Service Related Injuries

Question 1

Situations where the members physician is prescribing a CT Scan, MRI, X-Ray or any other radiological examination related to an SRI, what company has been contracted to perform the examinations?

Answer 1

CareIQ Radiology Network

Question 2

As a member, in all SRI cases what are you to complete ?

Answer 2

NYS Workers Compensation Claimant Information Package
File forms C3 and/or C-3.3 with the NYS Workers Compensation Board

Question 3

If an injured member RMAs he/she must:

Answer 3

-complete a SRI report
- submit original report to investigating supervisor
-complete tour of duty

Question 4

If the member does not complete the tour of duty due to a SRI he/she must :

Answer 4

• be evaluated by a doctor prior to leaving his/her tour of duty
  -make notification to CU Supervisor

Question 5

If the member is treated at an emergency room, he/she shall:

Answer 5

-obtain copy of Hospital treatment form when discharged
-if able, complete the SRI report
-complete workers compensation medical form and attach to hospital treatment form
-submit all above forms to investigating supervisor

Question 6

If member is treated at ER, he/she shall:

Answer 6

Obtain copy of Hospital treatment form when discharged
Complete the SRI report
Complete Workers Compensation Medical Form and attach to hospital treatment form
Submit all original paperwork to investigating supervisor

Question 7

When attending WC evaluations with IME, what do you bring to first appointment?

Answer 7

Bring copy of SRI report

Question 8

When returning to duty prior to scheduled WC evaluations with the IME what steps do you take ?

Answer 8

Email WC or call to be advised with evaluation is still required.

Question 9

If unable to attend WC evaluation with the IME , who shall you notify?

Answer 9

Nicoleta Geiling and MCU at least 2 business days in advance of appointment

Question 10

At conclusion of WC evaluation with the IME what will the member receive ?

Answer 10

Workers compensation IME form

Question 11

At the end of the WC evaluation with IME obtain a copy of the workers compensation IME form and email the completed form to who?

Answer 11

MCU

Question 12

When out with an SRI and unable to attend OHS appointment who must you contact and by when?

Answer 12

Contact OHS and MCU at least 2 business days in advance of appointment.

Question 13

At the conclusion of OHS appointment related to an SRI what form do you need to obtain?

Answer 13

MD 40 and email to MCU

Question 14

What are some steps the investigating supervisor will take when dealing with a SRI injury to a member ?

Answer 14

Ensure member is escorted by another member in ambulance
Secure injured members weapon, shield, id
Photograph injuries and the scene if possible
Complete department incident report
Confirm CU has made notification to District CO

Question 15

Within 24 hours of investigating SRI what 2 forms are emailed? Within 24 hours, what original form will be mailed to Brooklyn?

Answer 15

SRI REPORT AND WORKERS COMPENSATION MEDICAL FORM AND HOSPITAL TREATMENT FORM (if applicable)

-Service Related Injury Report

Question 16

Within 24 of SRI incident who do you send the SRI cover page, SRI report and SRI packet to?

Answer 16

District CO

Question 17

If member requires additional medical treatment from SRI, how do you obtain a workers compensation claim # and what form do you bring to all visits with physician?

Answer 17

• obtain # by email Nicoleta Geiling
  -bring a workers compensation medical form

Question 18

What form will the injured member receive at the WC evaluation?

Answer 18

Workers compensation IME form and email to MCU

Question 19

The MCU Supervisor will forward reports, photos, and approved Department Incident Report to WC within how many days of the SRI?

Answer 19

5 business days

Question 20

Who will make notification to the immediate family or a line of duty death or a member with serious injuries as soon as possible?

Answer 20

District CO or command staff designee in his/her absence