Ch. 17 (Worker's Comp)

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Federal and State laws REQUIRE

employers to maintain Worker's Comp coverage to meet minimum standards, covering a majority of employees for work related illnesses and injuries.

Workers compensation laws

also protect employers and fellow workers by limiting the award and injured employee can recover from an employer

U.S Dept. of Labor (DOL) Office of Workers Comp Programs....

administers programs that provide wage/replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers.

the dept of labor also manages the following programs designed to prevent work related injuries:

1. mine safety and health administration (MSHA)
2. Occupational Safety and Health Administration (OSHA)
3. Jones Act

Energy Employees Occupational Illness Compensation Program

effective July 31, 2001, started providing benefits to eligible employees and former employees of the dept of energy.

Federal Black Lung Program

provides medical treatment and other benefits for respiratory conditions related to former employment in the nation's coal mines.

Those disabled due to Pneumoconiosis (black lung disease)

receive MONTHLY benefit checks

Federal agencies reimburse FECA for worker's comp through....

an annual budget chargeback process, which transfers funds from a responsible federal agency's budget.

the OWCP's' Division of Federal employees Compensation (DFEC)

processes new claims for benefits and manages ongoing cases. pays medical expenses & compensation benefits

Longshore and Harbor Workers Compensation Program

covers private industry workers who are engaged in the extraction of natural resources from the outer continental shelf, employees on American defense bases, and those working under contract with the US government for defense or public works projects outside the continental USA.

The Occupational Safety and Health Act of 1970

created the Occupational Safety & Health Administration (OSHA) to protect employees against injuries from occupational hazards in the workplace.

OSHA and its state partners

established protective standards, enforce those standards and reach out to employers and employees by providing technical assistance and consultation programs.

Material Safety Data Sheets (MSDS)

contain information about chemical and hazardous substances used on site. Training employees in the safe handling of these substances is also required.

Comprehensive records of all vaccinations administered and any accidental exposure incedences....

must be retained for 20 years.

Federal Employment Liability Act (FELA)

is not a workers compensation statute, but it provides railroad employees with protection from employer negligence and makes railroads engaged in interstate commerce liable for injuries to employees if the railroad was negligent.

Workers Compensation Insurance

provides WEEKLY cash payments

Workers Comp Board or Commission

administrates programs that provide wage replacement for injured workers.

State Insurance (or Compensation) fund:

a quasi-public agency that provides worker's compensation insurance coverage to private and public employers

Self insurance plans:

employers with sufficient capital to qualify can self insure which means they are required to set aside a state mandated percentage of capital funds to cover medical expenses

the injured employee's healthcare provider ALWAYS....

determines the extent of disability.

Medical treatment claims...

are the EASIEST to process.

Schedule loss of use

the employee has a loss of eyesight, hearing or a part of the body or its use. Compensation is LIMITED to a certain number of weeks according to a schedule set by law.

Providers who treat established pt's for work related disorders

should create a compensation file (separate from the established medical record)

survivor benefits

provide death benefits to eligible dependents. these benefit amounts are calculated according to the employees earning CAPACITY at the time of illness or injury

special handling of workers comp cases

providers are required to accept the workers comp allowable fee as payment in FULL for covered services rendered on cases involving on the job illnesses and injuries.

First report of injury forms

are completed by the provider, when the pt first seeks treatment for a work related injury.

Injury report must be completed in

QUADRUPLICATE

if the employer disputes the legitimacy of the claim

you should still file the First Report of Injury.

a detailed narrative progress/supplemental report

should be filed to document any significant change in the workers medical or disability status.

The PHYSICIAN should always....

personally sign the original and all photocopies of these reports.

adjudication

a judicial dispute resolution process in which an appeals board makes a final determination.

deposition

a legal proceeding during which a party answers questions under oath (but not in open court)

arbitration

a dispute resolution process in which a final determination is made by an impartial person who may not have judicial powers.

employer fraud

committed by an employer who misrepresents payroll amounts or employee classificaiton or who attempts to avoid higher insurance risk by transferring employees to a new business entity that is rated in a lower risk category.

employee fraud

committed when an employee lies or provides a false statement intentionally fails to report income from work, or willfully misrepresents a physical condition to obtain benefits from the state compensation fund.

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