300-5 Worker's Compensation Flashcards
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the COH shall:
Immediately notify or arrange for the notification of a supervisor. This shall be done, if physically possible, no later than ______ following the time of the injury or exposure.
24 hours
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the COH shall:
Seek immediate medical attention if necessary and avoid any activity that may aggravate the injury. Employees shall seek medical attention from a treating physician who __________patients. Failure to treat with an approved treating physician may make the employee ineligible for benefits under the Texas Workers’ Compensation Act.
accepts workers’ compensation
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the COH shall:
_________ the COH On the Job Injury Reference Sheet with a supervisor, if physically possible. Employees shall follow the rules and procedures listed on this form.
Review, initial, and sign
Employees who are injured or potentially exposed to a communicable disease while in the course and scope of employment with the COH shall:
Employees who have potentially been exposed to a communicable disease shall also submit to baseline blood tests within _______ following the exposure to a communicable disease.
ten calendar days
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 _______ after being made aware of the injury or event, or as soon as practicable.
HSU within 24 hours
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Arrange for ____ medical treatment of the employee, if necessary.
prompt
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Advise the employee to seek medical attention from a treating physician that ________. Failure to treat with an approved treating physician may make the employee ineligible for benefits under the Texas Workers’ Compensation Act.
accepts workers’ compensation patients
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Initiate the process of filing the workers’ compensation claim by completing the
required IOD paperwork. Completely fill out the ____________with the injured employee as soon as possible, but no later than ______ after being made aware of the injury or event.
The City of Houston Accident Report form shall be completed even if ___________.
The _________ (if applicable) shall be documented in the comments section of the form.
City of Houston Accident Report form, 24 hours
the employee does not seek medical attention.
HPD incident number
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Review, with the employee, the COH On the Job Injury Reference Sheet and have the employee initial, sign, and date this form.
Additionally, supervisors shall request for the employee to complete, sign, and date the __________.
If the employee refuses to initial, sign, or date any of the IOD forms, the supervisor shall document _______on each form that the employee refused to acknowledge.
The supervisor shall also have a ______sign and date the form noting the refusal.
Authorization for Disclosure of Protected Health Information form
the refusal
witness
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Report the claim via telephone to the _______ or ________ after being made aware of the injury or event. Obtain a reference number from the CRS and document the number on the City of Houston Accident Report form.
If the supervisor is unable to contact the administrator within 24 hours following the report of injury, the supervisor shall contact ______ for further instructions.
TPA’s Claim Reporting Service (CRS) as soon as possible, within 24 hours
HSU
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Forward a copy of the completed 100 forms to HSU within 24 hours following the report of injury or exposure (for example, via fax or email).
The originals should then also be forwarded to HSU. The originals may be attached to the correspondence that must be sent to HSU within _____ days.
15 calendar
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
- City of Houston Accident Report
- COH On the Job Injury Reference Sheet
- Rx Card/Rx Pharmacy Network Information Sheet
- City of Houston Summary Workability Guidelines E. 0. 1-33 booklet
Upon being notified of an occupational injury or potential exposure to a communicable disease, a supervisor shall:
Provide the employee information on the Family and Medical Leave Act (FMLA), if applicable.
FMLA notice is required whenever an employee reports ____ covered under FMLA guidelines
a condition
Supervisors do not have the authority to authorize medical treatment or benefits.
However, supervisors may inform a treating physician that a claim of occupational injury shall be or has been reported to the ______ and direct the treating physician to the TPA for authorization for treatment.
COH TPA
Read
Section 3 Employees Subsequent Duties
Supervisors shall ensure that the departmental IOD correspondence is sent to the HSU no later than _____ days following the report of occupational injury.
15 calendar
The injured employee’s supervisor shall ______ and include ______concerning the incident that resulted in the employee’s injury as well as findings from the investigation of the IOD event.
write correspondence, pertinent information
______ shall be submitted from both the injured employee and the supervisor for any recurrence of an injury.
Subsequent correspondence
Supervisors shall forward all _______ to the HSU after they are received from an injured employee.
DWC Form-73 forms
No one but the ________ shall forward forms to the TDI or to the TPA.
Health Safety Unit (HSU)
Supervisors shall immediately notify the ______ when becoming aware of an injured employee using scheduled or unscheduled leave for vacation.
HSU
Supervisors shall maintain contact with injured employees while they are on injury leave either by ______ or ______ .
telephone, personal visits
Supervisors shall __________ of any contacts. The purpose of maintaining contact with the injured employee is to determine the employee’s status and to assist in any manner to facilitate recovery and expedite the return to duty.
document the date, time, and results
Daily contact is not necessary if _______ that the employee shall be absent for a considerable length of time.
it is obvious from the nature of the injury
Unless otherwise directed by the employee’s division commander, supervisors shall contact an employee on injury leave at a minimum of _______.
once a week.
Mid managers shall contact an employee that is on injury leave between _____
and ____ calendar days of the IOD absence. After the initial contact, mid managers shall repeat this process on a weekly basis.
Division
the fifth and tenth consecutive
Division commanders shall contact any employee that has been on injury leave for _______ days. After the initial contact, division commanders shall repeat this process every two weeks.
30 consecutive calendar
Supervisors shall conduct a scheduled or unscheduled personal visit with any employee who has been on injury leave for 30 consecutive calendar days.
Supervisors shall continue to conduct personal visits with the injured employee at a minimum of once every ______ consecutive calendar days until the employee returns to duty.
30
Each supervisor shall report the details, date, and time of each visit to the HSU via email ______ following each visit.
within 24 hours
Should a supervisor have reason to believe an injured employee is feigning injury or perpetrating fraud, the supervisor shall immediately cease all communication with the employee, notify the HSU and the , _______ and follow procedures in General Order 200-03, Investigation of Employee Misconduct.
IAD/CIO
When an employee is absent for over _______ calendar days for any reason, the employee’s supervisor shall instruct the employee to submit to a drug test immediately upon returning to work (see General Order 300-17, Employee Drug Testing).
30 consecutive
