10.7 Injury and Illness Case Management Manual Flashcards
1
Q
What are the program objectives of the injury and illness case management program?
A
- Benefits – workers’ compensation benefits
- Reporting – injury and illness reporting
- Communication – communicate with employees off duty for occupational injury/illness
- Return to Work – return employees to work as soon as possible.
2
Q
What is the definition of an occupational injury?
A
Any injury resulting from an incident or exposure involving a single event in the work environment.
3
Q
What is the definition of an occupational illness?
A
Any abnormal condition, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment.
4
Q
What are the different categories of injuries / illnesses?
A
- Record only
- First Aid
- Non-disabling
- Disabling
5
Q
What is a non-disabling injury or illness?
A
Requires more than first-aid, but the employee is able to return to work (full or limited duty) for the next scheduled work shift.
6
Q
What is a disabling injury of illness?
A
Results in the employee being unable to return to work for the next scheduled work shift.
7
Q
What is a hazardous exposure?
A
Exposure to any chemical, biological, or physical agent which does not result in injury or illness.
8
Q
What is the difference between a recurrence and aggravation of injury or illness?
A
- Recurrence does not have a new defined incident to cause injury. It is a spontaneous reappearance of a prior condition.
- Aggravation has an identifiable new incident of injury and shall be processed as a new injury.
9
Q
Should an injury or illness should be deemed questionable as work-related if it was not witnessed?
A
No. Should not be deemed questionable as work related.
10
Q
When should an injury or illness be deemed questionable as work-related?
A
Pending State Compensation Insurance Fund (SCIF) decision of acceptance or denial.
11
Q
What is a record-only injury or illness?
A
One that is non-disabling and does not require first aid or medical treatment.
12
Q
What is a first-aid injury or illness?
A
Minor, non-disabling injury or illness that involves one-time medical treatment.
13
Q
What is the State Compensation Insurance Fund (SCIF)?
A
Adjusting agency for occupational injuries and illnesses by state employees.
14
Q
Can an employee who is off work due to injury or illness have his / her request for secondary employment suspended?
A
Yes, if the medical care provider indicates in writing that the secondary employment may impede the ability to recover.
15
Q
Employees should or shall notify a supervisor if their secondary employment is affecting the ability to recover.
A
Shall.
16
Q
When would a supervisor attend a Workers’ Compensation Appeals Board trial or hearing?
A
The supervisor shall attend the trial or hearing if he / she has knowledge of the case.
17
Q
How involved are supervisors in injury and illness case management?
A
Shall be personally and actively involved.
18
Q
Are supervisors responsible for reporting and routing procedures for injury, illness, and exposure?
A
Yes.
19
Q
Who assists employees in receiving prompt and proper medical care?
A
Supervisors.
20
Q
Supervisors should or shall accompany employees to their initial medical appointment to discuss work capability with the medical care provider.
A
Shall, if practical.
21
Q
Supervisors should be present when employees are being examined by medical care providers.
A
Shall not attempt to be present in any event.
22
Q
When should a supervisor attend a medical appointment for an employee from another command?
A
When the medical appointment is in the supervisor’s Area and it would be impractical for a supervisor from the employee’s command to attend.
23
Q
What shall supervisors do if an employee is not making a good-faith effort toward medical rehabilitation?
A
Shall notify the commander.
24
Q
When shall an employee notify a supervisor of a job-related injury?
A
As soon as possible and prior to seeking medical treatment unless immediate emergency care is needed.
25
Does the medical care provider need to be notified that the injury is believed to be occupational?
Yes. Employee shall advise the medical care provider.
26
What is an employee’s responsibility when off-duty due to occupational injury?
Inform his / her commander of where and how they may be contacted.
27
What does an employee need to obtain in order to reinstate a suspended secondary employment request?
Written authorization from the medical care provider.
28
Do the reporting and routing procedures for injury, illness, and exposure do no change depending on the severity of the claim.
Yes. Procedures do change depending on the severity.
29
Who reviews injury / illness / exposure claims forwarded by commands?
The Division Health and Safety Coordinator.
30
Is documentation concerning an employee’s injury / illness / exposure is confidential.
Yes
31
Does occupational injury of job applicants have to be reported?
Yes
32
Who initiates the reporting of an occupational injury of a job applicant?
The supervisor managing the application process.
33
What form is used to document the occupational injury of a job applicant?
CHP 121.
34
On the 121 for an occupational injury of a job applicant, what is indicated as “salary,” what is indicated as “occupation?”
None” for salary, and “job applicant” for occupation.
35
Are departmental volunteers eligible for workers’ compensation benefits?
No. They are not considered to be employees (unless the Department designates them as such).
36
Within how long after reporting a recurrence of an injury or illness does the employee have to submit a memo detailing the circumstances?
24 hours.
37
What shall happen if an employee is incapable of submitting a memo within 24 hours after reporting a recurrence of an injury or illness?
The employee’s supervisor shall write the memo within 24 hours and indicate the circumstances of the recurrence and the reason why the employee couldn’t write the memo.
38
What specific reporting is required of employers by Cal-OSHA and the California Code of Regulations concerning occupational injuries?
A Log of specific occupational injuries and illnesses must be kept. Called the OSHA 300.
39
When shall injuries / illnesses be recorded on the Log?
Within 6 workdays of knowledge of injury / illness.
40
Does the Log have to be updated for a status change in injury / illness?
Yes.
41
Do record-only and first aid injuries have to be recorded on the Log
No.
42
Who completes the CHP 121 for an employee’s injury? Within how much time?
The employee’s supervisor. Within 24 hours of notification of the injury / illness / exposure.
43
A CHP 121 should or shall be typed?
Shall.
44
When must the employee review and sign his / her 121?
Within 24 hours of reporting the injury / illness.
45
What happens if the employee is incapable of signing the 121 within 24 hours?
The supervisor shall document the circumstances that prevented the signing in the comments section of the 121. The employee then signs as soon as possible.
46
What shall happen if the employee refuses to sign his / her 121?
The supervisor types or prints “refused to sign” in the employee’s signature block and document the refusal in the comments section of the 121.
47
When does the 121 have to be filed with SCIF? Are there exceptions?
Within 5 days of notification of injury / illness. A 121 does not have to be filed with SCIF for record-only or first aid injuries.
48
Will SCIF accept a partial (incomplete) 121? How about a fax copy of a 121?
File a partial 121 to SCIF in order to meet the 5 day deadline. Include a statement that additional information is coming as soon as possible. Fax copies are OK pending completion of the completed original.
49
If an employee is temporarily assigned to another command and gets injured, which command completes the 121? Which command is responsible for subsequent case management?
The temporarily-assigned command, unless the assignment is for civil disturbance. Case management is the responsibility of the employee’s permanent command.
50
Who is responsible for completing an employee’s 121 in the injury occurs while the employee is traveling to or from a temporary assignment in another command?
The employee’s permanent command.
51
Who is responsible for completing an employee’s 121 if an injury occurs while the employee is temporarily assigned to and / or under the direct supervision of an entity other than the Department?
Appropriate Assistant Commissioner completes the 121. A copy of the 121 is forwarded to the employee’s permanent command which is responsible for case management.
52
Who is responsible for completing the 121 for a cadet who gets an occupational injury?
Academy. The 121 is sent to the cadet’s permanent command upon graduation. That command is then responsible for case management
53
What is the CHP 121A?
Supervisory review of occupational injury / illness / exposure.
54
Who completes the 121A? Within what time period?
Supervisor. Within 24 hours of injury / illness / exposure.
55
May the 121A be hand written?
Yes. Shall be typed or hand printed in ink.
56
Does the injured employee have to sign the 121A? If so, in what time frame?
Yes. Within 24 hours of reporting the injury
57
Who completes the 121B? In what time frame?
The injured employee. Within 24 hours of reporting the injury or illness.
58
What happens if the injured employee is incapable of completing and signing the 121B?
The supervisor shall document the circumstances that prevented completion / signing on the 121A. The employee shall complete / sign the 121B as soon as possible.
59
What happens if the injured employee refuses to complete / sign the 121B?
The supervisor types or prints “refused to complete or sign” in the employee’s signature block. Document the refusal on the 121A.
60
What is the CHP 121C?
Medical information release authorization.
61
Who signs the 121C? In what time frame?
The injured employee. Within 24 hours of reporting the injury.
62
What happens if the injured employee is incapable of signing the 121C?
The supervisor shall document the circumstances that prevented signing on the 121A. The employee shall sign the 121C as soon as possible.
63
What happens if the injured employee refuses to sign the 121C?
Supervisor shall advise that, pursuant to SCIF policy and procedures, refusal may cause delay or denial of workers’ compensation benefits. Supervisor shall type or print “refused to sign” in the employee’s signature block and document on the 121A.
64
What is the CHP 121D?
Illness / injury status report.
65
Who maintains the 121D?
Commanders maintain for injured employees who are off-duty or on limited duty. Shall not be posted for general viewing.
66
The supervisor should or shall provide the medical care provider with the Officer Task Statement (CHP 225) to help determine may perform full or limited duty.
Shall.
67
When shall the supervisor provide the medical care provider with a CHP 225?
As soon as possible after notification that a uniformed employee sustained an injury / illness requiring more than first aid.
68
What is the CHP 442?
Individual accident, injury, and safety recognition record.
69
Who completes the 442? In what time frame?
Supervisor. Within 3 days of initial notification of, or an status change of, an employee injury, illness, or exposure.
70
Does the medical care provider get a copy of the CHP 443 – approval of limited duty assignment?
Yes. As soon as possible after notification of a nondisabling injury / illness that requires limited duty status.
71
What is the CHP 600?
Right to privacy instructions relative to occupational injuries / illnesses and vehicle accident reports.
72
Who completes the CHP 600? In what time frame?
Supervisor. Within 24 hours of notification of injury / illness.
73
Who provides the employee with the Coping with your Injury form, CHP 601?
Supervisor. Within 24 hours of notification of injury / illness.
74
What is the SCIF 3301?
Employee’s claim for workers’ compensation benefits.
75
Who completes the SCIF 3301? In what time frame?
Supervisor. Provided to injured employee within 24 hours of notification of injury or illness, other than record-only or first aid injuries.
76
When must the SCIF 3301 be routed to SCIF?
Within 5 days of command receipt of the form.
77
The commands receipt of the SCIF 3301 or a Doctor’s First Report of Injury Form are considered equivalent regarding an employee’s notification of injury or illness.
True
78
Where must a Comm-Net Message be sent to notify of a nondisabling (other than record only or first aid) or disabling injury? In what time frame?
Disability and Retirement Unit (DRU) within 24 hours of notification.
79
Injury or illness status changes do not have to be advised to DRU.
False. Status changes shall be advised vial Comm-Net to DRU within 24 hours.
80
If an employee is going to off-duty status for an occupational injury, what does he / she have to provide to the supervisor? When?
A written statement by the medical care provider stating the reasons the employee was placed off-duty and the estimated date of return to full or limited duty. Must be done as soon as possible after being directed to off-duty status.
81
Can the injured employee get a copy of the 121, 121A, 121B, or 121C?
Yes. All of them. Shall be provided upon request.
82
How many physician’s can an employee predesignate for treatment of an occupational injury?
One. Must complete a CHP 242 prior to the injury and have it signed by the physician.
83
Where is the CHP 242, predesignation of treating physician, kept?
In the employee’s field folder; copies attached to any 121s.
84
If an employee has not predesignated a physician, which physician will the employee see for an occupational injury?
A physician on SCIF’s Medical Physician Network (MPN).
85
What is the purpose of the Department-ordered fitness-for-duty examination?
To determine in the employee is able to perform the essential duties of his / her classification.
86
Does a SCIF-ordered medical examination serve the same purpose (equivalent to) a Department-ordered examination?
Yes
87
Who performs the Department’s fitness-for-duty exam?
State-appointed medical care provider.
88
Who performs the SCIF medical exam?
A medical provider specified by SCIF.
89
Under what circumstances would a SCIF ordered medical exam be requested?
If the employee has a previous or current related occupational injury / illness claim on file with SCIF.
90
What are the potential outcomes for an employee after a fitness-for-duty exam?
Ineligible for continued employment or cleared for full-duty.
91
Where does the authority for a fitness-for-duty exam come from?
Government Code (Section 19253.5)
92
What shall a supervisor do when he / she becomes aware that an employee may have a condition that limits the physical or psychological ability to perform essential duties?
Notify the commander.
93
When a fitness-for-duty exam has been scheduled, what shall be requested of the employee?
* Sign a Medical Information Release Authorization (CHP 121C)
* Identify medical providers who have given treatment for related condition is the last 10 years.
94
Does the employee have the right to deny signature and identifying previous medical care providers for a fitness-for-duty exam?
Yes
95
Does a vacant employment position need to exist in order to assign limited duty?
No.
96
Can uniformed employees participate in full duty enforcement activities when assigned to limited duty?
No.
97
Can a uniformed employee on limited duty be assigned a position involving public contact?
Yes, but restricted to non-enforcement or limited enforcement encounters
98
Can a uniformed employee on limited duty wear a uniform or operate an enforcement vehicle.
Normally no, but it is the Commander’s discretion.
99
Does a limited duty assignment require the consent of the employee’s medical care provider.
Yes. The assignment shall be reviewed by the medical provider. Written consent and the duration of the assignment shall be documented on the CHP 443, Approval of Limited Duty Assignment.
100
Can an employee take prescription medication while on limited duty?
Yes.
101
What is the maximum duration of a limited duty assignment?
2 years.
102
Can a limited duty assignment be authorized if the medical care provided fails to specify a termination date?
No. Shall not be authorized.
103
Can an employee be ordered to perform medically approved limited duty?
Yes. Disciplinary action can result up to termination.
104
Can an employee continue to take prescription medication upon return to full duty?
Yes, provided the medical care provider has authorized in writing that the prescription will not interfere with the employee’s performance of duties.
105
What is the procedure for retraining a uniformed employee who is returning to full duty?
* If absent from full duty for less than 1 year; shall be retrained at currently assigned command.
* If absent from full duty for more than 1 year, but less than 2 years; may be retrained at Academy at the employee’s commander’s recommendation.
* If absent from full duty for more than 2 years; shall be retrained at the Academy.
106
What duty status shall an employee return to if PERS denies a request for disability retirement?
Full duty. (unless denial is being appealed)
107
Is SCIF a state agency?
Yes.
108
What does SCIF provide?
Workers’ compensation coverage to state employees. Determines is a claim is occupational.
109
How is SCIF funded?
Through premium payments from the organizations it insures.
110
Should supervisors directly contact SCIF to manage injury and illness cases.
Yes. Supervisors may directly contact SCIF.
111
Can an employee contact SCIF directly to discuss his / her case?
Yes. However, if the employee has an attorney, SCIF won’t discuss the case without permission from the attorney.
112
Can an employee appeal a decision made by SCIF? If so, with whom?
Yes. Appeals made with the Workers’ Compensation Appeals Board (WCAB) in the Department of Industrial Relations.
113
Is an employee attending his / her own WCAB hearing or trial, or who attends on behalf of another employee, eligible for the use of state time?
No. Additionally, the employee can not use disability or sick leave, unless the employee is on 4800 leave on the day of the hearing or trial.
114
How many tasks are involved in the Annual Fitness Challenge?
5.
115
Is the Annual Fitness Challenge voluntary or involuntary?
Voluntary.
116
How many times can an employee participate in the Annual Fitness Challenge?
Once per calendar year.
117
How is an employee designated “successful” and eligible for a Fitness Pin?
Reaching the 50th percentile in 4 out of 5 tasks.
118
Employees should or shall complete a medical prescreening questionnaire prior to the Fitness Challenge?
Shall.
119
Supervisors document injuries that are the direct result of participation in the Annual Fitness Challenge.
True.
120
If an employee participates in the AFC, the supervisor should enter related comments on the employee’s CHP 100 and CHP 118.
True.
121
Each Annual Fitness Challenge should or shall be staffed by a departmental EMT.
Shall.
122
How much time does the AFC require?
Up to 4 hours. This includes travel time, warm-up, performance, and return to employee’s command.
123
Can employee’s receive paid overtime to participate in the AFC.
No.
124
Normally, the AFC is scheduled during the employee’s regular work shift.
True.
125
Can CTO be authorized for the AFC?
Yes, if the AFC is scheduled outside of the employee’s normal working hours.
126
Employees on limited duty may participate in the AFC depending on extent of injury / illness.
False. Employees on limited duty will not participate in the AFC.
127
Injuries sustained by employees preparing for the AFC are occupational injuries.
False. Employees prepare on their own time.
128
Injuries sustained during actual participation in the AFC are handled as an on-duty injury.
True.
129
Can an employee participate in the AFC if he / she has an adverse action pending?
Not if the recommendation if for termination.
130
What is the goal of the Department’s Wellness Program?
Improve overall awareness of health and fitness in all employees.
131
What are the two parts of the Wellness Program?
* Mandatory – commanders support concept of health and fitness and disseminate information.
* Discretionary – commanders coordinate wellness activities for all employees.
132
Physical activity events organized as part of the Wellness Program shall be during off-duty time and shall be conducted off state property.
True.
133
What shall an employee be provided when that employee is medically determined to be permanently precluded from returning to his / her regular job duties?
Options letter. (Commander’s responsibility)
