310-12
WORKERS COMPENSATION/INDUSTRIAL INSURANCE PROGRAM

POLICY & PROCEDURE

Subject:

WORKERS COMPENSATION/ INDUSTRIAL

INSURANCE PROGRAM

Index: HUMAN RESOURCES

Number: 310-12 (supersedes 300-38)

Effective Date:

5/15/2012

Supersedes:

1/1/1993

Page:

1 of 5

Staff Contact:

Nancy A. Carlson

Approved By:

Denis Law

1.0 PURPOSE:

This policy describes the claims submittal and processing procedure for industrial insurance claims, and designates responsibilities within the organization for the administration of the self-insured Workers’ Compensation/Industrial Insurance Program.

2.0 ORGANIZATIONS AFFECTED:

All City departments and employees in a full/part-time status, excluding those employees who are members of the LEOFF I retirement system.

3.0 REFERENCES:

Chapter 51.28 RCW

WAC 296-15, 296-18

City of Renton Policy & Procedure 700-09, Occupational Illnesses and Injuries

4.0 POLICY:

Effective January 1, 1984, the City of Renton instituted a program of self insurance for all industrial insurance claims. It is the City’s policy to process all claims efficiently and expeditiously, to insure avoidance of unnecessary delays in either the receipt of benefits by injured employees or in the payment of claims for medical services rendered in the treatment of work-related injuries or illnesses.

Volunteers are covered by the City of Renton Self Insured Program for injuries sustained while volunteering for the City. Coverage is for medical payments only. Volunteers are not entitled to indemnity payments for time off work.

To insure that this objective is met, the following procedures will be followed in the administration of the self insured Workers’ Compensation/Industrial Insurance Program.

5.0 DEFINITIONS:

Not applicable.

6.0 PROCEDURE:

6.1    Administrative Services Administrator:

6.1.1    The Administrative Services shall be responsible for the assurance that the City meets all financial obligations as set forth by State law regarding the Workers’ Compensation Self Insurance Program. This will be accomplished through the establishment of an appropriate loss fund, posting of cash and performance bonds, and the securing of appropriate levels of excess insurance.

6.2    Human Resources and Risk Management Administrator or designee:

6.2.1    The Human Resources and Risk Management (HRRM) Administrator, through coordination with the City’s Third Party Administrator (TPA), shall be responsible for claims tracking once a reportable work-related injury or illness has occurred. Tracking shall include the forwarding of all claims information to the TPA, monitoring of claims via the claims database through final disposition, and maintenance of the internal claim files. It shall be the additional responsibility of the HRRM Administrator to advise the Administrative Services Administrator of any potentially large claims to insure adequate resources are identified to meet all monetary obligations related to those claims, and to assure the Excess Carrier has been notified.

6.2.2    The HRRM Administrator shall be responsible for the establishment of and representation of an employee education program to insure that all employees are aware of their rights and obligations in industrial insurance claims.

6.2.3    The HRRM Administrator shall be responsible for the analysis of causes of industrial injuries and the development of programs and policies that will aid in increased employee safety awareness and accident prevention.

6.3    Claims Administrator

6.3.1    The City of Renton has contracted with a Third Party Administrator for the purpose of representing the City and administering all claims activity due to work-related injuries/illnesses.

6.3.2    The Claims Administrator (TPA) shall, upon proper notification and receipt, be responsible for the investigation, audit, and payment of all industrial insurance claims. Verification shall be accomplished through comparison of the physician’s initial report and the Self Insurer Accident report.

6.3.3    Auditing responsibilities shall include determination of proper or excessive treatment and time loss authorizations by the attending physician.

6.3.4    Upon determination of the appropriateness of a claim, the TPA shall authorize and disburse on behalf of the City, any and all disability allowance benefits and medical treatment payments.

6.3.5    Additionally, the TPA shall insure that timely notification is issued to the HRRM Administrator regarding the status of all claims and to the Administrative Services Administrator regarding any and all disbursements from the claims fund.

6.4    First-line Supervisor: Upon notification of an injury requiring medical attention or resulting in time loss, the first-line supervisor shall take the following actions:

6.4.1    Direct the injured employee to seek immediate medical treatment if necessary. (See Policy and Procedure 700-09, Occupational Illnesses and Injuries.)

6.4.2    Provide the injured employee with an industrial insurance claims packet. (Packets are distributed to each supervisor’s office by the HRRM Department. Additional stock of claims packets are available upon request from the HRRM Department.)

6.4.3    In accordance with City Policy and Procedure 700-09, complete a Supervisor’s Report of Injury; and immediately notify the Department Administrator and HRRM Department of the name of the injured employee and the extent of the injuries.

6.4.4    Insure that, as soon as physically possible, the injured employee completes the Washington State Labor and Industries Form SIF-2, Self Insurer Accident report. Upon completion, the supervisor will complete the employer’s portion, sign and date and forward all copies to the HRRM Department.

6.4.5    Upon the return of an employee who has been on disability leave, the supervisor shall immediately notify the HRRM Administrator.

6.5    Employee

6.5.1    The employee is responsible for immediately reporting all work-related injuries to his/her supervisor.

6.5.2    When medical treatment is necessary, the employee must present to the attending physician the pre-addressed Physician’s Initial Report (contained in the claims packet); and inform the medical facility that his or her employer is self-insured for industrial insurance. If the employee does not have a claims packet, he or she merely informs the medical facility that the injury/illness is work related and that the employer is self insured. This will alert the facility to complete the appropriate forms, which should then be forwarded to the City of Renton HRRM Department, which will in turn forward the report to the Claims Administrator.

6.5.3    As soon as possible, complete the employee (worker) portion of the Self Insurer Accident report (contained in the claims packet) and forward it to your supervisor. This should be accomplished as soon as possible as failure to submit this report in a timely manner can result in delays in the receipt of time-loss payments by the injured employee or the satisfaction of medical treatment billing obligations on behalf of the City.

7.0 CLAIMS PAYMENT:

7.1    The TPA shall establish the proper amount of benefit payment, either or lost wages due to time-loss or for medical treatment, and will process payments in accordance with Washington State Industrial Insurance laws.

7.2    According to Washington State law no employee shall receive compensation for the day the injury occurs of the three days following it unless the disability continues for a period of fourteen (14) or more consecutive calendar days from the date of injury.

7.2.1    Accrued sick leave can be used to supplement time-loss payments. In those cases where accrued sick leave is applied in conjunction with the disability allowance, the disability allowance will be forfeited by the injured employee and the employee’s sick leave account credited for the value of the disability allowance.

7.3    Payment of benefits to employees or dependents for permanent disabilities or death is determined by the Washington State Department of Labor and Industries.

8.0 APPEALS:

8.1    In accordance with Washington State law, the Department of Labor and Industries shall retain jurisdiction over all appeals relating to industrial insurance claims.

8.2    Any employee who disputes the findings or payment of an industrial insurance claim may file an appeal directly with the Washington State Department of Labor and Industries, Appeals Division.