Employee Injury and Illness

Employee Injury and Illness

For employee injuries and illnesses, Workers' Compensation coverage is maintained by the Division. This coverage is provided by the State through a self-funded program and is administered by the CorVel Corporation.

 

The Workers' Compensation Act establishes three conditions that MUST be met for an injury or illness to be considered compensable. These conditions are :

 

  1. The employee must suffer a personal injury by accident. Intentional injuries are not covered.

     

  2. The injury must arise in the course of employment.

     

  3. The injury must arise out of employment. Employee must be performing job at time of injury.

     

 

The Office of State Personnel has developed a Workers' Compensation Handbook that is useful for employees to review. The handbook provides information on employee rights and responsibilities under the program.

In all other cases, follow the reporting process as shown below when an employee is injured while performing job duties.

 

Immediately following the accident:

 

 

 

 

  1. Employee must report the incident to their supervisor

  2. If the incident is a life-threatening injury:

     

     

     

    1. Dial 911, or
    2. transport to nearest preferred hospital, or
    3. take to nearest hospital if a preferred hospital is not nearby

  3. If the incident is NOT a life-threatening injury:

     

     

    1. Call a DEQ preferred medical provider in the preferred provider network (if available) and inform the provider that an injured employee is on the way to the medical facility and that case is a Workers' Compensation case.
    2. Provide employee with three copies of the Medical Authorization and Return to Work form.

  4. Employee is to distribute the above forms as follows:

     

     

     

    1. Give medical provider a copy of Medical Authorization Form
    2. Give medical provider a copy of Return to Work form and ask attending physician to provide requested physical capability information
    3. If prescription medications are prescribed by attending physician, provide the 2nd copy of Medical Authorization form to pharmacy.

 

Within 24 hours following incident:

 

  1. Supervisor must notify Safety Officer of the incident. The Safety Officer will provide the following:

     

     

    1. Industrial Commission Form 19.

       

      NOTE: Questions 11, 15 and 17 and OSHA 301 Information block will be complete by the Safety Officer

    2. Supervisor's Accident Investigation Form.

       

      NOTE: The form may be initially sent via e-mail, but must be followed by signed copies via interoffice mail.

       

      All incidents are to be investigated to determine if 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 Safety Officer should assist with the investigation if necessary.

     

  2. The employee is to fill out the WC Release of Information From and provide the original to the Safety Officer. Employee may keep a copy for their records.

     

  3. Employee is to provide to supervisor a completed Employee Statement and Leave Options form. 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's return to work

 

 

  1. Supervisor must maintain contact with employee while employee is away from work and/or recuperating from injury.

     

  2. Upon employee's return to work, employee must provide to the supervisor:

     

    1. Physician's completed Return to Work notice with any job restrictions indicated.

       

    2. Physician's note specifying reason for days away from work (past or future).

     

    NOTE: The Safety Officer must have a copy of these documents in the incident file.

  3. The Supervisor must keep Safety Officer informed of any days away from work and any work restrictions placed on the employee by attending physician.

     

  4. If attending physician indicates job restrictions, these must be accommodated for the period of time indicated. For information on the DEQ Return to Work Program, contact the Safety Officer.

     

  5. If the employee has out-of-pocket expenses for prescriptions, reimbursement is to be made on NCIC Form 25P (.xls) and then submitted to the Safety Officer.