WORKERS’ COMPENSATION PROGRAM NEWS
New forms are required by DWC beginning October 8, 2010. All JPIA members will be receiving a very small supply of forms by September 27, 2010, and can contact Cynthia Le at Cynthia.Le@yorkisg.com or (909) 942-4802 for more.
- Workers’ Compensation Claim Form (DWC-1) and Notice of Potential Eligibility
The DWC-1 and accompanying two pages of information must be given to the employee within one working day of the employer’s knowledge of an injury, illness or other claim for workers’ compensation benefits.
Photocopies may be used in place of original forms. A blank copy prefilled with the Authority’s program information is available here.
- Posting Notice (DWC-7)
A workers’ compensation notice must be posted with your other required employment notices. Please replace your existing notices by October 8 with the version found here. The link is for English and Spanish versions of the notice; you need only post the Spanish version if you have Spanish-speaking employees.
The notice has been prefilled with information for the Authority’s program, however you will need to enter the location for the nearest WCAB District Office. Click here for WCAB District Office addresses. Click here to search by zip code for the nearest office.
- Notice to new employees – “Facts about Workers’ Compensation”
All new hires are to receive the “Facts about Workers’ Compensation” pamphlet no later than the end of their first pay period. Copies of the pamphlet can be obtained from York at no charge by contacting Cynthia.Le@yorkisg.com. You may order copies from the California Workers’ Compensation Institute store at www.cwci.org/store.html. The Website has pricing and shipping information.
PROGRAM OVERVIEW
All employers must provide workers’ compensation benefits to employees who are injured or become ill as a result oftheir work activities. The California JPIA provides this coverage for its members. Workers’ compensation benefits include all medical treatment necessary to cure or relieve the effects of the industrial injury, transportation costs for medical appointments, temporary disability payments, compensation for scheduled permanent impairment, death benefits, and §4850 vouchers for retraining if the employee is unable to return to his/her usual occupation.
The CALIFORNIA JPIA, by contract with York Insurance Services, handles workers’ compensation claims from inception to closing, and monitors the activities of its strategic partners contracted to carry-out these responsibilities. Members need not worry about the details ofadministering and paying workers’ compensation claims, thereby allowing agency staff and resources to focus on preventing the occurrence of claims in the first place.
WHEN A WC CLAIM OCCURS
Follow these steps for effective claims management. The “Claims Management Checklist” is a useful tool for tracking activity on claims.
Immediately
- Administer first aid; call 911 for serious or catastrophic injuries
- Direct employee to selected medical provider; have someone accompany the employee, if possible. Use the “Authorization for Medical Examination” to instruct the clinic on billing and utilization review procedures. If your customary provider is closed for the day, refer the employee to another facility or the emergency room.
- Secure the area to ensure no one else is injured
First day
- Give injured employee “Employee Claim for Workers’ Compensation Benefits” (DWC-1) in person or by mail (must be done within one working day)
- Have employee complete “Employee’s Report of Injury or Illness”
- Conduct investigation into facts
- Complete “Supervisor’s Report of Injury or Illness”
- Report claim to York by completing “Employer’s Report” (5020) on-line at www.scrma.com.
- Follow up with the employee for results of medical exam, obtain disability slip
- Identify and offer suitable modified or alternate work
Contact clinic if necessary to get clarification of restr
First week
- Keep York updated on employee’s work status (full duty, modified/alternate work, off work)
- Forward appropriate claim documents to York, including completed DWC-1, wage statement, personnel file, disability slips
- Follow up with employee about return to work status, upcoming medical appointments, etc.
- Record claim on OSHA 300 log
Ongoing
- Maintain contact with employee and assist in answering questions; get disability slips, return to work slips, dates of upcoming appointments
- Monitor restrictions and work status; adjust duties for modified/alternate work as appropriate
- Keep York updated on employee’s work status
- Respond promptly to York's requests for information
REPORTING CLAIMS
Members are encouraged to report claims online to minimize delays in setting up claims and providing benefits to injured employees. Online reporting streamlines the reporting process and improves accuracy of the Employer’s Report of Injury (5020). Remember, claims must be reported within five days of knowledge.
Occasionally, there may be an incident that doesn’t appear to be work-related, such as an employee mugged in a parking lot, on suffering a heart attack, or one injured in an auto accident away from the agency’s property. We recommend that these incidents be reported to York promptly for a full investigation to determine if workers’ compensation benefits do apply.
Instruction for reporting claims online
- Go to www.scrma.com.
- Select Client Access from the green bar under the logo.
- Login. Note: each employer is allowed one user name. Because sensitive or private information cannot be accessed from this site, the password may be shared for use by other employees designated to report claims. To change user names or passwords, contact Diana Rich at the CALIFORNIA JPIA.
- Select Submit a new 5020 from the choices on the right side of the page. Use the pull-down button in Field 3A to select your agency.
- Complete the form, and submit it. You may save an incomplete form on-line, and return later to complete it. Once submitted, the 5020 form cannot be edited. To advise SCRMA of changes or corrections after the form is submitted, email your agency-assigned adjuster.
- Mail all claim documents to York, including the completed DWC-1, doctor’s reports or disability slips, wage statements, and witness statements.
Claim Correspondence
The above sections explain how to report claims. All claim files are now paperless so supplemental claim information and general claim correspondence should be sent to:
York Insurance Services Group
PO Box 619079
Roseville, CA 95661
Mail fax: 866-548-2637
WC FORMS AND RECORDKEEPING
First Aid
Minor injuries requiring only first aid care (as defined by OSHA) can be treated at the work place or at your agency's designated medical facility. First aid is defined as a one-time treatment (and subsequent observation) of minor scratches, cuts, burns, splinters, and so forth, which do not ordinarily require medical care. Such treatment and observation are considered first aid, even though provided by a physician or registered professional personnel.
First aid claims are to be reported to York the same as regular claims. The medical provider should be instructed to bill York. Even though a first aid claim is reported to York, it is not recordable on the OSHA 300 log.
OSHA 300
Federal and state law require that every employer must maintain a log of occupational injuries and illnesses, known as the OSHA 300. Forms and instructions can be found at http://www.osha.gov/recordkeeping/
Completing Claim Documents
All injuries and illnesses that are work-related, or potentially work-related, must be reported to SCRMA within 5 days. Following is a brief description of the primary employer forms used in claims handling:
- 5020 - Employer's Report of Injury
This form must filed with York within five (5) days after the date of knowledge of a potential claim. It is preferable that the 5020 be filed electronically, using the online reporting process at www.scrma.com. Do not delay filing while waiting for information. Human Resources or Personnel usually completes this form, as they have all of the necessary employee information on file.
- DWC-1 - Employee's Claim for Workers' Compensation Benefits
- The DWC-1 must be given to an employee within one (1) day of knowledge of an injury or illness, or after a request for a form. Failure to provide the DWC-1 within one day can expose the agency to penalties; however, there is no requirement that the employee return the completed form. The form may be mailed to the employee within one day of knowledge if the employee is off work. When giving out a DWC-1, first complete lines 1, 9, 11 and 12, and keep one copy as a temporary receipt. When the employee returns the form, complete the remainder of the employer’s section. Give a copy of the completed form to the employee, and send a copy to York.
- Supervisor's Report of Injury or Illness
Use of this form facilitates the collection of information needed to report the claim, collect additional facts and capture witness names for third-party negligence. It also asks for information that can be used by the agency’s safety committee in reviewing corrective measures.
- Employee’s Report of Injury or Illness
This form captures the employee’s version of the incident in detail. It also includes a medical release to allow the claims administrator to gather additional records that may be needed to facilitate diagnosis and treatment plans.
- Wage Statement
A wage statement, with up to 52 weeks of pre-injury earnings, should be completed on every lost-time claim and every claim where the employee’s earnings are less than $300 per week. York will prompt you for this form if needed.
Additional forms and guidelines can be found in the “Workers’ Compensation Desk Reference”, which is located in the documents section of this page.
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INTERPRETING CLAIM SUMMARIES
Monthly claim summaries are sent to each member participating in the workers’ compensation program. We encourage you to review the summaries every month.
- Update and maintain the OSHA 300 claim log, as required by law.
- Verify claim summaries for accuracy.
- Compare your log of claims to those on the claims summary, and verify make certain all information is complete and accurate, including agency name, claim categorization, date of injury, date of knowledge, and date DWC-1 given to employee.
- Use claims summary as a reminder to send York a completed wage statement and other essential documentation.
- Review initial reserves, and any changes to reserves.
- Understand how reserves are determined, and what causes increases or decreases.
- Highlight claims with significant changes in reserves.
- Share the reports with management.
- Identify and understand any lags in reporting claims to York (remember, the law allows 5 days to report).
- Know what information is needed for York to effectively handle the claim, including police reports, incident reports, witness statements, wage statements, and personnel files.
- Discuss the existence of “red flags” and ensure all are reported to York.
- Use the monthly summaries to conduct quarterly reviews with department heads and supervisors, and safety committees.
- Discuss impact to budget and/or allocation to departments.
- Support management and the safety committee.
- Assist in loss identification and analysis.
- Develop goals, ideas, and programs to prevent losses in the future.
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