SOP: Workers Compensation Flashcards
Notice of injury or occupational disease/Incident report is what numbered form?
C-1
Employers report of industrial injury or occupational disease is what numbered form?
C-3
Employees claim for compensation/report of initial treatment is what numbered form?
C-4
A certificate of recovery and fitness is described as what form?
Medical release
What is defined by NRS as an unexpected or unforeseen event happening suddenly and violently, with or without human fault and producing at the time objective symptoms of an injury?
Accident
What is defined by NRS as a sudden and tangible happening of traumatic nature producing an immediate or prompt result which is established by medical evidence, including injuries to prosthetic devices?
Injury and Personal Injury
Who maintains a self-insured and self-administered program for industrial claims?
City of Las Vegas
Who is responsible for managing claims for all city employees?
The workers comp administrator
Personnel are responsible to know and follow SOP 100.12 ______ ______ ______ regarding modified duty/ light duty release by a treating physician.
Transitional Work Assignment
All _______ shall assist their subordinates in obtaining medical care, if needed, and complete the _______ portion of all workers comp forms.
Supervisors, supervisors
Supervisors shall submit all paperwork and forms in a timely manner, within ______ days, not ______
7, shifts
Who shall co-ordinate with Human Resources and/or workers comp administrator to ensure compliance with city policies?
Deputy Chief of Admin
Who shall manage appropriate payroll processes in compliance with city policies
Payroll Assistants
Who shall maintain an employee injury log and route forms and paperwork to Human Resources or the workers comp administrator?
Payroll Assistants
Who shall communicate as needed with the injured/ill employee regarding items related to the injury such as paperwork, schedules and time keeping?
Payroll Assistants
All work related injures/illness should be reported to their immediate supervisor within _____ calendar days, not _____.
7, shifts
When reporting a work related injury/illness, the employee shall fill out a _____ form.
C-1
Submitting a C-1 does not initiate a _____ ______ ________
worker comp claim
Submitting a C-1 is only an incident report until ______ _______ is sought.
medical treatment
The injured/occupationally diseased employee has _______ calendar days after the date of injury to seek medical care.
90
If no medical attention is sought for the injury, the competed C-1 remains on file for ________ years and then is destroyed.
3
If medical treatment Is sought, a ______ claim for compensation and supervisor investigation form must be completed and submitted.
C-4
If ______ is completed and submitted, the workers comp administrator will complete the ______
C-4, C-3
The design and information required on the C-1, C-3 and C-4 forms is mandated by who?
The state of Nevada
If a claim is denied, instructions and appeal rights are provided to the employee by who?
Workers comp administrator
Transitional work assignments are commonly referred to as what?
Light/Modified Duty
Transitional work assignments shall be offered to employees with valid workers comp claims and if authorized by who?
The employees physician
Taking a vacation during a workers comp claim is _____________
Discouraged
If an employee goes on vacation while on occupational disease or injury, there timecard must be changed to what?
vacation leave
City approved forms and information related to workers comp are available electronically where?
City HR Intranet
If an injured/ill employee in in need of medical attention, they will seek treatment at an ___________ occupational clinic.
Approved
For true medical emergencies, the employee may report to a ________
Er
Going to an unapproved provider may ________ the employees claim.
Jeopardize
The initial treating medical facility or physician must compete which form?
C-4
The employee must sign the ______ section of the C-4 otherwise it is not valid.
Middle
On the C-4 the treating physician completes what portion?
Bottom
Typically, the treating physician sends the C-4 to the city of Las Vegas ________.
Directly
Who is responsible to ensure that the C-4 is submitted and received by human resources?
The employee
Human Resources receipt of the C-4 ________ the employees claim.
Initiates
Who is responsible for providing his/her supervisor a copy of the completed C-4 after initial medical treatment.
The employee
Due to the importance and time sensitivity of workers compensation forms, it is recommended that injured/ill employees and supervisors submit forms _________ and/or _______
electronically, hand deliver
Electronically submitted workers comp forms should be sent to what email group?
Fire Payroll
Who completes time cards for employees entirely off work due to occupational disease or injury?
Workers comp administrator
Time off shall be coded as what?
Admin OJI-W
Paid coverage of ______% is provided to IAFF employees for _______ calendar days if the claim is accepted.
100, 60
After 60 days has elapsed and the employee is not able to return to work, the workers compensation fund pays approximately _______ of their monthly salary.
2/3
When full pay coverage expires, the employee may use what to receive a full pay check.
Sick, VL
The city will not take any _________ from the workers comp check.
Deductions
What is not available if the employee is only being paid their 2/3 salary from the worker comp fund?
Direct Deposit
Employees off duty for more than ______ days since their last regular worked day shall submit a fitness for duty form.
90
Return to duty must be completed before the employee is assigned to the ___________
Training Center
The employee is assigned to the training center to complete what?
Return to duty task book
