FUNCTIONAL AREA #4 Health, Safety & Workers’ Compensation Sfty_Workers Comp_SLIDES.pdf · Health,...

FUNCTIONAL AREA #4 Health, Safety &

Workers’ Compensation

Presented by:

Gina de Miranda, M.A., SPHR-CA, SHRM-SCP TPO Bilingual Consultant

PHRca Instructor [email protected]

HEALTH, SAFETY & WORKER’S COMPENSATION

Responsibilities under this functional area include: • Develop and implement policies and procedures to comply with state

laws and regulations regarding health and safety administration • Ensure compliance with state laws and regulations regarding health

and safety • Provide state required training programs governing health and safety

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This area is worth 12% of your test score

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Cont…Responsibilities under this functional area include: • Develop and implement compliant policies and procedures regarding

workers compensation, including return to work • Ensure compliance with state laws and regulations regarding workers’

compensation • Establish and administer documentation and records retention policies

and procedures required under state law governing health, safety, and workers’ compensation



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Knowledge under this functional area includes:

• Cal/OSHA requirements

• Injury and Illness Prevention Program (IIPP) requirements

• Heat illness prevention requirements

• Ergonomics reporting requirements

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Cont…Knowledge under this functional area includes:

• Workers’ compensation notification and reporting requirements, claims administration, and fraud

• Return to work requirements

• CA Drug Free Workplace Act

• Legal requirements for postings and notices

• Documentation and records retention requirements



WHAT DOES Cal/OSHA STAND FOR?

• CA Occupational Safety and Health Act or Cal/OSHA is the LAW

• Division of Occupational Safety and Health (DOSH) is the DIVISION that sets and monitors the standards for health and safety in CA

• Cal/OSHA, enacted in 1973, is a federally approved workplace safety program. CA, through state and local laws, provides greater levels of workplace health, safety and Workers’ Compensation than federal law

• The federal Occupational Safety and Health Act (OSHA) honors state laws that exceed or at least equal the provisions under Cal/OSHA


CA Occupational Safety and Health Act

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THE DOSH & Cal/OSHA FRAMEWORK

• Both the federal government and the state regulate safety • The CA Department of Industrial Relations has oversight over DOSH • DOSH monitors safety and health in all industries

http://www.dir.ca.gov/dosh/dosh_publications/osha_userguide.pdf • General Industry Safety Orders or GISO spell out safety standards in the workplace • TITLE 8 – of the CA CODE OF REGULATIONS requires that employers have Illness

and Injury Prevention Plans (IIPP) and specifies their contents to a certain extent

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1. Injury and Illness Prevention Program

2. Personal Protective Equipment

3. Emergency Action Plans

4. Fire Prevention Plans

5. Hazard Communication

6. Machine-Guarding

7. Lockout-Tag out

8. Industrial Trucks

9. Blood Borne Pathogens

10. First-Aid

11. Storage of Materials

12. Good Housekeeping

13. Safe Work Surfaces, Aisle Ways, and Walkways

14. Building Codes


GENERAL INDUSTRY SAFETY ORDERS (GISO)

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The Most Generally Cited GISOs include:

OFFICE OF EMERGENCY SERVICES (OES)

This office is under the Governor of the State of CA


The OES is based on four (4) phases of emergency management:

1) Preparedness 2) Response 3) Recovery and 4) Mitigation

OFFICE OF EMERGENCY SERVICES (OES)

• Support training activities for their local government and the community

• Support preparedness and disaster-recovery training for their managers and workers

• Become a link between the government and the public.

• Research and learn about state and federal disaster assistance programs.


EMPLOYEE RIGHTS UNDER Cal/OSHA • To receive training from their employer about workplace hazards and

worker’s rights

• To receive information on injuries, illnesses, and hazardous substances in their workplace, such as material safety data sheets (MSDSs) and exposure records (now called SDS)

• To request action from their employer to correct hazards or violations

• The ability to file a complaint with Cal/OSHA if it appears that there are either violations of Cal/OSHA standards or workplace hazards

• To be involved in Cal/OSHA’s inspection of their workplace by participating in the walk-around or walk-through

• To find out the results of a Cal/OSHA inspection


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EMPLOYEE RESPONSIBILITIES UNDER Cal/OSHA

• Comply with all Cal/OSHA rules, regulations and standards

• Follow all lawful employer safety and health rules and regulations

• Use all required personal protective equipment (PPE) while working


EMPLOYER RIGHTS UNDER Cal/OSHA

• Appeal citations issued by DOSH • Protect their trade secrets • Participate in developing new standards

before the Occupational Safety and Health Standards Board

• Seek variances from Cal/OSHA standards


EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA As of July 1, 2017 : Establish, implement and maintain an effective Injury and Illness Prevention Program (IIPP). Provisions included: • Train workers in safety and tool usage • Inspect the workplace to identify and correct unsafe or hazardous

conditions • Ensure safe tools and that equipment is properly maintained • Warn employees of potential hazards in the workplace • Establish and communicate operating procedures for health and safety • Provide medical examinations required by Cal/OSHA standards


Report serious injury, illness or death immediately, and no later than (8) hours, by telephone or fax to the nearest Cal/OSHA Enforcement Unit

• Non-reporters can be fined ($5,000)

• Employees serving in supervisory management or similar roles may be individually liable for up to (1) year in jail and/or a ($15,000) fine

• Corporations face fines up to ($150,000)


EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA

• Keep records (Cal/OSHA Log 300) of work-related injuries or illnesses, unless exempted by the regulations

• Post “Safety and Health Protection on the Job” at a prominent location within the workplace, the Cal/OSHA poster informing employees of their rights and responsibilities.


EMPLOYER RESPONSIBILITIES UNDER Cal/OSHA

WORKPLACE SAFETY POSTINGS and NOTICES

• All CA employers are required to post the Safety and Health Protection on the Job Cal/OSHA poster

• Postings of the list of emergency phone numbers • (If using hazardous or toxic substances) the access to Medical

and Exposure Records notice

• All covered CA employers with eleven (11) or more employees in the previous year are required to post the Cal/OSHA Summary of Occupational Injuries and Illnesses (Form 300A) from February 1-April 30 each year

• The Whistleblowers Protections notice (size 14 font+)

• No smoking signs


TARGETED INSPECTION & CONSULTATION PROGRAM (TICP)

A Cal/OSHA program that: • identifies certain high-hazard employers • requires them to pay a fee to fund a special

inspection unit. • offers other consultation services to help

businesses avoid investigations and costly fines


INJURY & ILLNESS PREVENTION PROGRAM (IIPP)

• Management commitment • Assignment of responsibilities • Safety communications systems with employees • System for assuring employee compliance with safe work practices • Scheduled inspections/evaluation system • Accident investigation procedures • Procedures for correcting unsafe/unhealthy conditions • Safety and health training and instruction • Recordkeeping and documentation


Required elements of an IIPP include:

SUCCESSFUL IIPP WILL INCLUDE:

• Actual objectives for accident and illness prevention • An emphasis on staff's safety and health responsibilities • The implicit message that management staff, supervisors

and employees will be held accountable and back this up with action

• Provide a means for employees to report unsafe conditions with assurance that management will take action

• Allocate company resources for identifying and controlling hazards in new and existing activities


IIPP SAFETY COMMITTEES

• Meet regularly but not less than quarterly • Prepare and make available written records of the

safety and health issues discussed and maintained those for review by the Division upon request

• Review results of the periodic scheduled worksite inspections

• Review investigations of occupational accidents and exposure to hazardous substances

• Submit suggestions to management for prevention of future incidents


IIPP SAFETY COMMUNICATIONS

• Occupational accident and injury history with possible comparisons to other company locations

• Feedback from the employees • Guest speakers from WC insurance carriers or agencies

concerned with safety • Brief audio-visual industry-related materials • Control of the meetings • Stress that the meeting’s purpose is safety • Management should attend these meetings


HAZARD ASSESSMENT & CONTROL (Inspections)


• Every Injury and Illness Prevention Program begins with the required hazard assessment survey/inspection by a qualified person

• An effective hazard control assessment identifies: – Hazards that exist or develop in the workplace – How to correct those hazards – Steps that can be taken to prevent recurrence – Provides that baseline against which progress is

measured 23

ONGOING INSPECTIONS

Ongoing inspections to identify and evaluate hazards: • Whenever new substances, processes, procedures, or

equipment are introduced to the workplace that represent a new occupational safety and health hazard; and

• Whenever the employer is made aware of a new or previously unrecognized hazard

• Include steps to protect employees until the hazard is abated

• Follow up on previous changes to see if those changes were effective in mitigating hazard


HAZARD ASSESSMENT & CONTROL

• Hazards should be corrected as soon as they are identified.

• For any that can't be immediately corrected, set a target date for correction

• Provide interim protection to employees who need it while correction of hazards is proceeding

• A written tracking system such as a log helps monitor the progress of hazard correction


ACCIDENT INVESTIGATIONS

• Cal/OSHA requires that employers include a “procedure to investigate occupational injury or occupational illness” as a part of the IIPP

• Accident and near-miss investigations are critical components of all safety programs

• Accident investigations should focus on why it occurred and what actions can be taken to prevent a recurrence

• The investigation should be in writing and identify the causal events as well as prevention


Who? What? When? Where? Why? How?


ACCIDENT INVESTIGATIONS

• Accidents must be followed up – corrective measures – were they successful

• Document actions taken and pending

• Any pending corrective action and reason for delaying its implementation should be identified

SAFETY & HEALTH TRAINING

• Training is one of the most important elements of any IIPP • Training allows employees to learn their job, how to use tools and

equipment and reinforces existing practices • Employees benefit from such training through fewer work-related

injuries and illnesses • Employers benefit from reduced workplace injuries and illnesses,

through increased productivity • Cal/OSHA requires IIPPs to include training for both supervisors

and employees


SAFETY & HEALTH TRAINING for SUPERVISORS

Supervisors are key to the successful implementation of an IIPP • Supervisors need training on the importance of establishing and

maintaining safe and healthful working conditions • They need to know:

• what the dangers are, • how to recognize the symptoms of exposure and • how to teach their workers how to avoid problems • and how to respond to incidents in the workplace


SAFETY & HEALTH TRAINING for EMPLOYEES

Any IIPP’s success depends upon the employees using: • General safe work practices as well as those that are job-specific • Using personal protective equipment (PPE) appropriately and

maintaining it in good condition • How to react in emergencies and when medical attention is needed • Not undertaking a job without proper safety instructions • Ensuring that mechanical safeguards are used • Reporting unsafe working conditions • Reporting any injury or illness immediately


SAFETY & HEALTH TRAINING for EMPLOYEES

• To all employees when the IIPP is first established • To all new employees • To employees changing jobs • Whenever anything new to the workplace presents a new hazard • For all supervisors to familiarize them with the safety and health

hazards • Temporary workers and vendors/independent contractors


REVIEW of CURRENT IIPP for a SAFETY & HEALTH SURVEY

• Accident, injury or illness data • Workers’ Compensation costs • Rates of employee turnover or absenteeism • Information on safety and health activities ongoing or previously tried • Company policy statements • Rules-both work and safety • Guidelines for proper work practices and procedures • Records of training programs • Compliance with requirements of CA's Right to Know Law and Hazards

Communications Standard • Employee capabilities


CITATION &PENALTIES

For NOT Complying with CA Workplace Safety Laws:

• Non-serious or minor violations, up to ($7,000) • Repeat or willful violations – from ($5,000) to ($70,000) • Serious violations – up to ($25,000) • Failure to correct or abate a violation – up ($15,000)

for each day that failure continues


When a Cal/OSHA inspector conducts an investigation or on-site inspection at a workplace:

• Employees have the right to tell the inspector about unsafe or unhealthful conditions

• Upon request, Cal/OSHA will withhold the names of employees who make statements during an investigation or inspection


FILING a COMPLAINT of WORKPLACE SAFETY in CA

EVALUATING the SUCCESS of SAFETY & HEALTH ACTIVITIES

• Reduction or elimination of injuries or illnesses • Reduced Workers’ Compensation Claims


SAFETY & HEALTH REPORTING & RECORDKEEPING REQUIREMENTS • Each employer (unless exempt by size or industry) must record

each work-related, fatality, injury, or illness that meets one (1) or more of the general recording criteria specified by Title 8

• Record each injury or illness on the Cal/ OSHA Log of Occupational Work Related Injuries and Illnesses (Form 300)

• Prepare an Injury and Illness Incident Report (Form 301) • Annually review and certify the Cal/OSHA Form 300 and post

the Form 300A no later than February 1st where employees can see it until April 30th

• Maintain the last five (5) years of these records in the files


FILING a COMPLAINT of WORKPLACE SAFETY in CA

• Even though the basic Cal/OSHA records are for reportable injuries and illnesses

• It is still a good idea for CA employers to include all (including non-reportable) workplace safety and health-related incidents to assist in pinpointing unsafe acts, conditions or procedures

• Employees must be given access to these logs • Cal OSHA specifies what personally identifying info may be

deleted from reports before they are circulated


EXPOSURE RECORDS

In addition to IIPP records: • Toxic Substances & Hazardous Exposures

Records – Physical Exam Reports – Employment Records

• Regulated Carcinogens – Additional Reporting and Recordkeeping

• Exposure records Must be Maintained for thirty (30) years

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SAFETY & HEALTH REPORTING RECORD KEEPING REQUIREMENTS

• Records of scheduled and periodic inspections – The records are to be maintained for

at least one (1) year • Documentation of safety and health

training – This documentation is to be

maintained for one year • There are several exceptions to these

recordkeeping requirements


MODEL PROGRAMS

Three model IIPP’s are available from DOSH • 1A — High Hazard Employers • 1B — Non-High Hazard Employers • 1C — Employers with Intermittent Workers

There are no requirements to use these exact programs


CAL/OSHA CONSULTATION SERVICE


Separate and Distinct from the enforcement activities of DOSH Consultants do not issue citations or assess penalties, Free Professional Assistance:

• Identify actual and potential safety or health hazards • Technical assistance support • Written summary reports • Standards Interpretation • Injury and Illness Prevention Programs (IIPP) • Helping develop and/or conduct safety and health training

HAZARD EVALUATION SYSTEM & INFORMATION SYSTEMS (HESIS)

• Answers questions about the health effects of chemical and physical agents in the workplace

• Includes procedures for identifying and evaluating workplace hazards and scheduling periodic inspections

• Exception: – Employers with <10> employees – Permitted to orally communicate and instruct employees about

job-specific assignments


SAFETY & HEALTH RECORD KEEPING REQUIREMENTS

Required Records of steps to implement & maintain the IIPP: • Scheduled and periodic inspections • Documentation of safety and health training • Periodic meetings • Identify Safety Coordinator

Recordkeeping Exceptions (Listed on page 140) • Employers with <10> employees • Low hazard employers with <20> employees • Joint Power Authority (JPA) • Labor/Management Safety & Health Committee • <1> year of employment • Emergency Medical Response (EMR) 1.1 or less


CODE OF SAFE PRACTICES

A written CODE OF SAFETY PRACTICES is required: • It Must:

– Be posted at a conspicuous location at each job site office, or – Be provided to each supervisor who shall have it readily

available • Employers Must:

– Hold periodic meetings of supervisory employees to review safety problems and past accidents

– See that supervisors conduct safety meetings at least every ten (10) working days to emphasize safety


REPETITIVE MOTION INJURIES (RMI)

The Repetitive Motion Injuries (RMI) Standard is commonly referred to as the Ergonomics Standard

• Ergonomics is the scientific study of the relationship between people and their work environments

• The RMI Standard requires employers to address workplace injuries due to repetitive motions hazards: −Work tasks that require repeated actions with the additional stress of

improper ergonomics or work-station design • Employee must report injury within 12 months


CA’s HEAT & AGRICULTURE PROGRAM

CA employers are required to take four (4) steps to prevent potential heat illness for outside workers: 1. Train all employees and supervisors 2. Provide fresh water 3. Access to shade (80+) encourage cool down breaks 4. Written procedures 46

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CA’s HEAT & AGRICULTURE PROGRAM

Additional employee protections for temperatures (95+): • Communication • Observation • Emergency Medical Services Access • Reminders to drink water • Pre-Shift meetings • For Agriculture:

– 10 minute cool down breaks every 2 hours


HEAT ILLNESS TRAINING

ALL supervisory staff should be trained in: • The specifics relating to employee work environment • Risks associated with the equipment used • Rest periods, acclimation, and water requirements • The importance of reporting, and how and to whom to report • First aid available and from whom • Signs and symptoms to look out for • Emergency medical services contact information • How to monitor and respond to hot weather reports


CA’s HAZ-COM STANDARD

All hazardous materials are required to have: • Pictograms • A signal word • Hazard and precautionary statements • The product identifier • Supplier identification

Labels cannot be removed or defaced


CA’s HAZ-COM STANDARD

1. What employers, types of substances and exceptions 2. Hazard determination 3. Safety Data Sheets (SDS) 4. Labels and other forms of warning 5. Written hazard communication program 6. Employee information and training 7. Trade secret protection

(Page 145)


INDUSTRY SPECIFIC WORKPLACE SAFETY UNITS

• Temporary & Permanent Amusement Rides • The Crane Unit • Mining and Tunneling • Pressure Vessel Unit


• Hospitals must adopt Workplace Violence Prevention and Response Programs

• California DOSH has issued an “Injury and Illness Prevention Model Program for Workplace Security”

WORKPLACE VIOLENCE PREVENTION & RESPONSE


CLASSES OF THREATS

Type I – threats or assaults that may result in injury or fatality that occur during the commission of a robbery or some other crime Type II – acts of violence that may be committed by someone who either receives or is object of a service provided by the affected workplace or victim Type III – workplace violence caused by an individual who has some employment-related involvement with the workplace


STEPS to MINIMIZE WORKPLACE VIOLENCE

• Establish an in-house team for workplace violence prevention

• Include as part of the IIPP • Prohibit threats and acts of violence in the workplace • Consider creating a Domestic Violence Policy • Train managers, supervisors and employees on the

early warning signs of workplace violence and what to do if such signs are spotted.

• Handle all terminations and other adverse job actions with care and respect

• Review and update policies and procedures


DOMESTIC VIOLENCE

CA and federal law provide protections and rights for employees who are victims of domestic violence. The California Workplace Violence Act of 1995 provides:

• The right for employees to obtain restraining orders and injunctions

• Ways for employees to help victims of domestic violence

• Employers (who can show a credible threat of violence exists) may also obtain a restraining order or injunction to help protect other workers


• Prohibits businesses from discharging toxic chemicals into sources of drinking water

• Requires businesses to give a clear warning with regard to chemicals listed by the state as causing cancer or reproductive harm

SAFE DRINKING WATER & TOXIC ENFORCEMENT - PROP 65


• Applies to the owners of buildings constructed prior to 1979

• Requires building owners and employers who know that the building has asbestos-containing construction materials to notify co-owners, employees, lessees, and tenants of the presence of asbestos in the building

ASBESTOS NOTIFICATION ACT of 1989 (CONSTRUCTION)


CORPORATE CRIMINAL LIABILITY ACT (CLAA 1989)

• Commonly referred to as the “Be a Manager, Go to Jail” Act • Criminal liability for failing to disclose concealed hazards. • The penalties include:

– Punishment of imprisonment up to three (3) years, or – a fine not exceeding: Twenty-Five Thousand Dollars ($25,000) for an individual manager

or up to One Million Dollars ($1,000,000) for a covered employer or by both imprisonment and a fine


SUITABLE SEATING

Most CA Wage Orders Provide That: • All working employees shall be provided with

suitable seats • When nature of the work requires standing, seats

shall be provided and employees shall be permitted to use such seats when it does not interfere with the performance of their duties


CA’s NO SMOKING LAW (1994)

• Bans smoking in virtually every indoor workplace • To protect workers and citizens from diseases allegedly

caused by exposure to secondhand smoke • There are also a number of anti-smoking local CA city and

county ordinances that can be even stricter than state law


• prohibits use of wireless telephones (cell phones) by a driver while operating a motor vehicle unless a hands-free device is used

• Employers are encouraged to have specific cell phone policies and may want to consider providing their workers with hands-free devices

WIRELESS TELEPHONE AUTOMOBILE SAFETY ACT (2008)


CA UNIFORM TRADE SECRETS ACT (UTSA - 1984)

A trade secret means information, including a formula, pattern, compilation, program, device, method, technique or process, that: 1. Derives independent economic value, actual or potential, from not

being generally known to the public or other persons who can obtain economic value from its disclosure or use, and

2. Is the subject of reasonable efforts to maintain its secrecy

CA courts have stated more simply that a trade secret is “information which is valuable because it is unknown to others, and which the owner has attempted to keep secret.”


CA UNIFORM TRADE SECRETS ACT (UTSA - 1984)

To protect intellectual property and other assets, CA employers generally should: • Limit access to trade secrets only to individuals who have a need to

know take electronic measures to protect trade secrets • Adopt policies or agreements, approved by their legal counsel, to

help provide further protection for information and other assets that the employer wants to protect

• Have solid Exit Procedures for all employees, consultants, and contractors


NOTE: See the Employee & Labor Relations module for further discussion of the UTSA in relation to other important California laws, such as “Section 16600” and unfair competition. In addition, the key elements of a so-called “e-policy,” which many employers have chosen to adopt, appear in the Employee & Labor Relations module under Privacy.

• Required income reimbursement and medical coverage program

• No-fault insurance • Required if even one (1) employee

Roofers with no employees required to WC insurance

• All employees are covered on their first day of employment

• Independent Contractors are excluded • Sole owner provisions apply

CA’s WORKERS' COMPENSATION INSURANCE (CWC)


CWC EMPLOYER’S COVERAGE ALL employers are required to either:

• Purchase a WC insurance policy from a licensed insurer authorized to write policies in CA or become self-insured

• Self-insurance requires state approval and has many legal requirements Resources:

• The Division of Workers' Compensation (DWC) does not provide Workers' Compensation insurance or information

• The Workers' Compensation Insurance Rating Bureau (WCIRB) can provide information about WC insurance

• The State Compensation Insurance Fund is required to provide employers with coverage, however, there are other options


CWC PREMIUMS

• WC insurance premium rates are not regulated by the state • The WC Insurance Rating Bureau issues recommended rates

and carriers must file their rates with the CA Dept. of Insurance; rates can vary from carrier to carrier

• Many factors determine premium costs including: – Industry classification, Employer’s past history of work-related injuries (known as the

experience modification or XMOD), payroll, any special underwriting adjustments such as use of a certified health care organization, and any special group or dividend programs eligible

• WC insurance is 100% paid by the employers, employees cannot be asked to pay any part of the premium


Required “Notice to Employees” poster: • In a conspicuous place at the work site

Provides employees with information on WC coverage and where to get medical care for work injuries

• Failure to post this notice is a misdemeanor that can result in a civil penalty of up to ($7,000) per violation

• California insurers are required to provide this poster to their clients

• New employees must be given the Workers' Compensation pamphlet explaining their rights and responsibilities

CWC POSTER & REQUIRED PAMPHLET


CWC INJURY & ILLNESS COVERAGE

An injury or illness will be covered by Workers' Compensation if:

• It occurs while the employee is engaged in their work – The job played an “active” role and was a “positive” factor in the injury

• During activities that are incidental to their work (i.e., arriving or leaving the workplace)

• The injury happened at home, if the employee’s work duties require tasks at home

• If they are at a company-sponsored event

• The injury or illness can be considered specific, relating to one (1) incident or exposure, or cumulative, meaning it occurred after repetitive mental or physical activity

• The injury was caused by something to which the employee was exposed during his/her employment period

Travel time to, or from, work is not included, unless the employer has control of the employee during this time.


CWC INJURY & ILLNESS COVERAGE

WC covers the following types of injuries regardless of whether first aid or surgery is required so long as the injury is either work disabling or medical treatment is required and is job related: • Cumulative mental/psychiatric injury • Specific mental/psychiatric injury • Cumulative physical injury • Specific physical injury


CWC INJURY COVERAGE

Some injuries may be excluded from WC coverage under the below scenarios:

• Employee was intoxicated or under the influence of drugs or alcohol

• Employee’s injury was intentionally inflicted • Employee was involved in roughhouse actions • Employee was convicted of a felony at the time of the

injury


Workers’ Comp

DOCUMENTATION & RETURN TO WORK The carrier or TPA, if self-insured, must provide the claim forms free of charge.

In the event of a workplace injury or illness, employers must within (1) working day:

• Provide a WC claim form to them after the work-related injury or illness is reported

• Return a copy of the completed form to the employee of receipt

• Forward the claim form, along with the report of occupational injury or illness, to the claims administrator) of receipt

• Of receiving the employee’s claim, authorize up to ($10,000) in appropriate medical treatment

• If the employee is the victim of a crime that happened at work, notice of Workers' Compensation eligibility must be given within (1) working day of the crime

• Provide transitional work (light duty) whenever appropriate


One

Day

DOCUMENTATION & RETURN TO WORK

An injured employee’s treating doctor will examine him/her and describe:

• Clear and specific limits to the employee’s job tasks or any restrictions during recovery

• Any changes needed to the employee’s schedule, assignments, equipment or other working conditions while recovering

• If the employee cannot work while recovering, then the employee cannot be required to work

• If medically authorized to return to work without restrictions, an employer usually must give the employee the same job and pay that he/she had before the injury


DOCUMENTATION & RETURN TO WORK

When medically released to return, could involve: • Regular Work – The employee’s old job • Modified Work – The employee’s old job with some

changes/modifications • Alternative Work – A new job at the same employer


Employers are only allowed to request INFORMATION THAT IS RELATED to the diagnosis and treatment provided for the injury or illness. Not the specific diagnosis or treatment.

MODIFIED or ALTERNATIVE WORK

• May be required to accept or reject the work within thirty (30) days

• Should the employee not respond within thirty (30) days, the offer may be withdrawn

• If the employee fails to respond modified or alternative work offered within thirty (30) days or rejects the work, the employee will probably not be entitled to supplemental job displacement benefits


MEDICAL PROVIDER NETWORK (MPN) HEALTH CARE ORGANIZATION (HCO)

A Medical Provider Network (MPN) is: • A group of health care providers set up by the

insurer (or the employer if self-insured) and approved by DWC's administrative director to treat workers injured on the job

• If the employees are covered by an MPN, their Workers' Compensation medical needs will be taken care of by health care providers in the network except for employees with pre-designated health care provider


A Health Care Organization (HCO) is: An organization certified by the DWC to provide managed medical care to injured workers.

PRE-DESIGNATED MEDICAL PROVIDER

• The employee can give a written notice pre-designating his/her personal physician or medical group prior to the date of injury for which treatment is sought and the notice includes the physician's name and business address

• The employee has healthcare coverage for non-occupational injuries or illnesses on the date of injury in a plan, policy or fund

• The employee's personal physician or medical group agrees to be pre-designated prior to the dates of injury. 76 ©2017 TPO - The HR Experts. All rights reserved. www.tpohr.com

It is illegal for an employer to pay medical bills directly A claim form (DWC form 1) must be filed with the claims administrator for all injuries that require more than first aid

DWC FORM 1


If a Claim Appears Invalid employers should: • Report that opinion to their WC

claims administrator • Tell them all the facts, any

witnesses, and the people they should talk to

• Follow up any phone or verbal report with a letter

WORKERS' COMPENSATION FRAUD


WC Fraud is a Crime, examples: • A Worker saying they were injured

on the job when their injury really occurred while skiing;

• An Employer saying their employees work at desk jobs when they’re really construction laborers;

• A Medical Provider billing for six (6) treatments on an injured worker when they only provided two (2).

Is a Criminal Offense: • Section 3700.5 of the CA Labor Code makes it a

misdemeanor punishable by a fine of not less than ($10,000) or imprisonment in the county jail for up to (1) year, or both

• CA issues penalties of up ($100,000) against illegally uninsured employers

• Proof of insurance should be maintained onsite and is provided to employers from their insurance carrier

FAILURE to HAVE WORKERS' COMPENSATION COVERAGE


This Concludes Functional Area 4 HEALTH, SAFETY & WORKERS’ COMPENSATION


FUNCTIONAL AREA #4 Health, Safety & Workers’ Compensation Sfty_Workers Comp_SLIDES.pdf · Health,...

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