300-05 Workers' Compensation Flashcards
The City of Houston (COH) has a program by which eligible employees who suffer a _____ in the course and scope of their employment with the COH may receive workers’ compensation benefits in accordance with state statute, Texas Department of Insurance (TOI) regulations, and COH Executive Order No. 1-33, Work Ability Guidelines.
compensable injury
The Houston Police Department’s _____ is responsible for the internal administration and processing of workers’ compensation claims. Employees having questions regarding occupational injuries or workers’ compensation benefits and claims should contact HSU for assistance.
Health and Safety Unit (HSU)
Adjuster.
An employee of the Third Party Administrator who investigates and adjudicates insurance claims.
Exposure.
Confirmed contact with an infectious agent, such as through inhalation,
percutaneous inoculation (puncture or cut by a sharp object), or contact with an open wound, non-intact skin, or mucous membrane.
Fraud.
When a person knowingly or intentionally conceals, misrepresents, or makes a false statement to deny, obtain, or prolong workers’ compensation benefits or insurance coverage or otherwise profit from the deceit.
Injury.
The damage or harm to the physical or neurological structure of the body and those diseases, conditions, or infections naturally resulting from the damage or harm. This term also includes occupational illness that is a bodily injury or health impairment resulting from exposure
to conditions of the recovering employee’s physical environment and/or work area.
Injury Leave.
Leave authorized by Section 14-226 of the COH Code of Ordinances and Section 143.073 of the Texas Local Government Code and accorded to a recovering employee who sustains an injury or illness in the course and scope of employment with the COH.
Occupational Injury.
An injury, disease, or illness sustained in the course and scope of employment with the City of Houston.
Third Party Administrator (TPA).
Independent administrator contracted by the City of Houston to be responsible for the adjudication of workers’ compensation claims including payments to recovering employees and health care providers in compliance with the law.
Transitional Duty Assignment.
A temporary work assignment designed to allow an employee who is injured, ill, or unable to work at full-duty capacity to perform tasks that are within the specific restrictions set by the employee’s treating physician.
Treating Physician.
For the purpose of this General Order, an individual, group, or facility
authorized by the City and the TOI to direct the medical treatment of a recovering employee.
Treating Physician’s Statement.
A document provided by an authorized health care provider after an office visit with an injured employee.
The treating physician’s statement must contain the following information:
the date of the office visit,
the date of the incident,
the name and contact information of the health care provider completing the statement,
the current work status of the injured employee,
the range of dates covered by the statement,
and the employee’s work and/or activity restrictions, if any.
Affidavit of Exposure to a Communicable Disease.
Affidavit completed by an injured employee and used to request mandatory testing of the source of an exposure to a communicable disease.
Authorization for Disclosure of Protected Health Information.
Medical release form, signed by an injured employee, which gives permission to disclose and receive the employee’s medical records.
City of Houston Summary Workability Guidelines E.O. 1-33.
This is a summary of the work ability guidelines in City of Houston Executive Order 1-33 regarding injured employees.
City of Houston Supervisor’s Incident Report.
Form used to document an employee’s injury. This report provides a description of how the injury occurred, location of the injury, and the employee’s personal information.
COH On the Job Injury Reference Sheet.
Informs employees of their benefits and priority responsibilities while on injury leave or working a transitional duty assignment.
Employees shall initial, sign, and date the form and follow the rules and procedures listed
Employee Request for Travel and Authorization Form.
Form completed and signed by an injured employee’s treating physician allowing the employee to travel while the employee is on injury leave.
Injured or Ill Employees and Transitional Duty Report.
Internal document, used to notify the Health and Safety Unit of employees who are working in a transitional duty assignment or unable to work due to an injury or illness.
Rx Card/Rx Pharmacy Network Information Sheet.
A first fill card that allows an employee to receive initial prescriptions under the City’s workers’ compensation program at most pharmacies.
Texas Workers’ Compensation Work Status Report (DWC Form-73).
Report completed by an injured employee’s treating physician indicating the employee’s work status and activity restrictions.
The DWC Form-73 provides the employee’s prognosis for discharge from treatment and work readiness, including the date of release to return to work and any restrictions upon returning to work at less than full duty.
The DWC Form-73 also serves as a release to any type of transitional duty assignment or a return to full duty with no restrictions.
The injured employee shall submit a DWC Form-73 if any City work time is lost due to an occupational injury or while in a transitional duty assignment.
The DWC Form-73 should be submitted by an employee to his immediate supervisor within 24 hours after receiving the completed form from the treating physician.
Texas Workers’ Compensation Work Status Report (DWC Form-73).
The DWC Form-73 also serves as a release to any type of transitional duty assignment or a return to full duty with no restrictions.
The injured employee shall submit a DWC Form-73 if…
The DWC Form-73 should be submitted by an employee to his immediate supervisor within ____ hours after receiving the completed form from the treating physician.
1) any City work time is lost due to an occupational injury or while in a transitional duty assignment.
2) 24
EMPLOYEE’S INITIAL DUTIES
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the City of Houston (COH) shall:
a.
Immediately notify or arrange for the _____. This shall be done, if physically possible, no later than _____ following the time of the injury or exposure.
1) notification of a supervisor
2) 24 hours
EMPLOYEE’S INITIAL DUTIES
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the City of Houston (COH) shall:
b.
Seek _____ if necessary and avoid any activity that may aggravate the injury.
Employees shall seek medical attention from a treating physician who _____.
Failure to treat with an approved treating physician may make the employee ineligible for benefits under the _____
1) immediate medical attention
2) accepts workers’ compensation patients
3) Texas Workers’ Compensation Act.
EMPLOYEE’S INITIAL DUTIES
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the City of Houston (COH) shall:
c.
Review, initial, and sign the _____, if physically possible. Employees shall follow the rules and procedures listed on this form.
COH On the Job Injury Reference Sheet with a supervisor
EMPLOYEE’S INITIAL DUTIES
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the City of Houston (COH) shall:
d.
Employees who have potentially been exposed to a communicable disease shall also submit to baseline blood tests within _____days following the exposure to a communicable disease.
Employees shall complete the required injured on duty (IOD) forms including the _____
1) ten calendar
2) Affidavit of Exposure to a Communicable Disease.
SUPERVISOR’S INITIAL DUTIES
It is the supervisor’s responsibility to ensure all of the initial IOD forms and required workers’ compensation forms and documents are completed and forwarded to the _____ within _____ after being made aware of the injury or event, or as soon as
practicable.
1) Health and Safety Unit (HSU)
2) 24 hours
SUPERVISOR’S INITIAL DUTIES
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
a. Arrange for ______ of the employee, if necessary.
prompt medical treatment