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Austin Fire Department IOJ Employee Resource Packet

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Austin Fire Department IOJ Employee Resource Packet Austin Fire Department IOJ Employee Resource Packet We want to ensure you receive the best care possible. This packet includes: AFD Policy E110.3, City of Austin Introduction, City of Austin Benefits Related to Workers' Comp, FMLA, Workers' Comp Insurance Information, Texas Department of Insurance DWC-41 form, Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System, Office of Injured Employee Counsel First Responder Liaison, and Texas Department of Insurance Return to Work Checklist. If you have any questions, please contact AFD Workers' Compensation: Office Tel: 512-974-1310 / Fax: 512-974-4102 Email: [email protected] Location: 517 S. Pleasant Valley Rd, Austin 78741 WC $GPLQ: -HQQL*DUFLDH[W WC Admin: Rocio Hernandez H[W WC 51: 'DZQ3HSHH[W SPECIAL INSTRUCTIONS FOR INJURED EMPLOYEE 7KH:&,QIR )RUPVHPDLOZLOOFRQVLVWRIVSHFLDOLQVWUXFWLRQVDQGGLIIHUHQWDWWDFKPHQWV 3OHDVHPDNHVXUHWRUHDGWKHIXOOHPDLODQGFRQWDFWRXURIILFHZLWKDQ\TXHVWLRQVRU FRQFHUQV ,I<RXU'XW\6WDWXV&KDQJHV ¾ &RQWDFW$)':&LPPHGLDWHO\IRUIXUWKHUGLUHFWLRQ'RQRWDVVXPHWKDW\RXFDQMXVW VKRZXSWRVKLIWZLWKRXWGLUHFWLRQIURP$)':&WKH5HWXUQWR:RUNSURFHVVVWDUWVZLWK our office. ¾ If applicable, please make sure the Chief's Aide form is complete. This form is required to be considered for the Light Duty 53 hour program, otherwise the default is a 40 hour Assignment. ¾ Return completed forms immediately after your medical visit to AFD WC via email or fax. :HOOQHVV&HQWHULVFORVHG)ULGD\6DWXUGD\6XQGD\DQGDOO&2$+ROLGD\V Austin Fire Department IOJ Employee Resource Packet – Rev. 2020 CITY OF AUSTIN WORKERS’ COMPENSATION INTRODUCTION The City of Austin is committed to providing Workers’ Compensation benefits in accordance with the regulations set forth in the Texas Workers’ Compensation Act and Rules. The Texas Workers’ Compensation system has established rights and responsibilities for employees who are injured on-the- job or whose illness is work-related. The following information is intended to give you an overview about these benefits. For questions or further assistance, contact your Departmental Workers’ Compensation Representative, Austin Fire Workers' Compensation Team, (Name) at 517 S. Pleasant Valley Rd, Austin, TX 78741, phone no. (512) 974-1310. (Department Location) Your Workers’ Compensation Benefit: x Is provided for on-the-job injuries/illnesses that are deemed compensable x Replaces a part of your wages while losing time from work x Begins to accrue on the 8th day of lost time x Is paid to you at a rate of: i 70% of your average weekly wage (AWW) up to the maximum amount set by law x Average Weekly Wage is based on the actual wages you earned during the 13 weeks prior to the injury x Is provided on a non-City check and is known as a Temporary Income Benefit (TIBs) x TIBs will stop when you return to work at pre-injury wages or Maximum Medical Improvement (MMI) is reached x Covers reasonable and necessary medical treatment related to the injury/illness Resources/Contacts x The City contracts with a Third Party Administrator, Sedgwick. Sedgwick sends the Workers’ Compensation TIBs checks to eligible employees and pays reasonable/necessary costs such as doctor visits, prescribed medicine, and prescribed medical equipment for claims accepted as compensable. x If you have questions about your claim, talk to your Departmental Workers’ Compensation Representative or contact Sedgwick at 512-427-2481. x The Human Resources Department’s Risk Management staff is also available at 512-974-3400 to answer your Workers’ Compensation questions. HRD/Risk Management Employee’s Workers’ Compensation Packet 2016 Page 2 of 5 Risk Management: Workers’ Compensation Vol.5 - Revised 5/1/17 Page 82 of 95 General Order AUSTIN FIRE DEPARTMENT Number Policy and Procedure E110.3 Subject: Effective Date: Rescinds: 12/13/2018 E110.2 On-the-Job Injury/Illness Page: 1 of 7 Application: Authorized by: All AFD Personnel Joel G. Baker, Fire Chief I. Purpose To establish guidelines for the proper documentation and investigation of the occurrence of on-the-job injury or illness and to provide information regarding workers’ compensation benefits to members. II. Policy The injured member’s Battalion Chief/Section Supervisor shall be responsible for the investigation of any on the job injury or illness to include the completion of all required documentation. A Safety Chief may be contacted by the investigating Battalion Chief/Section Supervisor for assistance with completing this process. III. Procedure A. When any member is injured on the job, or thinks they have been injured, regardless of whether or not they are planning on seeking medical treatment, they shall immediately notify their immediate supervisor. B. For injuries occurring while on the scene of an emergency response, the member’s immediate supervisor shall contact Command and notify them of the injury. As the incident allows, Command will then notify Fire Dispatch and request that an injury page be sent. The incident number for the emergency response will be used for the injury documentation and Command will be responsible for ensuring that the casualty module is completed within RMS. Policies and Procedures On-the-Job Injury/Illness E110.3, Page 2 of 7 C. If the injury is not associated with an emergency response (Example: an injury that occurs at the station), the member’s supervisor shall immediately notify Fire Dispatch and request that an injury page be initiated. Fire Dispatch will generate an IOJ-INV call type and assign the affected member’s unit (if applicable) and the member’s Battalion Chief/Section Supervisor to the response. The Company Officer and the member’s Battalion Chief shall coordinate to determine if the unit can be returned to service with reduced staffing, based upon the nature and severity of the injury. D. If the member’s Battalion Chief/Section Supervisor is not available for response, another Battalion Chief shall be assigned to the call. The injured member’s immediate supervisor shall be responsible for ensuring that an incident report is completed, along with the casualty module, within RMS. E. When a member believes that they may have suffered an exposure to a contaminant or contagion, this same process shall be followed. See AFD General Order B311, Haz-Mat Incident Response Roster and Exposure Reports for additional information regarding this topic. F. Although the member may decide not to seek medical evaluation and treatment, it is strongly encouraged and should be sought immediately as many injuries may worsen with a delay in treatment. Additionally, a delay in seeking medical treatment may produce a negative outcome with regard to the overall success of the member’s workers’ compensation claim. Ideally, the member’s Battalion Chief/Section Supervisor or the Safety Chief should provide transportation to the medical facility if transport by ambulance is not required. G. If the member’s Battalion Chief/Section Supervisor transports the member, the member’s Battalion Chief/Section Supervisor, in coordination with the injured member, shall complete the First Report of Injury (FROI) form. The FROI form is only available on the Battalion Chief level iPad devices. H. If the injury is very minor and the member declines immediate medical treatment, the member’s Battalion Chief or the Safety Chief shall complete the FROI as a “precautionary report” and will be submitted to the Workers’ Compensation Office. I. Regardless of the decision to seek or not to seek medical treatment, the member’s Battalion Chief/Section Supervisor must be notified and shall respond to the member’s location to properly document and investigate the cause of the injury. The member’s immediate supervisor, Battalion Chief/Section Supervisor, and Safety Chief may coordinate to determine whether or not the injury warrants an immediate response. Photographs will be taken and included in the report, noting the location where the injury occurred, the actual mechanism of injury, as well as any other pertinent or relevant Policies and Procedures On-the-Job Injury/Illness E110.3, Page 3 of 7 findings. The investigation shall endeavor to identify the cause of the injury as well as provide an intervention or remediation plan to prevent further occurrences of injury. J. The FROI form will automatically, as part of the design of the application, email a copy of the form to the member, the Safety Chief, and the Workers’ Compensation Group. K. If the member declines medical treatment and cannot perform their assigned duties, they must request personal leave time as only a medical provider can place the member off duty (in a no-duty status) for an injury that occurs on-the- job. The member shall be informed that this action may cause the workers’ compensation to be automatically denied. Within this policy, the term “medical provider” is defined as a medical professional who is licensed and approved to treat workers’ compensation injury claims. L. If the member decides to seek medical treatment at some later date/time, they must notify the AFD Workers’ Compensation group immediately. This contact can be made via email at: [email protected] or by phone at 512- 974-1310. M. Any member who receives treatment by a medical provider for an on-the-job injury shall also: 1. Submit a completed Texas Workers’ Compensation Work Status Report Form 73 (DWC73) or, the Emergency Room Work Status Report Form, within 24 hours following each medical provider’s visit. This form will be supplied to the member upon submission of the FROI via email, within the IOJ Employee Resource Packet. 2. Retain the responsibility for ensuring that the medical provider completes and signs the DWC73 prior to submitting it to the Workers’ Compensation Group. The member must ensure that the medical provider checks the appropriate box on the DWC73 to indicate the return to work (or no work) status and indicate the effective date. If restrictions to duty are indicated, the medical provider must document these on the DWC73. 3. Provide the medical provider with a copy of the “Essential Job Tasks” for both Firefighter and Chief’s Aide, as well as the Chief’s Aide Qualification Checklist (all provided within the IOJ Employee Resource Packet).
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