRANSITIONAL WORK/LIGHT DUTY ASSIGNMENTS Transitional work assignments (light duty) will be provided to all employees with valid Workers’ Compensation claims, if available and if authorized by the employee’s physician. The Fire Department may not always have transitional work assignments (light duty) available. If the Department does not have a transitional work assignment (light duty) available, the Workers’ Compensation Administration Division will attempt to locate a light duty assignment elsewhere in the City.