Injury
& Illness Reporting
The Division maintains Worker's Compensation coverage for all employees
of the Division. This coverage is provided by the State through
a self-funded program and is administered by Key Risk Management
Services, Inc.
The Worker's Compensation Act establishes three conditions that
MUST be met for an injury or illness to be considered compensable.
These conditions are :
- The employee must suffer a personal injury by accident.
Intentional injuries are not covered
- The injury must arise in the course of employment.
Employee must be State Government employee at time
of injury.
Students and volunteers are NOT considered employees
of the State.
- The injury must arise out of employment.
Employee must be performing job at time of injury
The Office of State Personnel has developed a Worker's Compensation
Handbook
that is useful for employees to review. The handbook provides
information on each employee's rights and responsibilities under
the program.
If three (3) or more persons are hospitalized or an employee
death occurs, call the Safety Office immediately.
In
all other cases follow the reporting process as
shown below when an employee is injured while performing his or
her duties.
Immediately following the incident:
- Employee must report the incident to his/her supervisor. If the injury is a tick bite, please log the bite incident on this Tick Incident Log.
- Supervisor is to make a determination of the injury severity.
If the incident is a life-threatening injury,
contact EMS or take directly to hospital, and if available to
a preferred hospital.
If incident is not a life-threatening injury:
- Provide employee with two copies of the Medical
Authorization and Pharmacy form.
-
Call a DENR preferred medical provider in the preferred provider network (login & password use KRCC) and inform the provider
that an injured employee is on the way to the medical facility
and that case is a Worker's Compensation case. If a
preferred medical provider is not available, send employee
to a local medical facility.
- Employee is to distribute the above copies as follows:
-
Give medical provider a copy of Medical Authorization
Form and ask that attending physician provide requested physical
capability information.
-
If prescription medications are prescribed by attending
physician, provide the 2nd copy of Medical Authorization and Parmacy form
to pharmacy. This form has a listing of the Key Risk authorized
Tymesys pharmacies.
Within 24 hours following incident:
-
Supervisor must notify the Safety Office of the incident, complete
the following forms and send to the Division Safety Office via
the Section Chief:
-
The forms can be initially sent via email, but must be followed by signed copies via interoffice mail.
All incidents are to be investigated to determine whether
any work processes or procedures need to be changed to remove
or reduce the likelihood of repeat incidents. Process changes are to be noted on the Supervisor's Accident Report Form.
-
The employee is to fill out the WC Release of Information form and provide the original to the Safety Office. The employee may keep a copy for his/her records. If the injury results in any days away from work, the employee shall complete the Employee
Statement. The employee is to provide a statement of what happened, and if necessary, how the initial days away from work will be counted. The supervisor is to fill-in the appropriate blocks on the second page, sign and date the form, then forward the form to the Safety Office.
Incident Follow-up and employee return to work
- Supervisor must maintain contact with the employee while the employee
is away from work and/or recuperating from the injury.
- Upon employee return to work, the employee must provide to the
supervisor:
- Physician completed Return to Work notice with any
job restrictions indicated.
- Physician note specifying reason for days away from
work (past or future).
The Safety Office must have a copy of these documents in the
incident file.
-
The Supervisor must keep the Safety Office informed of any days
away from work and any work restrictions placed on the employee
by the attending physician. Days away can be counted using
the DWQ specific NCIC Form 22 DWQ. When the claim is complete or when requested, send the form to the Safety Office.
-
If attending physician indicates job restrictions, these must
be accommodated for the period of time indicated. For information
on the DENR return to work program, contact the Safety Office.
-
If the employee has out of pocket expenses for prescriptions,
reimbursement is to be made on NCIC
form 25P (Excel file) and then submitted to the Safety Office.
The maximum weekly benefit
effective January 1, 2007 is $754.00.
Last Update: November 3, 2008
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