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Revised 5/2015

Workers’ Compensation

Employee Injury

Procedures

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Table of Contents

CONTACT INFORMATION ………………………………………………………………………… 3

SECTION I – INTRODUCTION……………………………………………………………………… 4

Florida State Statute…………………………………………………………………….. 5

Drug & Alcohol-Free Workplace – S.B. Policy 3.96……………………………………………. 6

Post-Accident and Reasonable Suspicion……………………………………………………. 6

SECTION II – HOW TO REPORT AN INJURY/ILLNESS………………………………………………….. 7

Workers’ Compensation Administration Procedures for injury/illness …………………………..8

First Report of Injury (PeopleSoft Instructions)…………………………………………….9-11

After Hours Reporting…………………………………………………………………...12

Pharmacy Information…………………………………………………………………..13

Authorized Initial Care Facilities……………………………………………………..…14-18

SECTION III – HOW TO REPORT A BLOODBORNE PATHOGEN INCIDENT…………………………………...19

Job Classification List……………………………………………………………………20

Bloodborne Pathogen PeopleSoft Query……………………………………………………21

SECTION IV – WORKERS COMPENSATION GUIDELINES ……….……………………………………….22

Guidelines for Employees with Work Restrictions (LIGHT DUTY)

….………………………….23-25

Workers’ Compensation Leave……………………………………………………………26

Line of Duty (LOD)……………………………………………………………………..27-28

Payroll Codes for Regular Full Time Employees……………………………………………...29

Guidelines to Workers Compensation Doctor Appointments…………………………………...30

SECTION V – SUBSTITUTES AND VOLUNTEERS..……………………………………….……………..31

Reporting Work Related Injuries for Substitutes and Volunteers…………………….....………32

.SECTION VI –

FORMS……………………………………………………………………….…..33

Resources/Forms……………………………………………………………….......…34-38

Employee Guide to Workers’ Compensation……………………………………………………39-45

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General QuestionsAssistance with People Soft entry of Notice of Injury

Kathy Donnelly, W/C Claims. Tech.

Jack Orozco, W/C Claims Tech.

561-434-8677 PX 48677

Fax Risk and Safety 561-434-8467Modified Duty Assignments / Questions on work restrictions

Jack OrozcoW/C Claims TechJulie Sessa,Claim Specialist

561-434-8176 PX 48176 561-434-7440 PX 47440

Determination of Injury Days Timekeeping Assistance for payroll contacts

Jack OrozcoW/C Claims Tech

Kathy DonnellyW/C Claims Tech

561-434-8176 PX 48176561-434-8677 PX 48677

Medical Treatment QuestionsAssistance with questions regarding Medical treatment

Ellen OrtuFARA Nurse Case ManagerPaula Adams FARA Nurse Case Manager

1-800-482-3272 

Accident Investigation Identifying and analyzing key areas of potential Risk

Safety Technician for your Area:Area 1 – David DaleyArea 2 – Thomas ClarkArea 3 – Troy WilkinsonArea 4 – Fred Cahill Area 5 – Call PX 47578

561-357-7578

Retirement Credit for W/C Leave

Julie SessaClaim Specialist

561-434-7440 PX 47440

Assistance with Statutory W/C Benefit questions

FARA Claims Adjuster

1-800-482-3272

After Hours Assistance FARA After Hours Operator

1-877-815-3272

KEY CONTACT INFORMATIONWORKERS’ COMPENSATION SECTIONRISK AND BENEFITS MANAGEMENT

SECTION I

INTRODUCTION

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Introduction

Florida State Statute 440.015 Legislative Intent

It is the intent of the Legislature that the Workers’ Compensation Law be interpreted so as to assure the quick and efficient delivery of disability and medical benefits to an injured worker and to facilitate the worker’s return to gainful re-employment at a reasonable cost to the employer.

The School District of Palm Beach County Risk & Benefits Management

An effective workers’ compensation program begins before an accident occurs. There are many players in the workers’ compensation system concerned with the delivery of benefits to the injured worker: The District Risk & Safety Office staff, F.A. Richard (FARA)/York Risk Adjusters, the physicians, but most of all you the employee. Without the employer’s hard work, dedication and involvement, the workers’ compensation system will not work.If a School District employee experiences an unexpected or unusual event an accident resulting in personal injury, it is our intent to make sure that the injured worker receives the best care available.

Therefore, the Risk & Benefit Management Department has put together this “Employee Injury Procedures”, that outline proper steps and the forms needed to file a claim. These procedures will help expedite medical treatment for the injured worker to facilitate a speedy recovery.

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Introduction(Cont.)

Drug & Alcohol-Free Workplace – School Board Policy 3.96

Purpose: The School District of Palm Beach County hereby affirms its commitment to maintaining a drug-free workplace. The term “drug-free” includes “alcohol-free”

DRUG TESTING

Pursuant to recent statutory amendments, all employees receiving treatment through the District’s workers compensation program may be subject to substance abuse testing by participating physicians. Results that are not in compliance with the District’s drug-free workplace policies will be forwarded to the School Board’s Office of Professional Standards for further review and disposition.

POST-ACCIDENT AND REASONABLE SUSPICION DRUG/ALCOHOL TESTING

School Board Policy 3.96

As soon as practicable under the following circumstances, post-accident reasonable-suspicion testing will be done on all employees/applicants/volunteers who are involved as a driver in any vehicular accident while performing their duties:

A. on a surviving employee/applicant/volunteer when an accident results in loss of human life. The employee/applicant/volunteer need not have been cited for a moving traffic violation or deemed at fault to be subject to testing under this paragraph;

B. when an employee/applicant/volunteer receives a citation for a moving violation(s) and one (1) or more of the vehicles involved in the accident is towed from the scene of the accident; or

C. when an employee/applicant/volunteer receives a citation for a moving violation(s) and one (1) or more persons involved in the accident received medical treatment away from the scene of the accident.

Sites must have trained supervisor(s) observe behaviors.Call Professional Standards for assistance.

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SECTION IIHow to Report an

Injury/Illness

Workers’ Compensation Administration Procedures for Injury/Illness

First Report of Injury (PeopleSoft Instructions)

After Hours Reporting

Medical Facilities

Pharmacy Information

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Workers’ Compensation Administration Procedures for

an Injury/Illness

 BEST PRACTICES

1. Cover injury reporting procedures in school/side wide staff meetings.

2. Emphasize the use of the Workers’ Compensation Primary Care Providers and post the list in several conspicuous places so all employees have access.

3. A minimum of 2 people (usually the school secretary plus 1 back-up) should have access and ability to enter Notice of Injury (DWC-1) in PeopleSoft.

4. Train employees to immediately report any work-related accident or injury to their supervisor/manager/school/department secretary.

5. Provide injured worker with Workers’ Compensation approved Primary Care Providers.

6. Instruct the injured worker to return back to the work location with ALL paperwork from the doctor including the DWC 25 Form “Work Status Form.”

7. If the medical provider recommends an employee for modified duty, the injured worker is to return to their regular work location. Whereas, the supervisor MUST allow the injured worker to return to work and insure that the employee does not exceed the doctor’s limitations.

8. Give the worker a copy of the “Employee Guide” for the workers compensation program.

9. Remind the worker that the ER is for emergencies only! When site personnel determine that emergency care is warranted for an injured employee the employee MUST follow-up with an authorized initial Care Medical Provider with 24 hours of emergency treatment.

10.Notify the Risk and Safety Office in Risk & Benefits Management at 561-434-8677 immediately when any employee is sent out to Emergency Room.

11.Injuries after 8PM may use the emergency room. However , the next day they must follow- up with one of the Primary Care Providers.

12.Remind employees NOT to use their United Health Insurance for any services related to Workers’ Compensation Injury/Illness.

13.For custodial or food service employees, coordinate modify duty restrictions with the lead custodian or food service manager to keep all levels of management informed of workers restrictions.

 All information may be found on Risk & Safety website under workers’ compensation http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp 

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First Report of InjuryPeopleSoft Instructions

Part 1 of 3Incident Details

ENTERING A NEW INJURY/INCIDENT

Log into PeopleSoft – Human Capital Management

CLICK Workforce MonitoringHealth and SafetyObtain Incident InformationIncident Details (add to favorites if desired)

CLICK Add a new value tab (system will assign a # once info is all saved)

CLICK ADD button

ENTER Incident date

ENTER Incident time

DEFAULT Incident type (defaults to “injury,” can select “illness,” DO NOT select “incident”)

CLICK Notification Tab

ENTER Date reportedTime reportedEmp ID of person it was reported to (usually conf. secretary)Injured Emp ID of person injured or ill

CLICK Description TabDescribe what happened; include anything you want

Third Party Administrator (FARA) to know (witness names, statements, location (within the School Bldg #5 or C Hallway, etc) if different from school e.g., Washington, DC field trip, etc.) DO NOT USE SPECIAL CHARACTERS (for example, @, $, #, “ “)

CLICK Location Tab – will pre fill – DO NOT CHANGE INFORMATIONIf elsewhere use EXACT LOCATION to explain

CLICK SAVE ***MAKE NOTE OF INCIDENT NUMBER_________ 

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Reminder – Sites should have at least 2 people trained to complete this form.

First Report of InjuryPeopleSoft Instructions

Part 2 of 3Injury Details

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Look up at the grey bar/breadcrumb trail

CLICK Obtain Incident Information

CLICK Injury Details (add to favorites if desired)

VERIFY Incident Number

VERIFY Employee ID of injured person

VERIFY IMPORTANT: Employee Record Box - The number “0” represents the primary job of the employee.

NOTE: Only change this Empl Record # if the employee is working outside their primary position i.e. job 01, or job 02.

VERIFY Correct location and job code in the “Employee Data at Incident Date” box.

CLICK Description Tab

CLICK Primary Outcome Box – Check Either INJURY (default), ILLNESS, OR DEATH

DEFAULT Treatment Required Box (“Medical” will default, ok, leave this alone)

Check-off either MEDICAL, FIRST AID, HOSPITALIZED, OR NONE (if RPO = Reporting Purposes Only)

INPUT Injury/Illness Details Box – Briefly describe injury/illness. Ex: back pain, right knee, neck, panic attack (short answer, MANDATORY)

CLICK Statements Tab – Only if the following occurs: IF Employer (principal, director) objects to statement, check box and enter Employer’s

statement. If Unsure – signify this on the Description TAB

YOU NEED NOTHING ELSE ON THIS PAGE

CLICK Details Tab

Injury Description Box – CLICK and select BODY PARTS. If you need to add additional body parts, click on the “+” sign.

CLICK Nature of Injury – select the best one

CLICK Accident Type – select

CLICK Diagnoses Tab

SKIP Type of Health Care (Default = Not needed go to Medical Facility”)

SKIP Physician ID (not using this field)

SELECT Medical Facility - where treated (MANDATORY FIELD) If you don’t select Medical Facility you will not be able to print at the end. Use RPO if no treatment is required. Give the employee a cc of the doctors list anyway.

 CLICK SAVE

First Report of InjuryPeopleSoft Instructions

Part 3 of 3PB Workers Compensation Form

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 CLICK Obtain Incident InformationCLICK PB Create DWC-1 Form (add to favorites if desired)

ENTER your initials @ Run Control ID promptCLICK SearchENTER Incident # (last number you did will be there, need to change)

Emp ID of injured person (or use magnifying glass, then click on name)CLICK Validate Incident Data - OKCLICK RUNSELECT PSNT Server Name (may default to this name already)

OK CLICK Process Monitor CLICK Refresh (until you see “Success” & “Posted”) CLICK Details CLICK View Log /Trace TO SAVE Right click on PDF file, select “Save Target As” and choose a folder to store it in. CLICK Save to your selected folder CLICK on PDF File – open and view it. Print a hard copy for your employee & records when desired or to take to the Doctor’s office EMAIL As an attachment to Principal/Director, supervisor or Safety Advocate (if desired)   For Assistance with any errors:Risk Technician – PX 4-8677 (434)Workers’ Compensation Technician – PX 4-8176 (434) 

After Hours Reporting

 Report injury to Supervisor as soon as possible. (Informe de lesión a Supervisor tan pronto como sea possible)  Fill out attached Report of Injury Form.

(Llenar el formulario adjunto informe de lesión)   If medical treatment is needed select an approved Workers’

Compensation physician from the list in this booklet along with the completed Report of Injury Form. (Si el tratamiento médico es necesario, seleccione a un médico de compensación aprobado en la lista en este folleto junto con el formulario informe de lesión)

Note: The physician list is arranged by district area.(Nota: La lista del médico es organizada por el área del districto)

 For after-hours injuries or questions on care, call

F.A. Richard (FARA) after hours at: 

1-877-815-3272 

Please visit the Workers’ Compensation website for the following:http://www.palmbeachschools.org/riskmgmt/WorkersCompWorkers Compensation Guidelines.asp  · New Claim Instructions

· Doctors’ List

· Emergency Room (ER) Guidelines

· Modified Duty

· Frequently Asked Questions (FAQ) 

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Pharmacy Information

The District uses the vendor listed below to assist you in obtaining prescription drugs related to your workers’ compensation claim. The pharmacy form that is printed with the Notice of Injury enables you to fill your first prescription written by your authorized workers’ compensation physician for the medications related to your recent work injury. Simply present the pharmacy form (sample below) to the pharmacy at the time your prescription is filled. The prescription form guarantees that you will have no out-of-pocket expenses when you fill your first prescription. Remind employees Do NOT use United Healthcare medical card.

You may use your local pharmacy to process your prescription, or call the toll-free customer service number or visit the website below to identify additional network pharmacies in your area.

NOTE: The prescription information allows you to fill your initial prescription(s) with a cost maximum of $150 per prescription and no more than a 14-day supply per prescription. Once your claim has been reviewed, you will be sent a prescription card in the mail. If you do not receive the pharmacy card within a few day, call the vendor at the number listed below.

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PHARMACY FORM FOR PROGRESSIVESAMPLE FORM PRINTED WITH NOTICE OF INJURY

Employer Name: School District Palm Beach CountyBin#: 600471Group ID: E871Member Name: (Name of Employee) This information will generate from the DWC-1Member ID: 557906162014Date of Injury: (Date of Injury) This information will generate from the DWC-1

Pharmacy Help Desk: 1-877-228-4814Progressive website: www.progressive-medical.com

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Authorized Initial Care Facilities

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North Area

COACH Comp America/Urgent CareMonday - Friday4714 Okeechobee Blvd. 7:30 am – MidnightWest Palm Beach, FL 33414 Saturday & Sunday561-640-7505 9:00am – 5:00 pm561-640-7506 (FAX)

Concentra Medical Center Monday - Friday4455 Medical Center Way, Suite 100 8:00 am – 6:00 pmWest Palm Beach, FL 33407561-881-0066561-881-5533 (FAX)

Gardens Urgent CareMonday - Friday3855 Northlake Blvd. 8:00 am – 8:00 pm561-626-4878 Saturday - Sunday561-627-5112 (FAX) 9:00 am – 6:00 pm

MD Now Urgent CareMonday - Sunday2007 Palm Beach Lakes Blvd. 8:00 am – 8 pmWest Palm Beach, FL 33409561-688-5808561-420-8550 (FAX)

MD Now Urgent CareMonday - Sunday9060 North Military Trail 8:00 am – 8:00 pmPalm Beach Gardens, FL 33410

561-622-2442561-622-6235 (FAX)

Urgent Care of Palm BeachesMonday - Friday11951 US Highway 1, Suite 108 8:00 am – 7:00 pmNorth Palm Beach, FL 33408 Saturday & Sunday561-429-6109 9:00 am – 4:00 pm561-429-6513 (FAX)

Tequesta Urgent CareMonday - Friday225 US HWY 1 8:00 am – 7:00 pmTequesta, FL 33469Saturday561-747-4464 8:00 am – 4:00 pm561-747—5598 (FAX) Sunday

9:00 am – 3:00 pm

Revised 12/2015

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Central Area

 MD Now Urgent CareMonday - Sunday2272 N Congress Ave 8:00 am - 8::00 pmBoynton Beach, FL 33426 561-737-1927561-742-3436 (FAX) MD Now Urgent CareMonday - Sunday4570 Lantana Road 8:00 am – 8:00 pmLake Worth, FL 33463 561-963-9881 561-963-1390 (FAX) MD Now Urgent CareMonday - Sunday6868 Forest Hill Blvd 8:00 am – 8:00 pmGreenacres, FL 33413 561-967-8771561-439-5484 (FAX)  

Revised 12/2015 

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West Area

MD Now Urgent CareMonday - Sunday11551 Southern Blvd8:00 am – 8:00 pmRoyal Palm Beach, FL 33411 561-798-9411561-422-8161 (FAX)  Palm Glades Rural Health AssociatesMonday – Friday 217 West Avenue A8:00 am – 5:00 pmBelle Glade, FL 33430Saturday 561-992-4888 8:00 am – 1:00 pm561-942-4888 (FAX) COACH Comp America/Urgent CareMonday - Friday11327 Okeechobee Blvd8:30 am – 5:00 pmRoyal Palm Beach, FL 33411561-795-4565561-795-3992 (FAX)

Revised 12/2015 

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South Area

Boca Medical Walk in ClinicMonday - Friday9834 Glades Road, Suite C-5 9:00 am – 6:00 pmBoca Raton, FL 33434Saturday561-470-1110 9:00 am – 3:00 pm561-470-1184 (FAX) Delray Physician Care CenterMonday - Friday2280 W. Atlantic Avenue 8:00 am – 7:00 pmDelray Beach, FL Saturday561-278-3134 8:00 am – 4:00 pm561-278-3922 (FAX)Sunday

9:00 am – 3:00 pm MD Now Urgent CareMonday - Friday7035 Beracasa Way Suite 105 8:00 am – 8:00 pmBoca Raton, FL 33433561-361-1515561-361-6441 

US Health WorksMonday - Friday1786 N.W. 2nd Avenue 8:00 am – 6:00 pmBoca Raton, FL 33432Saturday561-368-6920 8:00 am – 12:00 pm561-368-6194 (FAX)

ER Doctors Monday - SundayPalomino Park 3319 SR7 8:00 am to 8:00 pmWellington, Fl 33449561-333-4400561-333-8851

Revised 12/2015 

 

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SECTION IIIHow to Report a

Bloodborne Pathogen Incident

Bloodborne Exposure is a Workers’ Compensation Injury

Note: Bloodborne Forms to be utilized in addition to Notice of Injury - PBSD 1504, 1505 and 1506

Job Classification List

PeopleSoft Queryo How to obtain a list of staff members for

the Bloodborne Pathogen Refresher Course

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Bloodborne PathogenJob Classification

The bloodborne pathogens task force identified categories of jobs where employees are likely to incur occupational exposure to blood or other potentially infectious materials. Category 1 jobs are those in which all employees are considered at risk for exposure. Employees in Category 2 jobs are at risk for occupational exposure when they perform certain tasks. All personnel in Category 1 and employees in Category 2 whose tasks may expose them to blood will be offered the Hepatitis B inoculation series. Other school district personnel are not reasonably anticipated to be at risk of occupational exposure to bloodborne disease. These employees will be offered the Hepatitis B inoculations and medical follow up in the event of a reported exposure to blood or other potentially infectious materials during the performance of job duties. Category 11. Adult Vocational Education Instructors in Health Care Field2. Behavioral Intervention Assistants3. Bus Attendants4. Coordinator-Teacher ESE5. CORE Team Members6. Custodians (all)7. Electricians8. ESE/Speech Language Impairment9. ESE Speech Pathology10. Manager – FHESC Bldg.11. Paraprofessional 1/11 (working with ESE) ------ Asst. Behavioral/Phys Needs I and II)12. Paraprofessional 1/11 (working with Pre-K)13. Plumbers14. Pre-K Early Intervention Child Development Associates15. Principals/Assistant Principals16. School Clinic Volunteers17. School Nurses/Nurse Aides18. School Police Officer19. First aid/CPR responders20. School-based personnel who staff school clinics21. Teacher – Elem/Physical Education22. Teacher – ESE/Crisis Intervention23. Teacher – ESE/EH24. Teacher – ESE/Physically Impaired25. Teacher – ESE/PMH26. Teacher – ESE/SEH27. Teacher – ESE/TMH28. Teacher – ESE/VE29. Teacher – Physical/Occupational Therapist30. Teacher – School Psychologist31. Teacher – Sec/Physical Education32. Teacher – Voc/Family and Consumer Science (Home Economics)33. Teacher – Voc/Cosmetology34. Worker – Window and Lock Repair Category 2 Task35. Alternative Education Individuals acting as First Responders or have 1-on-1 duties with students36. Bus Drivers ESE Drivers, Bus Driver II’s, Radio Drivers37. After School Directors and Assistant Directors 38. Coaches Providing first aid to students participating in the following: sports.

Football, Basketball, Baseball, Soccer, Wrestling, Softball & Lacrosse39. Building Mechanic If required to perform duties of plumber40. Trades Helper If required to perform duties of plumber41. Crisis Response Team Members Individuals who have completed team training & act

as First Responders42. Mail Couriers Transporting bio-hazardous waste

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Bloodborne PathogenPeopleSoft Query

(PeopleSoft Query) DIRECTIONS(To obtain your list of staff for the BBPR Program) PLEASE NOTE: In the event you do not have PeopleSoft access – please give the query directions to your head secretary so she can print your list. Log into People SoftClick on HCM HRPRO

Reporting ToolsQueryQuery ViewerScreen will say “begins with” - fill in:PB_BBPR_JANUARY_BY_LOCATION

Click on SearchClick on Excel

Screen will say “Enter as of Date (Nov. 1st): fill in11/1/2013Next line will say “Exc/BBPINIT’s (June 30th): fill in6/30/2014Next line will say “Department ID”: fill inYour 4-digit school or department number

Click on View ResultsClick on Open You now have your list in an excel format. You will want to delete the columns you don’t need and sort by employee name before you print your list.  IMPORTANT: After you print your list you may notice the following: Clinic Back-Up – names will not show up. Add them to your list - they should do the BBPR.Paraprofessionals – If they are not on your list, but are in a Pre-K or ESE classroom – add them to your list - they should do the BBPR.Coaches - If you are at a Middle School or High School please ask your Athletic Director to identify staff that coach in BBP Category sports (football, basketball, baseball, soccer, wrestling, softball & Lacrosse). They will need to do the annual BBP Refresher. NOTE:New employees, who began employment this school year (August, 2013), might not show up on your query - THEY ARE NOT REQUIRED TO COMPLETE BBPR THIS YEAR. 21

SECTION IVWorkers’ Compensation

Guidelines

Modified Duty (Light Duty)

Workers’ Compensation Leave

Line of Duty

Payroll Codes for Regular Full Time Employees

Guidelines to Workers’ Compensation Doctor Appointments

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GUIDELINES FOR EMPLOYEES WITH WORK RESTRICTIONS (MODIFIED OR LIGHT DUTY)

Instruct the injured worker to return back to the work location with ALL paperwork from the authorized workers’ compensation doctor including the DWC 25 Form “Work Status Form”.

If the medical provider recommends an employee for modified duty with restrictions, the school and /or department should accommodate their employees who get injured on the job by providing work assignments in accordance with any authorized Workers’ Compensation doctor restrictions. In most cases, the employee can self-regulate; adjust their work to prevent further injury according to specified restrictions (section 23 of the DWC – 25).

Contact your Area Safety Technician for assistance on return to work if there are any safety concerns or work place modifications needed. See the Risk and Safety website: http://www.palmbeachschools.org/riskmgmt/Safety/index.asp

If the employee feels too sick or injured to return to work after the doctor releases them to modified duty, the lost time should be marked as sick, annual or without pay. After 10 days without pay, all rules for leave of absence apply.

School responsibilities for light duty contact:

Sign light duty employee in and out if TCD is not usedExplain to the employee their assignments (cannot exceed doctor’s restrictions), location, hoursCommunicate with timekeeper regarding work comp timeReport any behavior issues to Risk Management as soon as possible so it can be addressed 

SUGGESTED MODIFIED DUTY ASSIGNMENTS

General light duty assignments:

Hall duty – extra eyes and ears to assist monitoring student conductShredding paper, making copiesParking lot security – eyes and ears using a walkie-talkie, pick up trash with a stickVideo camera monitorCafeteria monitor, helping students open milk cartons and juice boxesEscorting students/guests on campus when they arrive late or leave early for appointmentsAssist the front office/ guidance officeStuffing envelopes, making phone calls, distributing flyersInspect for safety hazards, document hazards, complete work orders, report hazards to safety school committeeRestroom monitoring, light duty clean upGym locker/art room monitoring – eyes and ears for large class sizes  

 

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GUIDELINES FOR EMPLOYEES WITH WORK RESTRICTIONS (MODIFIED OR LIGHT DUTY) Cont.

For light duty teachers/administrators:

Grading papers, proofreadingTutoring students one on one, listening to students readLesson plans, surveys, flyersSigning in visitors, volunteers, escorting them to and from destinationMaking phone calls such as setting up teacher parent conferences for guidanceInventory athletic equipment for Athletic DirectorInventory text books complying with any lifting restrictionsAssemble statistics for Athletic Director; make flyers for upcoming games, dances, eventsRemain in class with students and have substitute do the “heavy lifting”Inspect PE fields/playgrounds for hazards, note hazards, complete work ordersParking lot/hall monitor using golf cart if available, eyes and ears monitoring in cafeteria, bus loop

For light duty custodians/food service:

Light dustingLight sweeping, spot moppingPicking up trash with a spear/stickUsing spray cleaner to wipe down desks, cafeteria tablesEmptying trash when bag is only ½ full to comply with lifting restrictionsClean the sinks in the classrooms, fill soap dispensersClean every water fountain, wipe down computer screensDust books in the media center to comply with restrictionsWash windows- bucket can be placed on a cart to comply with bending/twisting restrictionsRemove gum from under desks and counter tops, lunch room tablesClean graffiti from desks and other surfaces complying with appropriate restrictions For sedentary restrictions: (Examples from a seating position)

Hall duty – extra eyes and ears to assist monitoring student conductMonitor Parking lot Restroom monitoringMedia Center – check out books, monitor students, dust books and book shelvesVideo camera monitorStuffing envelopes, making phone callsMonitoring Cafeteria - making sure that the trash is pickup and thrown away by students.Clean water fountains, desktops, computer monitors, cabinet doors, cafeteria chairs, book shelves, light switches etc.Make copies   

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GUIDELINES FOR EMPLOYEES WITH WORK RESTRICTIONS (MODIFIED OR LIGHT DUTY) Cont.

Sample cleaning schedule, amend to fit the needs and the schedule:

2:00 -3:00 cleans all water fountains 3:00- 4:00 cleans all desk tops in building # 4:00 -5:00 dusts all counters in building # 5:30 – 6:00 Lunch/Dinner break 6:00- 7:00 sanitize all cafeteria tables 7:00-8:00 cleans all remaining desk tops in building # 8:00 – 9:00 continues dusting all horizontal surfaces in building # 9:00 – 10:00 refill soap and paper towel dispensers in building #

The head/lead custodian can determine the amount of time it would take to complete one building. Direct the employee in writing, if necessary to follow this schedule. The employee must also be directed that no changes are made to the schedule without prior administrative or supervisory approval.

Use the time reporting code WCQ for those employees who are at an alternate site for light duty or those employees working in their own job at a reduced capacity.

While not all injuries or employees heal at the same rate, employees should show steady progress toward full duty evidenced by fewer restrictions over time. If you believe that the employee does not seem to be making reasonable progress toward full duty, contact the adjuster at FARA/YORK 1(800-482-3272) or Risk Management.

Guidelines involving workers’ compensation are located on the District’s website:

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

If the site administrator feels the restrictions are so severe that they cannot accommodate the modified duty recommended by the treating physician at the home school/site, please contact Risk Management and an alternate work assignment and location will be considered based on availability.

REV: 09/2014

Workers’ Compensation Leave

When an employee is off work due to an authorized workers’ compensation (WC) injury please follow these guidelines for payroll reporting and leaves: Mark the employee with a “WCL” if authorized for Line of Duty by the Workers’ Compensation doctor. (see Guidelines for Line of Duty) If the employee is out in excess of 10 days (or exhausts Line of Duty time) mark the pay screen with a “WOP” and follow regular Leave of Absence procedures (Note: WC will begin paying if authorized). If the employee is in an “unpaid status” (“WOP”) in excess of 10 days, leave forms are required (forms 1666 and 2312). Submit the form to the employee’s timekeeper. If employees are in an unpaid status for the MAJORITY OF THEIR DUTY DAYS in any given month, health benefits may be in jeopardy if intermittent FMLA has not been approved. NOTE: With respect to non-instructional personnel, you may advertise for an interim position if the employee is on an approved leave. Once an employee returns to duty, send an email message to risk@palmbeachschools.org to let us know.If you are not receiving Work Status Forms (DWC-25) regularly from the District’s Third Party administrator, contact them at 1-800-482-3272 or risk@palmbeachschools.org.  Beneficial queries in PeopleSoftTo determine how many Line of Duty (WCL) days the employee has used:PB_TL_PAYABLE_TIME_BY_EMPLID  To determine the PeopleSoft claim number using the Employee ID:WC_INCIDENT_SEARCH_BY_EMPLID  To view a list of employees with reported claims by school/site:WC_OSHA_300  If you have any question please call the Risk Management Technician, PX 4-8677 orPX 4-8176. 

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Line of Duty (LOD)

FL STAT 1012.63(1) Illness-in-line-of-duty leave. DURATION OF LEAVE AND COMPENSATION. – Leave of the district school board employee shall be authorized for a total of not to exceed 10 school days during any school year for illness contracted, or injury incurred.

District employees (regular or part-time) are permitted up to 10 paid days per school/fiscal year in the event of an injury sustained in the line of duty. LOD is recorded as “WCL” on the employee’s attendance screen as long as the following conditions are met: All employees:1. An authorized worker’s compensation physician places the employee on a “No

Work” status. Evidence must be on a DWC 25 form given to the employee’s supervisor and timekeeper to properly record. If written documentation is not provided, mark as a “sick” day. Attendance can be amended later if documentation is forthcoming.

2. LOD is limited to 10 work days per incident not to exceed 10 work days in any one school/fiscal year. If the employee has more than 1 incident during any one school year and/or is approaching the maximum 10 LOD days, please alert Claims Technician, PX 4-8677.

3. Non Regular or Temporary Employees are not eligible for LOD, example: “day to day” substitutes, afterschool programming workers.

4. If an employee has more than 1 job, LOD is granted for the job on which they sustained the injury. Attendance for the other job should be marked as “sick.”

5. In no event is LOD granted for days taken prior to the filing and acceptance of a compensable injury. If an injury is reported late, LOD will be on a “go forward” basis.

6. If the claim is denied by F.A Richard (“FARA”) or if the time off is due to an injury or illness sustained off the job, record as “sick,” “annual” or “without pay.” LOD does not apply here.

7. LOD can be used for approved medical appointments if employee cannot schedule appt. after work hours, example: the worker’s compensation doctor requests the employee obtain a diagnostic test (X-ray, MRI) right away. Total cannot exceed maximum as described in #2 above.

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Line of Duty (LOD)(Cont.)

CTAClaim must be reported to the Principal/Director within 2 days of occurrence except in “extenuating circumstances.”

FPSUEmployee shall notify Principal/Director (or designee) as soon as injury is apparent and file line of duty claim by the end of each month or pay period when the claim occurred. Line of Duty will affect attendance/merit pay. AESOPEmployee shall notify Principal as soon as injury is apparent and file a claim by the end of each month or pay period when the claim occurred. The employee must seek medical treatment for any injury received in line of duty within six months of the injury to be eligible for LOD. Line of Duty will affect attendance/merit pay. PBAIf police officer sustains in line of duty injuries maliciously or intentionally, employee shall be granted full pay status for up to 2 years or when officer reaches Maximum Medical Improvement (“MMI”) only after submission of a medical report which gives current diagnosis and work status.  Questions: Claim Technician, PX 4-8677, Claims Specialist, PX 4-7440.

 

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Payroll Codes for Regular Full Time Employees

Day of injury should be mark as regular time If Workers’ Compensation doctor checks off number 22 on the DWC 25 form. Work status (NO WORK) mark them WCL. (Line of Duty) (See sample form DWC-25 in Section 6)

If Workers’ Compensation doctor checks off number 23 on the DWC 25 form. Work status (Light Duty) mark WCQ. (See sample form DWC-25 in Section 6)  First 10 days (no work status) WCL = paid in full (must be approved by W/C Doctor) After 10 days of WCL and Workers’ Compensation Doctor still has them on no work status. Please notify Risk Management (PX 48677 or PX 47440) so they can notify FARA, the WOP will start. WOP = WC/FARA will pay 66 2/3, employee needs to apply for Leave of Absence (form 1666 - See sample form in Section 6)

 After 10 days of WOP – Leave of Absence form needed. Leave starts on the 11th day. After 12 weeks of leave – The employee will have to pay the District portion of their benefits, plus their regular deductions on their paycheck. The employee pays 100% of their benefits. Questions call Annette Arriaga PX 86393 or Juan Diaz PX 86307. EXAMPLES: Teacher working in classroom – not WCQ. Custodian completing only the light parts of the job, mark WCQ (think loss of productivity). Work Status Form DWC-25 (See Sample in Section 6 - Forms) 

# 21 Full Duty = REG (Regular Earnings)# 22 No Work = WCL# 23 Light Duty = WCQ

 

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Guidelines for Workers’ Compensation Doctor’s

Appointments

When an employee is required to attend doctors’ appointments related to a workers’ compensation injury, the employee should not schedule appointments during working hours. Our workers’ compensation locations offer “after hours” appointments along with weekend hours. If the employee insists on scheduling appointments during work hours, record as “sick” or “annual” time. The only exception to the above is if the doctor requires a diagnostic test which must be scheduled “As Soon As Possible” and the only appointment available is during work hours. The employee should schedule the appointment which will cause the least loss of time, i.e. late afternoon or early morning. In this case, Line of Duty time can be used (see Guidelines for Line of Duty). The time reporting code for Line of Duty is WCL. NOTE: Subs, volunteers, and temporary employees are not eligible for e.g. LOD pay or Light Duty from a work related injury. Questions? - Please call a Claim Technician at PX 4-8677 or PX 4-8176. 

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Substitutes And

Volunteers

SECTION V

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Reporting Work Related Injuries for Substitutes and Volunteers

SUBSTITUTES:

Substitutes have an employee ID, so the procedure for reporting the injury is the same as a regular employee in PeopleSoft. Refer to instructions for entering a claim in People Soft. Substitutes DO NOT receive Line of duty days. If they are placed out of work they will be paid by workers’ compensation for lost wages based on their average weekly wage. Typically, substitutes are not offered light duty. 

VOLUNTEERS:

Volunteers DO NOT have an Employee ID, hence First Report of Injury must be done through manual entry and faxed to Risk Management (PX 48467). Please make sure that you identify the word “Volunteer” on the First Report of Injury. Refer to Manual Entry instructions. (DWC1 form – First Report of Injury is on the WC website). Temporary employees from an agency need to report the incident to their employer as they are not covered under the District’s workers’ compensation Program. Volunteers DO NOT receive Line of Duty days. Typically they DO NOT receive wage loss as they are unpaid. They are medical coverage only claims. 

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SECTION VIResources/Forms

Notice of Injury (DWC-1)

Work Status (DWC-25)

Request for Leave of Absence (PBSD 1666)

Employee Guide to Workers’ Compensation

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Resources/Forms

MANUAL NOTICE OF INJURY FORM (DWC-1)

Directions for Completing and E-mailing the first Report of Injury (if school/site is unable to enter claim in PeopleSoft.

The report will NOT be accepted by FARA if you do NOT enter information into the following fields:1) Location Number 2) Full Social Security Number 3) Date First Reported

In the Employee Name line enter the Employee ID number after the employee name.If you are emailing the report select “N/A Form completed electronically” from the drop down menu in the both signature fields. Follow the directions below to email the form.

Email the PDF to:Claimopening@fara.com

Send copy to risk@palmbeachschools.org

Or

Fax to 1-(877)652-3272 within 24 hours, or as soon as possible

Note: Print out pages 2-4 and give to the injured worker along with a copy of the approved Workers’ Compensation Doctor’s List located on the district website:

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

DWC-25 – WORK STATUS FORM

Injured employees must provide a copy of the Medical Treatment/Status Report Form (DWC-25) after each medical appointment to their supervisor/school/department secretary. This form is commonly referred to as the “Work Status Form.”

Items To Review On DWC-25 – 1) Document next appointment date & time. 2) Look for work status , page two (re 21, 22 or 23 and 3) Confirm restrictions with employers supervisor.

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3636

3737

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School District Palm Beach County

EMPLOYEE GUIDE

Workers’ Compensation Program

Risk Management

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SECTION I

This information is being provided to you to explain your rights and responsibilities should a work-related 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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

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:

Your NameYour Home Address and Telephone NumberDate of Birth Employee IDDate, 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:

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp Authorized treatment and care may include:a. Doctor Visits (see Guidelines for Doctor Visits on the District’s WC website)b. Hospitalization 

Injured Worker Rights and Responsibilities

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Injured Worker Rights and Responsibilities

c. Physical Therapyd. Medical Tests e. Prosthesesf. Prescription Drugsg. 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. However, if you are disabled for more than 21 calendar days due to your work-related injury or illness then wage replacement or compensation benefits may be paid for the first 7 days of disability. 

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Injured Worker Rights and Responsibilities

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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp 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.

SECTION II

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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

B. Telephone Numbers:

WC ADJUSTERS: Claims Adjuster1 (800) 482-3272

 Risk Management(561) 434-8677 or (561) 434-7440

 OTHER: Florida Division of Workers’ Compensation

Employee Assistance Office1-800-342-1741 

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Injured Worker Rights and Responsibilities

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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

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. 

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Injured Worker Rights and Responsibilities

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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

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. 

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Injured Worker Rights and Responsibilities

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.

http://www.palmbeachschools.org/riskmgmt/WorkersComp/WCGuidelines.asp

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. 

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