North Carolina Department of Correction

Workers’ CompensationAnd

Salary Continuation Programs

Tracy AshworthProgram Manager

Tonya MarlinProgram Assistant

Phone - 919/716-3700 Fax - 919/716-3960

(Revised August 1, 2003)

Benefits Benefits Representative/SupervisoryRepresentative/Supervisory

Responsibilities Responsibilities• FORM 19FORM 19

Must be typed Treatment by physician must be completed Fax to the Personnel Office, Benefits Section

within 24 hours Mail the original Form 19 to the Benefits

Section in Personnel Do not send to the Industrial Commission

Address Will Remain the Same

NO Wage NO Wage InformationInformation

Return To Work?Return To Work?Sought Medical Sought Medical Treatment?Treatment?

Don’t Forget!Don’t Forget!

Does Not ApplyDoes Not Apply

Every question must be answered in the employees handwriting

Back of Form should ONLY be completed by facility nurse

Mail the original

Form DOC-WC-4

Catastrophic InjuriesCatastrophic Injuries

• Notify the Benefits Section and Key Risk Notify the Benefits Section and Key Risk Management ServicesManagement Services

• Examples Include:Examples Include:– Death Caused by a job related injuryDeath Caused by a job related injury– Amputation of a major extremityAmputation of a major extremity– Gun shot woundGun shot wound– Second or third degree burns over 25% of Second or third degree burns over 25% of

the bodythe body

Third Party Third Party Automobile Automobile AccidentsAccidents

Forward the following Forward the following documents to the Benefits documents to the Benefits Section:Section:• A copy of the A copy of the investigating investigating police police officer’s reportofficer’s report• A copy of the Motor Fleet A copy of the Motor Fleet

Management reportManagement report• Insurance information for Insurance information for

the other vehiclethe other vehicle

Employee Employee ResponsibilitiResponsibiliti

eses Immediately report injury to

supervisor

Follow prescribed medical treatment provided by Key Risk Management Services

Provide management with medical restrictions and out of work medical excuses

Contact supervisor on a weekly basis while out of work

Salary Salary ContinuationContinuation

(Injury Leave)(Injury Leave)

•Employees are required to use accumulated leave

•Benefit Reps/Supervisors must submit •Out of Work Notes•Time Sheets•Memorandum requesting Injury Leave Approval at the end of each 28 day work cycle •MUST REQUEST SPECIFIC DATES

•Who’s Covered?•Employees that are in certified classes•Non-certified employees injured by direct and deliberate act of an offender/inmate

• After receiving injury leave approval, reinstate leave to the employee’s CURRENT DC-113– Auditors request that the leave

taken be struck through and replace with an “I” for injury leave

Salary Salary ContinuationContinuation

(Injury Leave)(Injury Leave)

Shift PremiumShift Premium

Employees whose position entitled them to shift premium pay prior to the injury shall continue to receive shift premium pay while out of work due to a compensable job related injury

it is the facility’s responsibility to make sure eligible employees receive shift premium pay while on approved “Injury Leave”

Must submit, to payroll, a memorandum requesting shift premium pay along with the employee’s time sheet.

Workers’ CompensationWorkers’ Compensation

• Leave Without Pay Due to Leave Without Pay Due to Workers’ CompensationWorkers’ Compensation

Who’s Covered?Who’s Covered?

All Department of Correction employees including All Department of Correction employees including some temporary/contractual employees.some temporary/contractual employees.

•required 7-day waiting periodrequired 7-day waiting period

•Employee placed on LWOP after the required waiting period

•Employee will receive 66 2/3% of their average weekly wage for the 52 weeks prior to the date of injury

Workers’ CompensationWorkers’ Compensation vs. vs.

Family Medical Leave Family Medical Leave

• When the employee is receiving Salary Continuation (Injury Leave)– If the employee is eligible, then designate Family

Medical Leave

• When the employee is receiving Workers’ Compensation (Leave Without Pay due to Workers’ Compensation)– Do no designate Family Medical Leave (Per Office of

State Personnel)

Medical Medical TreatmentTreatment

• The facility shall:– refer injured employees to a

CompCare Provider physician

– if EMERGENCY medical treatment is required, refer employee to the closest medical facility for treatment

• Payment/Status of Medical Bills– contact Dana McCormick,

KRMS at 1-800-942-0225 ext. 388

Transitional Transitional Return to Return to

Work ProgramWork Program• The Department of Correction

accommodates temporary medical restrictions for an employee who has suffered a compensable job related injury

• The purpose of the Transitional Return to Work Program is to provide work to employees who are restricted from performing their normal job duties

• There is no limit of how long an employee can participate in the Transitional Return to Work Program

Goal of Transitional Goal of Transitional Return to Work Return to Work

ProgramProgram• To help employees during the healing

process by:– returning employees to a normal lifestyle

sooner– focusing on abilities instead of disabilities– improving employee morale– encourage cross training within Department

of Correction

Transitional Return toTransitional Return to Work Program Rules Work Program Rules

• Employee must have sustained a compensable job related injury

• Employee must provide supervisor with a medical note from the treating physician that list the temporary medical restrictions and the duration of the restrictions

• Every attempt should be made to place the injured employee in a transitional job

• If a transitional job cannot be identified the supervisor must contact the Benefits Section immediately

Transitional Job Transitional Job PlacementsPlacements

• Examples Include:– clerical duties: filing, data entry,

receptionist– control rooms– towers– any position short staffed where

accommodation can be met

Return to Regular DutyReturn to Regular Duty

• The employee must submit a return to work note from the treating physician stating that the employee may return to regular duty

Americans with Americans with Disabilities ActDisabilities Act

• Requirements– The employee’s treating physician must advise that

the employee has reached maximum medical improvement

– The employee must have permanent medical restrictions

• Process– The Benefits Section will send a copy of the

employee’s essential job functions to the treating physician

– If the employee cannot perform all of the essential job functions, the Benefits Section will ask the employee to complete the DC-730 (Request for Reasonable Accommodation)

– The Benefits Section will forward the essential job functions and the DC-730 to the Division and await a decision regarding the accommodation

– The Division will notify the employee and work location of the decision

Work StatusWork Status

• Employee Participating in the Transitional Return to Work Program– the employee will continue to work light

duty until the Division makes a decision regarding the accommodation

• Employee Not Working– the employee will remain out of work– the employee will continue to receive

Salary Continuation or Workers’ Compensation until a decision has been made by the Division regarding the accommodation

Any Questions?Any Questions?