Procedure 916-Workers' Compensation Flashcards
.01 INTRODUCTION
A. The purpose of this procedure is to establish guidelines for documenting all Workers’ Compensation claims and the
manner in which they are prepared. Supervisors are responsible for an accurate completion of all documentation
required for compliance with this procedure. Additionally, all members have a duty to report claims as early as
practical.
B. Sworn members affected under this procedure and requiring change of assignment status refer to GM Procedure
904, Limited Duty Assignment, for instructions.
.02 DOCUMENTATION OF OCCUPATIONAL INJURY/DISEASE
A. Members who are disabled in any way due to an occupational injury/disease and, due to the impairment, are unable
to perform any assigned duty will notify a supervisor of such occurrence as early as practical.
1. Notification shall be made by the affected member, in writing, by incident report with assignment number and
shall contain time and date of occurrence, location, type of injury/disease, and witness (es).
2. In the event the affected member is incapable of the required notification, the supervisor in charge at the time of
the injury shall be responsible for submitting documentation of the incident.
B. A supervisor, upon receiving notification of a member’s complaint of occupational injury/disease, regardless of the
severity of the complaint, shall complete the required form(s) in compliance with Workers’ Compensation mandates.
1. The affected member’s immediate supervisor, if on-duty, shall complete the necessary documentation.
2. In the event the affected member’s immediate supervisor is off-duty (i.e., relief day, vacation, sick, etc.), any
supervisor assigned to the same unit completes the necessary documentation.
C. Complete documentation is required for each incident or occurrence of occupational injury/disease sustained by any
member.
.03 PROCEDURAL GUIDELINES
A. Members requesting to be carried injured on-duty due to an occupational injury/disease are required to seek
immediate treatment by a physician, if they have not done so already. Before a member is carried injured on-duty,
he is required to have a physician complete SAPD Form #172, Physician Authorization for On-Duty Injury Status,
or the State Form #DWC073, Texas Workers’ Compensation Work Status Report. The completed form is submitted
to the supervisor.
B. SAPD Form #172 or State Form #DWC073 is required for determining the status of personnel injured on-duty. Each
visit to a physician must be documented by an SAPD Form #172 or State Form #DWC073, in order to continue to
verify an injured member’s status.General Manual Procedures – Section 900 Personnel Procedures Page 2 of 2 Effective Date:July 31, 2010
San Antonio Police Department
GENERAL MANUAL
Procedure 916 – Workers’ Compensation
C. The completed SAPD Form #172 or State Form #DWC073 is submitted to the member’s supervisor and the
supervisor is responsible for forwarding the documentation to the Accounting and Personnel Office no later than the
following business day.
D. For purposes of reporting an occupational injury/disease, a supervisor must complete the State Form #DWC01,
Employer’s First Report of Injury or Illness, and forward the completed form to the Accounting and Personnel
Office within forty-eight (48) hours of the occurrence.
E. Supervisors will no longer be responsible for completing items 36, 37, and 38 (Rate of Pay) on the State Form
#DWC01. These sections will be completed by the Accounting and Personnel Office.
F. In addition to the State Form #DWC01, the supervisor must complete City of San Antonio Form #RM-S-1, City of
San Antonio Supervisor’s Report of Accident Investigation. This completed form must be received in the Accounting
and Personnel Office within seventy-two (72) hours of the occurrence.
G. State Form #DWC-6, Employer’s Supplemental Report of Injury, is required to be completed by a supervisor in the
following instances
1. Within forty-eight (48) hours of the time the injured member started losing time from work due to an
occupational injury/disease, the form must be received in the Accounting and Personnel Office.
2. If the initial State Form #DWC01 submitted for the injured member did not note loss of time from duty and
time was subsequently lost due to the same occurrence, DWC06 is required for the member. This form must be
submitted within forty-eight (48) hours of the time the injured member began losing time from work.
3. Within forty-eight (48) hours of a member’s return to work from an occupational injury/disease, whether
returning to limited duty or regular assignment, the State Form #DWC06 must be completed and received in the
Accounting and Personnel Office. Members to be assigned to a limited duty assignment or returning to regular
duty following a limited duty assignment must report to the Office of the Chief in accordance with GM
Procedure 904, Limited Duty Assignment.
H. All completed documentation submitted must be typed and forwarded to the Accounting and Personnel Office
within the specified time-frames in order to avoid penalties imposed by the Texas Workers’ Compensation
Commission.
.04 ROUTING OF REPORTS
A. Supervisors are required to e-mail or fax documentation related to the member’s claim of occupational
injury/disease. The supervisor collects the copies, time-stamps them, and places them in the member’s unit level
field file.
B. Supervisors are responsible for ensuring submission of documentation, except for the incident report, is delivered to
the Accounting and Personnel Office within the specified time-frame. For purposes of this section, the documents
are considered “delivered to Accounting and Personnel Office” when they have been received by the Accounting
and Personnel Office within specified time-frame.
eneral Manual Procedures – Section 900 Personnel Procedures Page 1 of 2 Effective Date:July 31, 2010 San Antonio Police Department GENERAL MANUAL Procedure 916 – Workers’ Compensation Office with Primary Responsibility: SSO Effective Date: Prior Revision Date: July 31, 2010 October 01, 2009 Office(s) with Secondary Responsibilities: PSC, PNC, TSC, FTC, IDC Number of Pages: 2 Forms Referenced in Procedure: SAPD Form #172 State Form #DWC01 State Form #DWC-6 State Form #DWC073 Related Procedures: 904
