School District Palm Beach County EMPLOYEE GUIDE Workers Compensation Program Risk Management Updated 9/04/2013
SECTION I INJURED WORKER RIGHTS AND RESPONSIBILITIES This information is being provided to you to explain your rights and responsibilities should a workrelated injury or illness occur. If you are injured on the job (regardless of severity): 1. Report your injury to your supervisor/manager/school/department secretary immediately or as soon as possible. Work-related injuries not reported timely may not be covered by Workers Compensation. If your supervisor/manager/school/department secretary is not available, report your injury to Risk Technician, at 561/434-3677 or 561/434-7440. Failure to timely report your injury or illness may be used as a defense against your claim it is important to report on the job injuries immediately to avoid such penalties. 2. IN CASE OF A TRUE EMERGENCY, SEEK IMMEDIATE MEDICAL ATTENTION, and report the matter as soon as possible. Emergency Room is for emergency care ONLY. Guidelines are available for review on the District s web site. Examples include a bone penetrating the skin or a head injury. Important: you must follow-up with one of the approved Primary Care Walk in Clinics after the initial ER visit or when your injuries have stabilized. 3. You will be asked to provide information such as: a. Your Name b. Your Home Address and Telephone Number c. Date of Birth d. Employee ID e. Date, Time, Location and Nature of the Injury 4. If you require medical treatment, an authorized medical provider will provide the treatment you need for your work-related injury. Your authorized medical provider will be in charge of your care and will refer you to specialists as needed. All care must be authorized in advance of receiving treatment. Any treatment that is not authorized may not be covered. Depending on the severity of the injury, a nurse case manager may be assigned to assist in arranging medical treatment for your work related injury. a. The list of approved workers compensation ( WC ) clinics/doctors is located on the District s WC website: Authorized treatment and care may include: 1
a. Doctor Visits (see Guidelines for Doctor Visits on the District s WC website) b. Hospitalization c. Physical Therapy d. Medical Tests e. Prostheses f. Prescription Drugs g. Travel expenses to and from an authorized medical treatment or a pharmacy 5. If you are on school-related travel or away from your work site when a work-related injury occurs, call your supervisor/manager or/school/department secretary or Risk Management to report your injury immediately. They will help you get medical care. To report claims after normal working hours, call 1-877-815-3272. 6. You must have authorization before receiving medical treatment. YOU WILL BE RESPONSIBLE FOR ANY UNAUTHORIZED MEDICAL SERVICES OR TREATMENTS. 7. You must provide a copy of the Medical Treatment/Status Reporting Form (DWC25) after each medical appointment to your supervisor/school/department secretary. This form is commonly referred to as the Work Status Form. 8. You must return to work when you are released by your physician (check box 21 or 23 on the work status form) to avoid suspension of your lost wage benefits. In most cases, you will be permitted to work within your WC physician-assigned restrictions. Contact Risk Management if your supervisor is not permitting you to work within your assigned restrictions. 9. Once you reach maximum medical improvement (MMI), you are required to pay a $10 co-payment per visit for medical treatment for your work related injury or illness. The date of Maximum Medical Improvement means the date after which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability. In other words, more treatment is not valuable. MMI is determined by your treating physician. 10. If you are unable to work or your earnings are lower because of a work-related injury, you may be able to receive some wage replacement benefits. You may be eligible for wage benefits if you have been disabled for, generally, more than ten calendar days and have been taken off work by your authorized WC doctor. a. If you qualify, wage replacement benefits will generally begin on the eleventh day of temporary disability. In most cases, the wage replacement benefits for total disability will equal two-thirds of your pre-injury regular weekly wage, but the benefit will not be higher than Florida s maximum average weekly wage. b. In some cases, such as for temporary workers, per section 440.12(1) of the Florida Statutes, no wage replacement or compensation benefits shall be allowed for the first 7 days of disability, except for certain catastrophic injuries. 2
However, if you are disabled for more than 21 calendar days due to your workrelated injury or illness then wage replacement or compensation benefits may be paid for the first 7 days of disability. 11. Regular, full-time employees will receive 10 days of Line of Duty pay subject to eligibility contained in the Guidelines for In Line of Duty located on the District s web site. SECTION II 12. You are allowed one change to another physician per accident. Your request must be directed to your WC adjuster in writing. The provider must be of the same specialty as the one you are seeking a change from. The doctor must accept you. 13. Statute of Limitations Generally, you have two years from the date of your injury or illness or one year from the date of your last authorized medical appointment to claim workers compensation benefits if you have not been under continuous and active treatment. You should contact your WC adjuster to determine eligibility. GENERAL PROCEDURES A. Reporting an Injury 1. Immediately report any work-related accident or injury to your supervisor/manager/school/department secretary. 2. If no one at your work location is available, report any work-related accident or injury to Risk Management (561) 434-8677 (PX 48677) or (561) 434-7440 (PX 47440). After working hours, call 1 (877) 815-3272. 3. Once you have reported an accident or injury, you should seek medical treatment if needed from one of the approved workers compensation Primary Care Walk In Clinics. Your school or department will give you a copy of the WC list of clinics. It is also located on the District s website. B. Telephone Numbers: WC ADJUSTERS: Claims Adjuster 1 (800) 482-3272 Risk Management (561) 434-8677 or (561) 434-7440 3
OTHER: Florida Division of Workers Compensation Employee Assistance Office 1-800-342-1741 SECTION III FREQUENTLY ASKED QUESTIONS 1. What should I do if I am injured and need emergency treatment? You should obtain medical treatment at the nearest hospital or appropriate facility. When your condition no longer requires emergency treatment, you will be directed to an authorized Workers Compensation medical provider for continuing treatment. Be sure to report the claim timely to your supervisor/manager/school/department secretary. Guidelines for emergency room treatment are located on the District s website. Lack of timely reporting does not qualify as criteria for a visit to the emergency room. Many of our clinics are open from 8 am to 8 pm, Monday through Sunday and should be used for most injuries. 2. If I am injured and it is not an emergency situation, where do I go for medical treatment? You will need to advise your supervisor/manager/school/department secretary, who will assist you in finding an authorized Workers Compensation medical provider in the immediate area. If you are out of Palm Beach County, such as on a field trip, you should seek treatment at the nearest authorized walk-in clinic and report the claim by phone to ensure that you will not be charged for unauthorized medical care. The list of authorized providers is on the District s website (link above). 3. What if I have two jobs and now that I am out on Workers Comp, I can t work? Can I apply for the additional wage loss of my second job? Yes. Wages earned in a second job may also be incorporated into the calculation of your average weekly wage. You are responsible for providing information concerning the loss of earnings from the concurrent employment. Please discuss your secondary employment and wage loss with your WC adjuster in order to determine if you are eligible for wage loss benefits from both jobs. 4. What should I do if my doctor wants me to work in a light duty or restricted capacity? Advise your supervisor/manager about the restrictions. You should receive a DWC 25 form from the doctor which lists any limitations. Generally, the District will accommodate light/transitional duty within the same job. Contact Risk Management if any questions arise. If you feel too sick or injured to return to work after your doctor has released you to light duty, your lost time will be marked as sick, annual, or without pay. After 10 days without pay, all rules for Leave of Absence apply. 4
5. What if the Workers Comp Provider decides that I need to see a specialist such as a Neurologist? Once your authorized medical provider refers you to a specialist, your WC adjuster will arrange the referral, if appropriate. 6. What if I decide that I would rather see a specialist - can I request or select one on my own? No. All referrals to a specialist have to be made by your authorized medical provider and reviewed by the WC adjuster. If your authorized medical provider does not believe the referral is necessary, you can contact your WC adjuster to discuss your treatment plan. 7. After exercising my one-time change in physicians, what should I do if I am still dissatisfied with my medical provider? You should immediately express your concerns to your WC adjuster. 8. Will I have a co-pay? Employees who have reached Maximum Medical Improvement (MMI) will be responsible for a $10 co-pay for every office visit after that date. 9. Is Chiropractic treatment covered? Chiropractic Treatment is limited to 18 visits or 8 weeks, whichever comes first, provided you have the proper referral for chiropractic treatment and this treatment has been authorized by your WC adjuster. 10. What happens if I have to attend physical therapy or a doctor s appointment during the workday? Will I get paid for my absence? Schedule all appointments before or after working hours or least disruptive to the workplace. See website for Guidelines for Doctor s Appointments and Guidelines for Line of Duty. Very few doctor s appointments or therapy are subject to Line of Duty. 11. What if I have a question that isn t addressed here? Please contact your WC adjuster or Risk and Benefits Management (561) 434-8677 or (561) 434-7440. Other frequently asked questions are located on the District s web site. Note: In the event this document conflicts with State law or the collective bargaining agreement, the terms of the contract or State Law shall prevail. 5