Office on Volunteerism and Community Services. §65.2-603 Duty to Furnish Medical Attention Offer a...
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Transcript of Office on Volunteerism and Community Services. §65.2-603 Duty to Furnish Medical Attention Offer a...
§65.2-603 Duty to Furnish Medical AttentionOffer a panel of three physicians–
http://www.covwc.comIt is important to offer a panelSend in documentation of panel offeringReferrals to other doctors must come from panelInjured workers cannot change physician without
authorization
What Constitutes a Proper Panel?Three physicians who do not share a community
interest in a joint practiceNot valid if includes a physician unwilling to see
new patients or take WC patientsMay not be valid if travel of 50 miles each waySpecialty Panels—eye injuries, etc...Medical clinics do not meet panel requirements
as physicians must be listed by nameAvoid chiropractors, orthopedics are preferred
Where Can an Agency Locate a Panel?Online at http://www.covwc.com
Contact:Chad Smith or LaTarsha McMahand
Return to Work Specialists [email protected] or 804-786-2311 [email protected] or 804-786-2310
What Documents Do I Submit?First Report of Injury via Visual Liquid Web
(VLW)Anything Signed by the EmployeeSupervisor’s/Safety Officer’s Investigative
Report/PhotosWritten Witness StatementsMedical ReportsAny Police Reports
First Report of Injury Submit the claim electronically via Visual Liquid
WebVisual Liquid Web claim entry is
https://apps.frankgates.com/vaear-hr
Mail supporting documentation to:Managed Care InnovationsP.O. Box 1140Richmond, VA 23218
Electronically submit scanned documents:[email protected]
Identification of AmeriCorps in VLW
Employer Section AgencyAmeriCorps c/o DSS-OVC, Richmond, VaAgency 998
If there is an additional employer or location utilize the Employer case number and location fields in the Employer section
Claims Handling ProceduresIf claim cannot be immediately determined to be covered, the following activities may occur:
Investigations/Recorded StatementsAgency Internal Investigations or PhotosWritten Request for Information from Employer
and Medical Provider30 Day Letter will be sent if no decision can be
made
Coverage for Injuries Under the ActEmployees are entitled to receive compensation
benefits for an “Injury by accident, arising out of and in the course and scope of employment” or and “Occupational Disease”
Benefits include medical bill payment, mileage reimbursement, and prescription reimbursement
Coverage for Going and Coming to Work
Where transportation is provided by the employer, transportation cost reimbursed, or transportation time paid
Where the way used is the sole and exclusive way of ingress or egress or employer constructed
Where the employee is charged with some duty or task in connection with their employment
Exceptions to the going to or from work rule:
Cases Where Coverage May or May Not Apply
Voluntary ActionsHorseplayAssault/Murder/RobberyStress/PTSDIdiopathic/Unexplained FallsHeart AttacksGoing to or Coming from WorkPre-Existing ConditionsSuicideSteps/Stairs
“Willful Misconduct” Defined
The Safety Rule was ReasonableThe Rule was Known to the EmployeeThe Rule was for the Employee’s BenefitThe Employee Intentionally Undertook the
Forbidden Act
Employer Must Establish:
§65.2-603 Eyeglasses (Prosthesis)
Duty to provide only in cases of injury by accident, arising out of and in the course of employment.
Greater Risk and Work Related RiskTo be compensable, an injury must grow out of
risks particular to the nature of the work. Risks to which all persons similarly situated are equally exposed and not traceable to some special degree to the particular employment are excluded.
The mere happening of an accident at the workplace, not caused by any work-related risk or significant work-related exertion, is not compensable.
Injury by Accident, Arising Out of and in the Course of Employment
Occur at work or during a work-related functionBe caused by a specific work activityHappen suddenly at a specified timeNot incurred gradually or as a result of repetitive
traumaNotice must be given to their
Supervisor/Manager within 30 days of the injury
In order to be covered, an “Accident” must:
Your Requirements When a Claim OccursSubmit the claim via Visual Liquid Web (VLW)
within 10 days of the injuryEvaluate work-related injuries and illnesses to
prevent themEstablish goals to reduce serious occupational
injuries and illnesses and to enhance workplace safety
Include in managers’ performance expectations, when appropriate, goals to encourage a safer work environment and reduce injuries and illnesses
Websites to Visit for Phone Numbers, E-mail Addresses, or Answers to Your QuestionsFor the Virginia Workers’ Compensation
Commission:http://www.vwc.state.va.us
For the Dept. of Human Resource Managementhttp://www.dhrm.virginia.gov
For the Managed Care Innovations Workers’ Compensation Programhttp://www.covwc.com