1702 Leave and Payment for Workers’ Compensation and Special Injury Claims

All employees of the Department are covered by the Workers' Compensation Law unless specifically excluded by law or regulation.

All full-time employees who regularly work thirty (30) or more hours each week are covered by state law.

No compensation will be allowed for an injury, illness, exposure to occupational disease or death:

Work-related injuries, illnesses and exposures to occupational disease are to be reported immediately, as outlined in DHS Human Resources Policy #1701 — Workers' Compensation and Special Injury Return-to-Work Program.

Department of Administrative Services (DOAS) Workers' Compensation investigators acting as agents for the Department are authorized to have access to personnel and any other related files and information necessary to complete a review or investigation of a workers' compensation or special injury claim. An employee’s medical information is confidential and is available to individuals only on a need to know basis.

An employee must provide satisfactory medical documentation of an injury, illness or exposure to occupational disease to the designated organizational unit representative and the immediate supervisor.

Satisfactory medical documentation is certification from a workers' compensation Managed Care Organization physician or emergency health care provider that the employee is physically unable to perform the duties of employment as a result of the injury, illness or exposure to occupational disease on the specified date.

Failure by the employee to submit satisfactory medical documentation of a work-related injury, illness or exposure to occupational disease within two (2) weeks may result in the employee’s benefits being suspended.

An employee who does not initially contact the Manage Care Organization for a referral is not eligible for workers' compensation benefits unless the employee received emergency treatment.

If employees are absent due to workers' compensation claims, employees have the option of:

Employees must provide written notification of the selected option by using the Leave Election Form (Attachment #1)

Employees who choose to receive workers' compensation payments for lost salary will be placed on leave without pay. Employees cannot simultaneously receive workers' compensation payments and regular salary (i.e., use of accrued FLSA compensatory time or leave).

Absences due to a workers' compensation claim which qualifies as a serious health condition will be charged to family leave with and/or without pay if available and as determined appropriate.

The designated organizational unit representative must notify the DOAS Workers' Compensation Program, when the employee loses work time or when the employee returns to work.

The waiting period for workers' compensation wage loss payments is seven (7) calendar days. Usually no payment is due for the first week of the disability.

Entitlement to benefits for the first seven (7) calendar days of disability or any portion of the time, requires that the employee be disabled for at least twenty-one (21) consecutive calendar days and that the first seven (7) calendar days were leave without pay.

In the event available leave is inadequate to cover the entire period of disability [in excess of the first seven (7) calendar days of disability] the employee would be entitled to weekly benefits as of the day the leave was exhausted.

Medical expenses arising from a work-related injury, illness or exposure to occupational disease are covered if the claim is accepted by the DOAS Workers' Compensation Program. This includes hospital bills, prescribed drugs, ambulance charges, physician fees and other medical expenses. Expenses connected with a work-related injury, illness or exposure to occupational disease are excluded under the State Health Benefit Plan.

For treatment that is for some reason not covered by workers' compensation benefits, or if workers' compensation benefits terminate, employees should seek treatment from their personal health care provider.

An eligible employee who becomes physically disabled as a result of a physical injury incurred in the line of duty and caused by a willful act of violence committed by a person other than a fellow employee shall be entitled to regular compensation, up to a maximum of 180 workdays, for the period of time that the employee is physically unable to perform the duties of employment.

Benefits will not be provided for more than a total of 180 workdays for injuries resulting from a single incident.

Special injury (also referred to as “line of duty” injury) claims are to be reported in the same manner as other workers' compensation claims. (See DHS Human Resources Policy #1701).

Requests for special injury leave should be carefully reviewed. The individual responsible for workers' compensation reporting should review all available information with the designated organizational unit representative to determine if the injury falls within the provisions of the Special Injury Law.

Notification of the decision should be sent to the employee.

The designated organizational unit representative must also notify the DOAS Workers' Compensation Program when the employee loses work time or when the employee returns to work.

If supported by satisfactory evidence of physical disability, any absence during the first seven (7) days of physical disability is covered by special injury leave and must not be charged to sick leave, annual leave, personal leave, FLSA compensatory time or leave without pay (LWOP).

During the first seven (7) days of physical disability, the employee is not eligible for workers' compensation benefits; therefore, coordination of benefits with the DOAS Workers' Compensation Program is not necessary during this time. The employee will continue to receive his/her regular salary from the Department during this time. Refer to #3 of this Section, if absence due to disability exceeds twenty-one (21) consecutive calendar days.

Coordination of workers' compensation benefits with the DOAS Workers' Compensation Program is required for employees absent due to physical disability beyond the first seven (7) days. The designated organizational unit representative and the DHS Office of Financial Services (OFS) - Payroll Subsection will process special injury leave beyond the first seven (7) days, as follows:

If the employee is physically disabled for twenty-one (21) consecutive calendar days as the result of a special injury, the employee becomes eligible for workers' compensation salary benefits for the first seven (7) days of physical disability.

The employee’s supervisor must notify the designated organizational unit representative when the employee returns to work or has any other change in employment or workers' compensation status. (This includes time status changes.) The designated organizational unit representative must immediately notify the DOAS Workers' Compensation Program.

If the employee returns to work from a period of special injury leave, the supervisor or designated organizational unit representative should notify the appropriate transactions center staff to enter personnel action to return the employee from special injury leave.

An employee who remains physically disabled after 180 workdays is no longer eligible for special injury leave benefits. Regular workers' compensation benefits will then apply. The supervisor or designated organizational unit representative is to notify the appropriate transactions center to enter personnel action to return the employee from special injury leave.

The employee’s designated organizational unit representative is responsible for ensuring that the employee continues to have payroll deductions for any health insurance and/or flexible benefits premiums for which the employee is responsible during the period of special injury leave. If payroll deductions are not possible, the designated organizational unit representative must ensure the employee is made aware of the employee’s responsibility to make direct payment(s).