The City wants to protect its employees from injury while working in their position (on the job) and to treat them fairly if they are injured on the job.

2. REFERENCE

RCW 51.12.035; RCW 51.14, RCW 51.32; WAC 296.15, WAC 296, City of Olympia Policy 8 Employee Wellness, City of Olympia Policy 5 Drug and Alcohol, City of Olympia Policy 13 Leave, Americans with Disability Act (ADA); Washington State Labor and Industries Guide to Workers’ Compensation Benefits for Self-Insured Businesses).

3. APPLICATION

This Policy applies to all individuals employed by the City of Olympia, unpaid interns and volunteers injured in the performance of City functions, unless modified by contract or statute (e.g., civil service rules, union contract, individual employment contract or memorandum of understanding). If an employee sustains an injury because of an accident on the job, or an occupational disease because of the nature of their work for City, you should follow this Policy.

Failure to comply with this Policy may result in disciplinary action including separation from City service.

4. GUIDANCE

The City is “self-insured” for the purpose of Workers Compensation (WC) for employees injured on the job. This means that the City has its own WC program (that complies with the Washington State Labor and Industries Guide to Workers’ Compensation Benefits for Self-Insured Businesses).

4.1. On the Job Injury

An accident or occupational disease occurs when:

• The injury is a result of trauma (e.g. a physical wound or injury, such as a fracture or blow) that occurred while the employee was at work and completing the duties of their position);

• The injury occurred while performing required training for a City job;

• The injury occurred after a chemical, medical or workplace exposure;

• The injury arises as a disease or infection that arises naturally and proximately out of employment;

• For Fire department employees, when the injury occurred within six (6) hours of a working fire response or other activity where a Self-Contained Breathing Apparatus (SCBA) was used by the employee;

a. No Treatment Needed

If an employee is injured while at work in any of the ways described above and does not require medical attention, no WC “grey packet” is needed. However, the injured worker should complete the first page of the Injury/Illness Report and submit it to their supervisor. The supervisor will complete the second page of the Injury/Illness Form and forward to HR. The Injury/Illness Report will be kept on file for one (1) year in case medical treatment becomes necessary and two (2) years for occupational exposure claims.

b. Medical Treatment Needed

The injured worker may seek medical attention from any medical care provider for the initial visit. For minor injuries, there are several urgent care providers who can treat patients quickly compared to the wait time at an (ER). In an effort to save time and reduce costs, a list of local urgent care providers is included in the “WC grey packet”.

If additional treatment is recommended by the provider, the employee must select a medical provider from the Labor and Industries medical network: http://www.lni.wa.gov/ClaimsIns/Claims/FindaDoc/. The injured worker must obtain pre-approval from City’s third party administrator, Matrix or HR before transferring care to a new provider or seeking a second medical opinion or consultation.

Injured Worker Instructions:

☐ Contact supervisor and ask for a “WC grey packet”;

☐ Complete only the first page of the Injury/Illness Report (Supervisor will complete page 2);

☐ Complete the top portion of the yellow SIF2 form (HR will complete the bottom portion);

☐ Submit forms listed above to supervisor PRIOR to seeking medical treatment (unless the injury requires immediate attention);

☐ At initial medical appointment, ask medical provider to complete the Physician’s Initial Report (PIR) and the Physical Capacity Evaluation (PCE) Return to Work Form. In some cases, providers will provide an Activity Prescription Form (APF) in lieu of the PIR or PCE forms, which is acceptable;

☐ Immediately after the medical appointment, if the injured worker will not be returning to work that day or the following day(s) contact must be made with the supervisor;

☐ After all medical appointment, submit any/all medical provider evaluations or return to work forms to supervisor (or HR if you prefer to protect any sensitive medical information)

☐ Maintain discussions with supervisor regarding any/all return to work, physical restrictions, light duty, accommodations or ergonomic assessment needed as a result of injury as prescribed by a medical provider; (Refer to Light Duty Form if applicable)

☐ Discuss with supervisor any/all prescriptions that may affect ability to perform duties safely;

☐ Prescriptions for new WC claim may be filled by employees own private insurance and submitted to claims analyst for reimbursement or by using First Script Prescription Form included in WC “grey packet”. Assistance for First Script prescriptions contact toll free 877.804.4900.

☐ Follow the medical provider’s treatment plan and attend all scheduled appointments;

☐ Submit any outstanding medical bills received related to WC claim to claims analyst for payment;

☐ Contact HR (360.753.8442) or Matrix (800.903.3635 X31313) for any WC claims questions.

c. Accident/Incident Injuries

If an employee is injured due to an accident or incident, the employee together with their supervisor are required to complete an Accident Report Form (motor vehicle) and/or an Incident Report Form (property damage) in addition to all other WC injury paperwork and submit to the City’s claim manager.

Post-accident drug and alcohol testing may be required if an employee is involved in an accident while on duty if:

1) There is a fatality;

2) An injury is treated away from the scene

3) The driver receives a citation under state or local law

4) One of more vehicles is towed from the scene

5) The supervisor has reasonable suspicion to believe the employee involved in the accident might be under the influence of alcohol or drugs.

Refer to the Drug and Alcohol Policy

d. Fire Department Injuries

The City implemented a return to work pilot program for the Olympia Fire Department employees and Tactical Athletic Health & Performance Institute (TAHPI) for the period of July 1, 2019 to June 30, 2020. Fire department employees will follow the current injured worker policy and fire regulations, but will also have the opportunity to access an integrated single-source service solutions that may help reduce injury-related costs, streamline the case management of injury and rehabilitation. Fire department employee’s participation in the TAHPI pilot program is voluntary. Fire department employees must complete the WC “grey packet” forms and submit all forms to HR. To contact TAHPI regarding injuries, contact the Operations Chief.

4.2. Off the Job Injury

If something happens while the employee is at work that is not covered above (the employee feels ill due to a non-work related medical condition, faints or is physically sick) and the employee needs care from a medical provider, the employee should not report the event as a workplace injury. The employee should instead, use their City insurance benefit (if a benefited employee) or other means to pay for the treatment by a medical provider of the employee’s choice (ambulance, emergency room, physician, tests). However, the employee and supervisor should file an Employee Injury/Illness Report form for any medical issue that happens while at work.

Important exception to note: If an employee faints at work and is injured from falling down or hitting an object, then the injury would be considered a work related injury, and a “WC grey packet” would be completed and submitted.

If any employee sustains an off the job injury, the employee will use their own private insurance, and must inform their supervisor of any work restrictions or medications (including over the counter) that may interfere with the worker’s ability to perform their regular duties safely. The supervisor may request a doctor’s note or a Physical Capacity Evaluation Return to Work Form (non-work related) for absences exceeding three (3) days.

4.3. Serious Injury or Death

In the event of serious injury or fatality, the supervisor is required to follow the directions contained in the Death or Life Threatening Injury Procedures. If the injured worker is taken by ambulance for medical care, the supervisor can bring the WC “grey packet” to the hospital.

In case of workplace fatality, WC packet must be received in HR within 8 hours. Supervisors must provide the completed WC packet to HR within 24 hours for serious injuries listed below.

• amputation of limb (including loss of tip of finger)

• loss of eye

• in-patient hospitalization,

• the workplace death of an employee

For all other injuries, the supervisor must submit the following three (3) documents to HR within 72 hours of the injury:

1) SIF2

2) Injury/Illness Report

3) Some form of doctor’s note outlined above.

4.4. Time-loss compensation for work related injury (wage related replacements benefits)

a. Time-loss compensation payments range from 60-75 percent of the injured worker’s gross wage and benefits (depending on marital and dependent status).

b. The employee does not receive time loss for the day of the injury or for the first (3) three calendar days after the injury unless they are unable to work for 14 days from the date of the injury.

c. The City will augment time-loss payments with sick leave, floating holiday, comp time, and vacation leave in that order up to the amount of their full base salary. The employee may receive two (2) separate checks on their regular payday; one for their regular pay and one for their time loss pay to offset use of leave accruals.

d. If the injured worker is working, there is no time loss compensation for attending ongoing medical appointments or travel time related to a work related injury; leave will be coded according to section c above and according to the Leave Policy and applicable collective bargaining agreement(s). However, an injured worker may ask for reimbursement for time loss and travel to attend a mandatory Independent Medical Evaluation (IME) related to the claim.

e. Guild or IAFF employees working light duty due to a WC injury, may qualify for loss of earning power (LOEP) compensation depending on their timesheet hours each pay period.

f. An injured employee (regardless of whether the injury occurred on or off duty) who is: 1) approved for light duty by their doctor; 2) the department has light duty available for the employee; but 3) the employee does not want to come in to do the light duty work, must use vacation leave rather than sick leave because they are voluntarily deciding to stay away from work. For WC injuries, time loss compensation in this scenario could cease. (Refer to Light Duty Form)

4.5 Extended Leave and Benefits

For injured workers (regardless of whether the injury occurred on or off the job) who have been absent from work for an extended period of time should contact HR (360.753.8442) to determine if they may qualify for additional benefits such as:

• Family Medical Leave Act (FMLA)

• Paid Family Medical Leave

• Shared Leave

• Leave Without Pay

• Accident and/or Short Term Disability (AFLAC)

• Long Term Disability

• Community Chest

• Employee Assistance Program (EAP)

• Americans with Disabilities (ADA) accommodation

Refer to Leave Policy

4.6 Supervisors

The supervisors should always have immediate access on hand to the WC “grey packet”, which contains a variety of forms that need to be completed if medical attention is sought by the employee for treatment of the injury.

The supervisor should:

☐ Ensure that an injured employee gets immediate medical treatment if necessary; for serious injuries, refer to the Death or Life Threatening procedures and submit completed grey packet forms immediately to HR;

☐ Ensure that the injured employee completes the first page of the “Employee Injury/Illness Report” form and the top portion of the yellow SIF2 form to PRIOR to seeking medical attention (unless the injury is serious and medical attention is needed immediately

☐ Complete page 2 of the supervisor section of the Employee Injury /Illness Report form and report any safety hazard to the City’s Safety Program Officer;

☐ If the injured employee seeks medical treatment, ensure you or HR receives the completed the following three (3) documents to HR within 72 hours of the injury:

• SIF2

• Injury/Illness Report

• Some form of doctor’s note outlined above.

☐ If an employee is injured due to an accident or incident, submit an Accident Report Form and/or an Incident Report Form to the City’s Claims Manager. All other WC injury paperwork or medical documents are sent to Human Resources.

☐ Post-accident drug and alcohol testing may be required if an employee is involved in an accident while on duty. Refer to the Drug and Alcohol Policy

☐ Follow up with injured worker after medical appointments and review the Physical Capacity Evaluation Return to Work Form and any other medical provider’s forms, discuss any restrictions, light duty, accommodations, ergonomic assessment needed, etc.; (Refer to Light Duty Form if applicable)

☐ Communicate with HR claims analyst any/all follow up medical notes and restrictions regarding injured worker;

☐ The supervisor must always ask if the injured employee has been prescribed any medication which may impair the employee’s job performance and/or safety to themselves or others.

4.7 Human Resources will

☐ Work with the injured employee (to the extent necessary) to assist them with the process and their recovery;

☐ Gather all of the forms about the injury and send them to the third party administrator;

☐ Assist the supervisor on any return to work issues;

☐ Provide wage and benefit information (working with Payroll) to the third party administrator;

☐ Work with all parties to complete the claim; and

☐ Provide office ergonomic assessment if needed.

4.8 The Third Party Administrator will

☐ Process the claim;

☐ Pay medical providers for services;

☐ Collaborate with City HR and Payroll to ensure proper payments (if any) to injured employees and to work on completing the claim; and

☐ Work with the injured employee (to the extent necessary) to assist them with the process and their recovery;