Las Vegas Fire & Rescue Worker's Compensation Procedure PDF

100.11 Worker's Compensation.doc Page 1 of 8 Standard Operating Procedure for Worker’s Compensation No: Reviewed date: Effective date: Supersedes: I. FR100.11 5/2021 1/2/20 7/5/16 Type: Administration – 100 series Department: Las Vegas Fire & Rescue Signature: 5/26/2026 Expires: INTRODUCTION A. Purp...

100.11 Worker's Compensation.doc Page 1 of 8 Standard Operating Procedure for Worker’s Compensation No: Reviewed date: Effective date: Supersedes: I. FR100.11 5/2021 1/2/20 7/5/16 Type: Administration – 100 series Department: Las Vegas Fire & Rescue Signature: 5/26/2026 Expires: INTRODUCTION A. Purpose: To provide information regarding the procedures to initiate a workers’ compensation claim due to a job related illness or injury. B. Scope: These instructions are to be used by all Department personnel whenever an injury or illness occurs on duty. C. Author: The Chief over Administration, or designee, shall be responsible for the content, revision and review of this instruction. D. Authority: Nevada Revised Statutes Chapters (NRS) 616A-D, 617, and 618, and or city of Las Vegas policy. E. Definitions: 1. Workers’ Compensation forms: a) C-1 - Notice of Injury or Occupational Disease/Incident Report. b) C-3 -- Employer’s Report of Industrial Injury or Occupational Disease. c) C-4 - Employee's Claim for Compensation/Report of Initial Treatment, completed by employee and the initial treating physician. d) Certificate of Recovery and Fitness (Medical Release). 2. Accident: 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. 3. Injury and Personal Injury: Defined by NRS, means a sudden and tangible happening of a traumatic nature, producing an immediate or 100.11 Worker's Compensation.doc Page 2 of 8 prompt result which is established by medical evidence, including injuries to prosthetic devices. II. RESPONSIBILITY A. City of Las Vegas maintains a self-insured and self-administered program for industrial claims. This program adheres to all applicable state statutes and regulations. The Workers’ Compensation administrator is responsible for managing claims for all city employees. B. All Personnel shall use this instruction for any injury or illness incurred as a result of employment with the Las Vegas Fire & Rescue. Personnel shall follow City of Las Vegas procedures, as directed. 1. Personnel shall respond to communications from the City’s Worker’s Compensation administrator and/or Payroll assistant(s) as timely as possible. 2. C. All Supervisors shall assist their subordinates in obtaining medical care, if needed, and complete the supervisor’s portion of all workers’ compensation forms. 1. Supervisors shall submit all paperwork and forms in a timely manner, within seven (7) calendar days, not shifts. 2. III. Personnel are responsible to know and follow SOP100.12 Transitional Work Assignment (TWA) regarding modified duty / light duty release by a treating physician. Supervisors are responsible to advise personnel to follow SOP100.12 Transitional Work Assignment (TWA) regarding modified duty / light duty release by a treating physician. D. Deputy Chief over Administration, or designee, shall coordinate with Human Resources and/or the Workers’ Compensation administrator to ensure compliance with city policies. E. Payroll Assistant(s) shall manage appropriate payroll processes in compliance with City policy. Payroll assistant(s) shall maintain an employee injury log and route forms and paperwork to Human Resources or the Workers’ Compensation administrator as needed. 1. Payroll assistant(s) shall communicate as needed with the injured/ill employee regarding items related to the injury such as paperwork, schedules and time keeping, and other issues. POLICY A. ELIGIBILITY: All classified, appointive, and hourly personnel who are injured or acquire occupational disease out of or in the course of their 100.11 Worker's Compensation.doc Page 3 of 8 employment with the City of Las Vegas are eligible for workers’ compensation benefits. B. REPORTING: Any work-related injury/illness should be reported as soon as possible by the employee (within seven calendar days, NOT SHIFTS) to his or her supervisor. 1. 2. The employee shall complete and submit a C-1 (Notice of Injury or Occupational Disease) form. a) Submitting a completed C-1 form does not initiate worker’s compensation claim. It is only an incident report until medical treatment is sought. b) The injured/occupationally diseased employee has ninety (90) calendar days after the date of injury to seek medical care. c) If no medical attention is sought for an injury, the completed C1 remains on file for three (3) years and is then destroyed. d) With regard to occupational disease, the time frame for calculating the C-1 and C-4 are based on when the employee has knowledge of the disease and its connection as job incurred. If medical treatment is sought, a C-4 Claim for Compensation and supervisor investigation form must be completed and submitted. a) 3. Once the Workers’ Compensation administrator receives all forms, they will be reviewed to determine if Nevada guidelines for an acceptable claim have been met. a) 4. C. If C-4 is completed and submitted, the Workers’ Compensation administrator will complete the C-3. The design and information required on the C-1, C-3, and C-4 forms is mandated by the State of Nevada. While the time frame for reporting the C-1 and C-4 are the same, NRS 617.455 (presumptive disease of the lung) and NRS 617.457 (presumptive disease of the heart) do not require a connection to the work environment if the employee is a full-time, salaried firefighter or arson investigator and meets the time requirements of employment. REOCCURRENCE OF A PREVIOUSLY REPORTED INDUSTRIAL INJURY: In the event of a reoccurrence of a previously reported industrial 100.11 Worker's Compensation.doc Page 4 of 8 injury/illness, the employee shall contact his/her supervisor and the Workers’ Compensation administrator. 1. D. DENIED/UNACCEPTED CLAIMS: If a claim is denied, instructions and appeal rights shall be provided to the employee by the Workers’ Compensation administrator. E. TRANSITIONAL WORK ASSIGNMENTS (TWA): Commonly referred to as light duty or modified duty. These assignments shall be offered to employees with a valid Workers’ Compensation claim, if authorized by the employee’s physician. 1. F. G. Personnel should follow SOP100.12 when released to modified or light duty by their treating physician. LOST TIME: To receive benefits, the employee must provide the Workers’ Compensation administrator and Payroll Assistant(s) with an industrial/occupational treating physician's certificate stating the employee is unable to work for a specific time period. 1. Employees who are to remain off work at the doctor's instructions after the time written on the certificate, must obtain and submit a new certificate. 2. Certificates statutorily must contain limitations and restrictions. VACATION USE WHILE OFF: Taking a vacation during a Workers’ Compensation claim is discouraged, since the employee is under a physician's care and actively participating in treatment to receive benefits. An employee with scheduled vacation during time off regular duty due to an occupational injury or illness must have the treating physician's approval in writing. 1. IV. The employee shall submit a formal request in writing to the City’s third-party administrator. The employee’s request shall include claim number(s) and any medical documentation that may support the request. Time spent on vacation must be charged on the employee’s time card as “Vacation leave.” PROCEDURES A. WORKERS’ COMPENSATION FORMS/INFORMATION 1. City approved forms and information related to Workers’ Compensation are available electronically via the City’s HR department Intranet. 100.11 Worker's Compensation.doc B. Injured/ill employee in need of medical attention. 1. The employee shall seek medical treatment at an approved occupational clinic. 2. For true medical emergencies, the employee may report to a hospital emergency room. For any other medical care, the employee must report to an authorized and approved occupational clinic. a) C. If seen in an urgent care or emergency room, employees with a workers’ compensation claim must still be seen by an approved occupational health center. 3. Going to a non-approved provider may jeopardize the employee’s claim. 4. The employee shall inform the treating physician’s office that the injury/illness occurred on the job. The initial treating medical facility or physician must complete a C-4 Employee's Claim for Compensation/Report of Initial Treatment. 1. The employee must sign the middle section of the C-4; otherwise, the form is not valid. 2. The initial, treating physician completes the bottom portion. 3. Typically, the physician’s office sends the C-4 to the City of Las Vegas directly. 4. It is the employee’s responsibility to ensure the C-4 is submitted and received by Human Resources. a) 5. D. Page 5 of 8 Receipt of this form initiates the employee’s claim. It is the employee’s responsibility to provide his/her supervisor a copy of the completed C-4 after initial medical treatment. Submitting workers’ compensation forms. 1. Due to the importance and time sensitivity of workers’ compensation forms, it is recommended that injured/ill employees and supervisors submit forms electronically and/or hand-deliver. 100.11 Worker's Compensation.doc a) Submit electronically to email group “Fire Payroll” especially on city non-business days (Friday, Saturday, Sunday, cityrecognized holidays). b) Payroll assistant(s) shall review forms for completeness. c) 2. Page 6 of 8 (1) Incomplete forms will be returned to the submitter. (2) Incomplete forms will not be accepted by the Worker’s Compensation administrator. Payroll assistant(s) shall record receipt of forms and distribute to the workers’ compensation administrator. Claims shall be accepted or denied by the Workers’ Compensation administrator. All instructions regarding the claim at this point shall be provided by the Workers’ Compensation administrator. E. POST INJURY/ILLNESS WORK STATUS: The treating physician will determine if an employee: 1) must be off-duty for a temporary disability; 2) may return to full duty with no restrictions; or, 3) may return to modified/light duty with restricted activity (temporary transitional work assignment). F. TRANSITIONAL WORK/LIGHT DUTY ASSIGNMENTS: An employee authorized by his/her treating physician to return to modified duty with restrictions shall follow SOP 100.12 Transitional Work Assignments. G. CERTIFICATE OF DISABILITY or PHYSICAL CAPACITIES EVALUATION: The injured/ill employee must provide the Department/Workers’ Compensation administrator with a physician's Certificate of Disability or Physical Capacities Evaluation covering the period of disability. When the certificate expires, and additional time off is required, the physician must complete a new Certificate of Disability or Physical Capacities Evaluation. 1. The employee is to provide these certificates to the Payroll assistant and Workers’ Compensation administrator. 2. Not providing this form may affect the employee’s benefits. 3. TIME CARD CODING: The Workers’ Compensation administrator (NOT Fire Payroll) shall complete timecards for employees entirely off work due to an occupational injury or illness. a) Time off shall be coded as Administrative OJI-W. 100.11 Worker's Compensation.doc b) 4. Page 7 of 8 If at a later date the claim is denied, retroactive adjustments to time cards will be made. Paid coverage of 100% is provided to IAFF employees for sixty (60) calendar days, if the claim is accepted. If denied, adjustments will be made changing the lost time to sick leave. After the sixty (60) days has elapsed and if the employee is not able to return to work, the Workers’ Compensation Fund pays approximately 2/3's of their average monthly salary up to the State allowable maximum. After the sixty (60) days of full coverage, the employee has two options for pay. a) When full coverage (60 days) expires, the employee may receive a full pay check by using accrued sick leave or annual leave time to supplement the amount paid from the Workers’ Compensation Fund. (1) b) As a result, the employee will receive full pay and full benefits. Approximately two-thirds of the average monthly wage will be charged to the Workers’ Compensation Fund and one-third charged to the employee's accrued leave. If full coverage (60 days) expires and the employee does not have leave available or elects not to use accrued leave time to receive full pay the following option is to be used. (1) As a result, the employee will receive only the amount of money he/she is eligible for under Workers’ Compensation coverage, approximately 2/3 of the average monthly wage, up to the State allowable maximum. (2) The City will not take any deductions from the Workers’ Compensation check and direct deposit is not available with this option. The employee taking this option must realize that deductions for dependent medical coverage and the Public Employees Retirement System (PERS) cannot be taken from the workers’ compensation pay check. (3) Deductions from workers’ compensation checks is disallowed by Nevada statute except as set forth by the Divison of Welfare and Support Services (i.e., child support obligations). 100.11 Worker's Compensation.doc (4) H. I. Page 8 of 8 Employees taking this option must contact the Benefits Section of Human Resources or the IAFF Insurance third-pary administrator, depending on which insurance they have, in order to establish medical benefits. FITNESS FOR DUTY EXAMINATIONS Employees subject to an annual physical examination, off regular duty for more than ninety (90) consecutive calendar days since their last regular worked day, regardless of TWA status, shall submit to an examination to determine their fitness for duty based on the Department's Medical Standards (SOP 100.04). This examination shall be conducted by the LVFR clinic physician familiar with the duties of fire department personnel. 1. The clinic physician shall record the fitness for duty status on the department's "Certificate of Recovery and Fitness" (Medical Release) form. 2. The examination must be completed before the employee is assigned to the Fire Training Center to complete the Return to Duty task book. 3. The task book must be completed before returning to a full, regular duty schedule. ANNUAL PHYSICALS An employee may be relieved of duty or need additional diagnostic testing because of items identified during the annual physical examination process. Examples include extensive cardiac studies, special hearing examinations, and pulmonary testing. 1. In these cases the employee should consult the Workers’ Compensation administrator for a list of authorized medical providers for the necessary follow-up testing. 2. If the follow-up testing reveals a work related condition, the stated procedure for initiating a Workers’ Compensation claim shall be used. 3. The City will pay for the initial follow-up. 4. If a claim is initiated and no presumptive work related condition is medically substantiated, the claim will be denied.