IMPORTANT LINKS

WORKERS’ COMP/SAFETY FORMS

First Aid Log [in MS Excel format] [in Adobe PDF format]
Employee Report [in MS Word format] [in Adobe PDF format]
Supervisor Report [in MS Word format] [in Adobe PDF format]
List of TPA-Approved Pharmacies [in MS Excel format] [in Adobe PDF format]
Student-Visitor Report [in MS Word format] [in Adobe PDF format]
Statement of Claimant [in MS Word format] [in Adobe PDF format]

UNCA SAFETY AND WORKERS’ COMPENSATION TOPICS

Reporting Accidents/Injuries and Workers' Compensation Claims

First Aid Cases. The Occupational Safety and Health Administration (OSHA) requires that all First Aid cases be recorded on a log. The First Aid Log to be used may be printed out by going to First Aid Log ([in MS Excel format] [in Adobe PDF format])

NOTE: It is important that all small First Aid incidents be logged, as a later attempt to make a Workers’ Compensation claim based on an old, minor injury which unexpectedly continues to cause problems will not be approved unless it was documented on a First Aid Log at the time it occurred.

· Definition of First Aid Case. A First Aid case is defined as a one-time treatment and subsequent observation of minor injuries. Such minor injuries include the application of bandages, antiseptic, ointment, irrigation of eye to remove non-embedded foreign objects or the removal of foreign objects in a wound by using tweezers. Simple First Aid cases never involve loss of consciousness, restriction of work or motion, or reassignment to another job.

· Responsibility for First Aid Log. It is the responsibility of the director or chair of the department or program where the incident occurred to ensure that this log is properly maintained. He or she may delegate this responsibility.

· Reporting Requirements. At the end of each calendar quarter the First Aid Log must be returned to the Workers’ Compensation Administrator (WCA) for reporting purposes. If no First Aid Cases are encountered during the calendar quarter, a statement to this effect may be e-mailed to the WCA in lieu of the log. The total number of First Aid Cases each quarter are reported to the Office of State Personnel as an item in the Quarterly Statistical Reports of Injuries/Illnesses and Workers’ Compensation Expenditures.

Emergency Procedures

When any accident above the First Aid level occurs on the UNCA Campus, the UNCA Safety Officer should be called to the scene immediately. The Safety Officer can be notified during normal working hours (8:00 AM to 5:00 PM) by calling Facilities Management Customer Service at ext. 6564. When an accident occurs after normal working hours, Public Safety should be called (ext. 6710). The Public Safety Office will forward their incident report to the Safety Officer the next morning.

· Non-Life-Threatening Incidents . In non-life-threatening circumstances the employee's Supervisor should alert the Safety Officer and the Workers’ Compensation Administrator (WCA) by dialing ext. 6564 prior to seeking medical attention. This notification will enable the WCA to call to alert the provider to an incoming patient, bills for whom will be paid under Workers' Compensation. Accidents which are not life-threatening are commonly treated at the Sisters of Mercy Urgent Care Center located on Leicester Highway, just off Patton Avenue. For certain specific types of problems, however, injured employees may be set up immediately with another specialist, at the discretion of the WCA.

· Life-Threatening or Second/Third-Shift Incidents. Accidents which are life-threatening or which occur during the second or third shift after normal working hours are normally treated at Memorial Mission Emergency Room.

Þ Definition of Life-Threatening Accident. Accidents which are considered life-threatening include severe lacerations which may have punctured an artery, puncture wounds, foreign objects embedded in the eye or other body areas, second and third degree burns, severe chemical burns, or unconsciousness.

Þ To Summon an Ambulance. In the case of a Life-Threatening Accident, an ambulance will usually be needed. Call Public Safety at ext. 6710 and provide the dispatcher with the following information:

If for any reason Public Safety cannot be reached, then you should take responsibility for dialing 9-911 and getting an ambulance on the way.

Þ Care of the Injured Employee. Try to never leave an injured person alone. Have the person sit or preferably lie down. Keep him/her comfortable and warm to prevent shock.

Accident Report Forms

All accidents to UNCA employees resulting in injury, illness, or "near-misses" must be reported within one working day following the occurrence to the Workers’ Compensation Administrator (WCA).

· First Report of an Accident. The WCA and the Safety Officer can be reached by calling Facilities Management Customer Service, at ext. 6564.

Þ There are two required forms for this purpose: (1) North Carolina State Government Workers’ Compensation Program Employee Statement and Leave Options (SGWC-2), and (2) the Supervisor’s Accident/Incident Investigation Report. Interactive versions of both these forms are available. Go to Employee-Report and Supervisor-Report or print the PDF versions Employee-Report | Supervisor-Report

Þ Both report forms should be completed as thoroughly as possible and forwarded to the WCA as e-mail attachments or printed and mailed to her at CPO#1100.

Þ The WCA will check forms for completeness, share this information with the UNCA Safety Officer, and forward required reports to the State.

Reportable and Medical Only Workers’ Compensation Cases

· Definition of Medical Only Injuries/Illnesses. The case is “Medical Only” if the injury is severe enough to require outside medical attention, but the employee misses no more than one day of work and his/her medical expenses are under $2,000.

· Definition of Reportable Injuries/Illnesses. A case is defined as "Reportable" if medical expenses in excess of $2,00000 are accrued or if the affected employee is out of work for more than one day.

· Reporting Requirements. The North Carolina Industrial Commission (NCIC), which is the State agency responsible for oversight of the NC Workers’ Compensation Program, requires that all Reportable injury/illness cases be submitted to the NCIC within five (5) days following receipt of the first report. OSHA also requires that information be submitted on Reportable WC cases to the federal government. Medical Only Cases are reported on the Quarterly Statistical Reports of Injuries/Illnesses and WC Expenditures.

· Who Submits the Reports. The WCA submits these reports based on the information provided in the Employee’s Form 19 and the Supervisor's Accident/Incident Investigation Report Form.

State of North Carolina Third Party Administrator (TPA)

The State of North Carolina has contracted with a Third Party Administrator (Key Risk Managed Care, Inc., with its home office in Greensboro, NC) to manage State Workers’ Compensation Claims.

· Approved Providers. The TPA has compiled a list of approved local providers for Workers’ Compensation injuries and illnesses.

· How to Find an Approved Provider. If you have an accident or illness that is work-related and non-life-threatening, please contact ext. 6564 (Facilities Management Customer Service) before pursuing any follow-up care. They will put you in touch with the WC Administrator, who will then provide an official Workers’ Compensation recommendation to an approved local provider.

· Prescriptions. In instances where the attending physician prescribes medication, the employee should take the prescription directly to a pharmacy on Key Risk’s approved list.

Þ Every campus office should have a copy of this list available; or view this list at Pharmacy List ([in MS Excel format] [in Adobe PDF format]) .

Þ The State requires pharmacies to obtain approval from the TPA before filling a prescription – so do not be surprised if it takes a while to get your WC prescription filled.

Þ The employee should receive the prescribed medicine without having to pay any money and at a discounted price.

Þ If for any reason, an employee has trouble getting computer approval from Key Risk for his or her prescription, s/he may choose to pay for the prescription and bring or send the receipt to the campus WCA at the Physical Plant Building. The WCA will work with Key Risk to obtain reimbursement for the employee.

· Disagreements with decisions of the TPA. The UNCA WCA serves, as needed, as an advocate for employees who have disagreements with the TPA regarding treatments, liability, or other matters related to Workers’ Compensation injuries or illnesses. She will negotiate problems with the TPA, and will attempt to facilitate communication between the employee, the local providers, and the TPA.

· Payment of Medical Invoices. Payment of Medical Invoices for State Workers’ Compensation cases is made by the TPA under their contract with the State.

Þ Approval for medical procedures must be obtained from Key Risk; the UNCA WCA will commonly negotiate this approval for employees.

Þ Medical invoices will generally be mailed directly to the TPA.

Þ Once the medical bills are received, the TPA will remit payments to the medical provider in the amount approved by the North Carolina Industrial Commission's Fee Schedule.

Þ The WCA will contact the hospital after emergency care to verify Workers' Compensation payment for treatments received.

Þ If employee receive any medical invoices associated with his or her Workers’ Compensation claim, s/he should forward them to the WCA at CPO#1100 for corrective action.

Time Lost From Work Due to Work-Related Injury/Illness

The UNCA WC Administrator will work with the Third Party Administrator to ensure timely disability benefit payments to the employee.

· Waiting Period. The first seven (7) calendar days the employee is absent from work due to a Workers' Compensation injury or illness must be deducted from sick leave or taken as leave without pay.

· Temporary Total Disability (TTD). After this waiting period, the employee will receive TTD benefits in the amount of 66-2/3% of their average weekly wage. With the exception of sworn police officers, all employees are legally required to go on TTD.

· Use of Accrued Leave. Currently, State law allows the employee on TTD to use only two (2) hours a week of sick leave accrued prior to his/her Workers’ Compensation accident, to supplement his/her TTD payments. As TTD payments are not taxable income, this combination should come to approximately the employee’s normal net income.

· More than 21 Days. Should the Workers’ Compensation absence be longer than 21 calendar days, the employee will receive cash reimbursement at the TTD rate for the seven-day waiting period. The employee will not, however, recover the sick time thus used.

For more information about the State of North Carolina Workers’ Compensation Plan, go to the Office of State Personnel Employee Risk Services web site, http://www.osp.state.nc.us/emprsk/workcomp.htm .

Work Restrictions/Return to Work Options

The attending physician may choose to restrict the employee from performing certain activities and duties, and will issue a statement to that effect.

· This statement must immediately be forwarded to the UNCA WCA, who will notify the employee's supervisor of any work restrictions.

· If the employee has restrictions of a temporary nature which affect only a few of his or her normal work duties, it is the supervisor’s responsibility to adjust work assignments in the work area to enable the employee to work within his or her temporary restrictions.

· Restrictions may allow the employee to work, but be so stringent as to make it impossible for the employee to function in his/her normal position. In such cases, under the UNCA Return to Work Policy, the WCA will work with the Human Resources Department to identify an available temporary working position that the employee can fill during the period of his or her limitations.

Accidents Involving Students/Visitors

Should accidents occur which involve students, visitors, or other individuals who are not University employees a Student/Visitor Accident Report Form must be completed by the director or chair of the department or program where the accident occurred. A copy of this form is at Student-Visitor_Rept . This form should be forwarded to the Safety Officer at CPO#1100 within one working day following such an accident by the department director, area supervisor, or chairperson of the area where the incident occurred.

If the accident victim desires to seek financial reimbursement for medical expenses a Statement of Claimantmust be completed. A copy of this form is at Statement of Claimant([in MS Word format] [in Adobe PDF format]).