Worker’s Comp. Claims Reporting

800 Corporate Drive, Ste 600 Ft. Lauderdale, FL 33334 | 888.335.9545 Toll-Free | alphastaff.com

2013 Webinar Series

Workers Compensation Claims

Thursday: May 16, 2013 Presented by Norma Lango, ACA Senior Claims Specialist AlphaStaff

Simplifying business. Benefiting people.

AGENDA

• AlphaStaff Risk Kit

• State Posting Requirements

• What To Do Prior To An Injury

• What To Do In The Event Of An Injury

• Initial Treatment Form And Chain Of Custody Form

• Reporting The Injury

• Employer’s Report of Work-Related Injury/Illness (“ERI”) Form

• After A Claim Is Filed

• Workers’ Compensation Pharmacy Program

• Returning To Work

• Other Notifications

• Summary

• Contacts

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THE RISK KIT

• Step-By-Step Claims Reporting Instructions

• Employer’s Report Of Work-Related Injury/Illness (“ERI”) Form

• Employer Authorization for Initial Medical Treatment Form

• Workers’ Compensation Pharmacy Form

• State Workers’ Compensation Poster

• Medical Provider Panel

• Certificate of Insurance Request Form

• Safety & OSHA Packet

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STATE POSTING REQUIREMENTS

Post the State Workers’ Compensation poster and the medical panel (list of

medical facilities) in a conspicuous place where all employees can see it.

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WHAT TO DO PRIOR TO AN INJURY

Inform Your Employees About Workers’ Compensation

Advise your employees:

• That an injury is covered under workers’ compensation if the injury is job related.

• Job related means - the injury must arise out of employment or occur during the course of employment.

• The workers’ compensation adjuster will determine if the injury is compensable or not.

• Who they need to report injuries too.

• That work injuries must be reported immediately.

• That initial medical treatment must be sought at a designated urgent care facility or hospital emergency department (depending

upon the severity).

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WHAT TO DO IN THE EVENT OF AN INJURY

• Offer medical care/first aide to the injured employee.

• Direct the employee to a medical facility listed on your medical panel.

• Give the injured employee an Employer Authorization for Initial Treatment form and a Chain of Custody (“COC”) form.

• In the event of an acute injury call 911.

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INITIAL TREATMENT FORM & CHAIN OF CUSTODY FORM

• The Employer Authorization For Initial Treatment form must be given to the injured employee to present at the medial facility (if possible).

• A Chain Of Custody form must be given to the injured employee to present at the medical facility (if possible).

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REPORTING THE INJURY

• The employee’s supervisor/manager or other authorized personnel must report all injuries/incidents to AlphaStaff’s Risk Department, via the Employer’s Report of Injury/Illness (“ERI”), within 24 hours of knowledge of an injury/incident.

• The supervisor/manager gathers facts about the incident and the employee’s injuries then completes the ERI.

• Include as many details as possible including names of witnesses.

• Any doubts/questions regarding the injury should be documented on the ERI.

• Once the ERI is completed the supervisor/manager can fax or email it to AlphaStaff’s Risk Department. Fax: 866-632-6423 or Email: [email protected]

• The supervisor/manager must report injuries/incidents even if the employee refuses medical care; and/or does not want to file a workers’ compensation claim.

• Once the ERI is received, AlphaStaff promptly reports the injury/incident to the workers’ compensation insurance carrier. Therefore Filing a claim.

Prompt reporting helps keep the overall claims cost down.

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mailto:[email protected]


EMPLOYER’S REPORT OF INJURY/ILLNESS (“ERI”)

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AFTER A CLAIM IS FILED

• The workers’ compensation carrier assigns an adjuster and a claim number to the claim.

• In most cases the workers’ compensation adjuster will make initial contact with the supervisor/ manager to gain additional information regarding the employee’s work injury and return to work.

• If the employee (“claimant”) is going to be off of work more than 3 days, the supervisor/manager must complete the AlphaStaff Personnel Action Form (“PAF”) and submit it to their designated AlphaStaff Payroll Specialist, HR Account Manager, or to the HR Service Center.

• The AlphaStaff Risk Specialist or Claims Specialist monitors the adjuster’s handling of the claim and assist the client and the adjuster with any issues that may arise relative to the claim.

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PHARMACY MANAGEMENT PROGRAM

• The workers’ compensation carrier provides a pharmacy management program through Carlisle Medical Pharmacy network.

• A temporary Prescription Form should be given to the claimant:

– Complete the temporary prescription card.

– Carlisle’s customer service number is 800-553-1783.

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RETURNING TO WORK

Employee’s Responsibilities:

– After each doctors visit, the claimant must provide his supervisor/ manager with a work status report/note from the authorized treating physician. The report/note should specify any physical restrictions/ limitations, work status, and follow up appointments.

– Keep all follow up doctor and physical therapy appointments.

– Return to work when released by the physician and when the employer offers a position within the physical restrictions/limitations.

Employer’s Responsibilities:

– Every effort should be made to accommodate the claimant’s light duty restrictions.

– The benefits of accommodating light duty include:

• Promotion of rehabilitation and recovery.

• Gives the employer the opportunity to demonstrate concern for the claimant’s well-being.

• Improves the morale of the claimant.

• Keeps workers’ compensation claims cost down.

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OTHER NOTIFICATIONS

• Family Medical Leave (aka FMLA) runs concurrent with workers compensation. When an employee misses three or more days off of work complete a Personnel Action Form (PAF) and email or fax the completed form to your AlphaStaff HR Account Manager, Payroll Specialist and/or to the AlphaStaff HR Service Center, email: [email protected]

– If you have questions regarding this form call the HR Service Center at 888-335-9545 option “8”.

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SUMMARY

• Advise your employee’s that work related injuries must be reported immediately to

their supervisor/manager or other authorized personnel.

• Direct the employee to a medical facility.

• Make sure the employee takes an Authorization for Initial Treatment form and a

Chain of Custody form with him/her to the medical facility.

• Within 24 hours of your knowledge of an injury, gather the facts about the injury

and complete both pages of the ERI.

• Fax or email the ERI to AlphaStaff’s Risk Department, fax # 866-632-6423 or

[email protected]

• Be sure to obtain a work status report/note from the claimant after every appointment.

• Communicate with the employee during the course of their claim.

• Make an effort to accommodate light duty work.

• If the employee is going to be off of work more than 3 days, complete the Personnel

Action Form (“PAF”) and submit it to your designated AlphaStaff HR Account Manager,

Payroll Specialist and/or to the HR Service Center.

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CONTACTS

AlphaStaff’s Risk Department: • Phone #: 888-335-9545 option “3” / Fax #: 866-632-6423 /

Email: [email protected]

• Risk Specialist: Extension 1491 (First point of contact in the Claims Department)

• For Safety and OSHA questions: [email protected]

• For Certificate of Insurance Request: [email protected]

AlphaStaff’s HR Department:

• HR Service Center Phone #: 888-335-9545 option “8” / Fax #: 866-632-8157 / Email: [email protected]

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Conclusion

Questions?

Thoughts?

Napping?

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Contact Us ! • .

Copies of the presentation [email protected] 888-335-9545 (Option 8)


Upcoming AlphaStaff Webinars

Please mark your calendars !!!

Date: Thursday, May 31, 2013 Topic: Recent NLRB Rulings and Their

Impact on Non-Union Employers

Date: Thursday, June 20, 2013 Topic: Employee Assistance Program

Overview and Supervisory Awareness

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Thank you for your participation!

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