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Workers’ Compensation at Cook County

Workers’ Compensation at Cook County

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Workers’ Compensation at Cook County

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Presentation Transcript

  1. Workers’ Compensation at Cook County DEPARTMENT OF RISK MANAGEMENT Deanna Zalas, Director

  2. Workers’ Compensation Risk Management manages the administration and payment of workers’ compensation benefits for injuries or illness sustained in the course and scope of employment for Cook County in accordance with the Illinois Workers’ Compensation Act (820 ILCS 305).

  3. Initial Response The Employee • Reports injury to supervisor • Makes no statements regarding the accident • Completes Employee Accident Report All forms found at www.cookcountyil.gov/agency/department-risk-management

  4. Initial Response The Supervisor • Takes control of the scene • Calls first aid and emergency services • Identifies sources of evidence • Preserves evidence from alteration or removal • Gets responding Police Officer’s information, if applicable • Takes photographs • Identifies witnesses • Completes Supervisor’s Investigation Report All forms found at www.cookcountyil.gov/agency/department-risk-management

  5. Initial Response The Supervisor • Takes control of the scene • Calls first aid and emergency services • Identifies sources of evidence • Preserves evidence from alteration or removal • Gets responding Police Officer’s information, if applicable • Takes photographs • Identifies witnesses • Completes Supervisor’s Investigation Report All forms found at www.cookcountyil.gov/agency/department-risk-management

  6. Interviewing Witnesses • Remain calm, objective, impartial, open minded • Search for facts, not your opinions • Interview as soon as possible (theory increases as memory decreases) • Interview witnesses separately and privately • Use a tape recorder only with the permission of the witness • Any conflicting statements, conduct follow up interviews ASAP • Use open ended questions (cannot be answered with a simple yes or no) • Record critical information quickly • If not at the site of the accident, use visual aids, sketches, etc. • End on a positive note and keep the line of communication open • Review completed statement with witness and have witness sign it All forms found at www.cookcountyil.gov/agency/department-risk-management

  7. Collecting Evidence and Information • Record pre-accident conditions, accident sequence, and post-accident conditions. • Preserve Evidence – Gather equipment, materials, statements from witnesses, sketches, maps, photos, video. If the injured worker indicates that a chair was defective and caused injury, the chair should be tagged & set aside. It should not be thrown away or repaired until Risk Management advises that it is ok to do so. • Eyewitness Statements – statements from all witnesses, interview anyone involved separately. • Vehicle History – tires, brakes, engine, etc., that could have contributed to the incident • Training Evidence – all relevant training records (Valid Driver’s License Program, Driver’s Training Certificate)

  8. Preparing the Report • Report date, accident date and time of accident • Name of injured employee • Type of injury or damage/who and what was involved • Description of what happened including emergency response sequence • Identify witnesses • How the accident occurred and the extent of damage • Personal or environmental (weather) factors • Remedial actions temporary & permanent • Management review Note: • Timeliness of report is critical, best reports are written promptly. • Accident reports are usually ‘discoverable’ this means they can be used by parties to an action for damages or criminal charges.

  9. Summary of Reporting Responsibilities • All employees must report all incidents and accidents to their supervisor and complete an Employee Accident Report. • All supervisors are responsible for completing the Supervisor’s Investigation Report. • Risk Management can provide technical support to the Supervisor in the course of the incident investigation, issue incident information for communication to all

  10. Reporting Forms • Destroy old forms! • Bookmark our website • Employee Accident Report • Supervisor’s Investigation Report • Witness Statement Report • Release of Medical Records • New forms found at www.cookcountyil.gov/agency/department-risk-management • Forms can be filled out online and emailed to work.comp@cookcountyil.gov

  11. Reporting a Claim • It is the responsibility of injured employees to report any injury, regardless of severity, as soon as possible to their supervisor. • The responding supervisor should ensure that the employee is provided with the appropriate medical response to the injury. The supervisor may, depending on the nature of the injury, request outside medical response to the situation. • Once the injured employee provides verbal notice, the supervisor or manager is responsible for reporting the claim to Risk Management. • Within twenty-four hours, the supervisor must submit the Supervisor’s Investigation Report to Risk Management. Additional reports may follow. Risk Management – Workers’ Compensation Fax: 866-839-5397 Email: work.comp@cookcountyil.gov

  12. Adjuster Responsibilities Each claim is assigned to a Workers’ Compensation Adjuster for handling. The Adjuster will be assigned for the duration of the claim. The Adjuster is the “owner” of the claim and is responsible for all actions on the claim file. Risk Management has six (6) adjusters, each assigned to a a different work group at the County.

  13. WC 101 Temporary Total Disability = 66 2/3% of employee’s Average Weekly Wages (excluding overtime) • Three-point contact • Compensability determination • Medical Expenses • Indemnity Expenses • Associated Expenses • Return to Work • Resolution • Illinois Workers’ Compensation Commission • Litigation • State’s Attorney Disfigurement, Permanent Partial Disability, permanent Total disability or death = additional benefits

  14. How to Contain Claim Costs? • Accident Prevention! • Adjusters use a variety of cost containment measures including: • Medical bill review with fee schedule reductions and PPO network deductions. • Utilization Review (UR) used when the recommended treatment is costly and/or complicated. UR can be done on a prospective basis or a retrospective basis. • Independent medical exams (IMEs) are performed can be used to help determine whether a medical condition is work-related, whether treatment is appropriate, and whether an employee can return to work. • Pharmacy benefit management • Surveillance and other sub rosa investigations when merited • Vocational placement services work with employees who have permanent work restrictions, attempting to find them new work when their physical limitations prevent them from returning to work in their former capacity. • Coordination with adjuster and legal counsel • File Review Sessions (larger departments with chargebacks) • Transitional Return to Work • Return to Work

  15. Corvel • Corvel has partnered with Cook County Risk Management for cost containment and will provide the following services: • Medical bill review • Diagnostic Imaging • IME & Peer Review • Transportation • Translation • Durable Medical Equipment (DME) • Utilization Review (UR)

  16. Pharmacy • In partnership with Corvel, Caremark will be providing a pharmacy benefit management tool specifically for workers’ compensation claims. This will enable us to manage our workers comp costs via Utilization Review specifically for prescription drugs.

  17. Transitional Return to Work (TRTW) • Transitional Return to Work Program (TRWP) is an interim step in the physical recovery of an employee who suffers a work injury. The focus of the program is to temporarily modify an employee’s existing position and/or work schedule, or provide temporary assignments that will accommodate the temporary physical restrictions identified by a physician. These assignments are limited in duration and assist with transitioning employees back to their full time positions.