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USA Operations Centers Workers Compensation May 2017
As this policy is reviewed, please note the following States/areas for which exceptions exist:
California
Hawaii
Maine
Texas
Ohio
Washington
North Dakota
Specific details on each exception may be found within the Workers Compensation Carriers and State Variations sections of this text.
Overview Joyner carries workers compensation coverage for you. If you are injured or become ill while performing the duties of your job, workers compensation may provide payment for:
Medical services resulting from your work-related injury or illness
A portion of lost wages resulting from a work-related injury or illness
Benefits to the surviving family if the injury or illness leads to death
Joyner pays the premium for this insurance except where state law requires employees to share in the premium cost.
In most states, the workers compensation third party administrator is Sedgwick CMS (Sedgwick). The states with state-run and state funded workers compensation programs are as follows:
Joyner does not penalize you in any way for filing a workers compensation claim.
Eligibility The following individuals are eligible for workers compensation coverage:
All Joyner employees, whether full or part-time, located across the United States. Work locations may include Hubs, Operations Centers, , Virtual Inspection Sites, and other remote locations, such as mobile worker homes and insured premises.
Note: Joyner Third Party Sales Agents are independent contractors / service providers and they and their employees are not covered under this policy or program
If You Are Injured on the Job Employees must report all work related injuries and illnesses as soon as possible to their management. Document workplace injuries and illnesses through completion of an Incident/Accident Report. Under federal law, employees have the right to report work-related injuries and illnesses and Joyner is prohibited from discharging or in any manner discriminating against employees for reporting work-related injuries or illnesses.
Report the accident or illness to your management and to Safety & Insurance Services if you need first aid.
Get emergency medical treatment right away by calling 911.
Notify the Work Comp Team as soon as possible if you are hospitalized for this incident.
Your supervisor will ask you about the incident(s) that led to the injury or illness. Answer all questions thoroughly. Your supervisor will work with Administrative Services and others to address any safety concerns and assist you with completing the incident/accident report as needed.
To File a Claim Workers compensation claims are handled through the Work Comp Team (WCT) in the Employee Care division of Human Resources. To initiate the workers compensation claim process, submit an Incident/Accident Report found in Joyner Forms.
A Joyner nurse from the WCT will contact you to discuss your injury/illness.
Provide clear, accurate information about the accident or illness. The nurse will collect information from you pertaining to your incident. This information will be submitted to our workers compensation third party administrator.
The information the nurse will need includes:
The date and time of your injury or illness
Your full name and social security number
Your office location code and zip code
Your work telephone number
Date of birth, gender, and marital status
Your department/function
Your associate ID
Your job title
The state in which you work
Time, date, and description of accident or exposure in detail
Nature of injury – part of body injured
Name of object or substance involved which directly injured you
Extent of injury
If time will be lost from work, beginning date and approximate ending date of the disabling condition
If treatment was needed, the facility name and address
Physician name and phone number
Location of the incident
Your supervisor’s name and phone number
The workers compensation claim examiner from the third party administrator reviews the claim and determines if it is compensable under state law.
Pre-existing conditions: If an employee has a pre-existing physical impairment, regardless of whether that impairment was caused by another workers compensation injury, the WCT will notify the claim examiner.
In a case with a pre-existing condition, the workers compensation carrier may pay for all the medical expenses from the work-related injury. When applicable, the carrier files a claim with the appropriate state Second Injury Fund for reimbursement of the pre-existing injury expenses.
Coverage Provided Generally, workers compensation coverage provides payment for the following:
Payment of Medical Bills Employees injured or ill as a result of a work-related incident are reimbursed for eligible medical bills. This payment comes directly from the claim office. The employee cannot receive reimbursement twice for the same injury or illness, i.e. cannot collect from both Joyner’s Group Medical Plan and workers compensation.
Ask your medical provider to send unpaid bills directly to the workers compensation third party administrator’s claim office. (You can obtain the address from the workers compensation claims examiner.)
You should send paid bills to the claim office address yourself. Be sure to note on the bills that you have already paid them and provide a copy of the check and receipt.
If you receive a notice from your medical provider saying you owe a balance on the bill, contact the workers compensation claim examiner.
Don't send workers compensation medical bills to the Group Medical Insurance carrier, your HMO or other private health insurance carrier. Don't use your Prescription Drug Card or the Mail Order Service for prescriptions. Instead, pay for your initial prescription(s) and submit a copy of the check and the receipt with your other bills to the workers compensation carrier.
For on-going medications for a workers compensation injury or illness, talk with your examiner about making arrangements with a specific pharmacy.
The examiner will contact you if more time is needed to investigate the claim, but usually bills are paid within 30 days. (You will receive a notice if the claim is denied.)
If Your Claim is Denied The examiner sends you a letter explaining the reasons for the denial. If this happens, you may submit your medical bills to your private carrier (Group Medical Insurance, HMO, or other private health insurance plan). Be sure to include a copy of the denial letter.
If You Miss Work If you are absent from work due to a work related illness/injury, it is important to notify Joyner’s third party Health Service Provider and the WCT as soon as possible. The Health Service Provider will review your lost workdays for FMLA/State Leave protection. The WCT will track and report your lost time to the HREC Leave Team.
The Leave Team will begin entering lost workdays on your timesheet using the Work Comp-Joyner Paid code. This code is used to continue your Joyner salary until the vendor determines whether or not your claim is compensable, according to state workers compensation regulations.
If the workers compensation vendor determines the claim is compensable, and the waiting and retroactive periods have been met, the vendor will begin making workers compensation benefit payments for your absences. Payments may or may not begin on the first day you miss work.
The workers compensation benefit for time off work is a percentage of your wages/salary. The percentage is set by the state.
For a period of up to 26 weeks, Joyner makes up the difference between your salary and workers compensation payments through supplemental payments (“Supplemental Workers Compensation Payments”) so you receive your full salary while you're off work during this period. Depending upon state law, you may receive workers compensation benefits for more than 26 weeks but Joyner will only supplement those benefits for up to 26 weeks as calculated under this policy.
You will be asked to sign a Memorandum of Understanding that states you will reimburse Joyner if you receive more than your regular gross salary through workers compensation and other disability payments.
Note: Joyner has elected to pay employees from the first day of their absence until the workers compensation vendor determines whether or not the claim is compensable. If the vendor determines a claim is compensable, payment for lost workdays is made retroactively. This creates an overpayment. Employees must work with Financial Services – Employee Compensation Services (FS-ECS) to correct all overpayments. Joyner will recover any salary paid to employees either by reducing the employee’s PTO bank (if time is available and as permitted by law), asking for repayment of salary, or both.
If the workers compensation vendor denies the claim, the WCT notifies the Leave Team to change WC Joyner Paid coding to PTO. The leave team codes PTO for up to one calendar week and then follows Short Term Disability (STD) procedures to request STD benefits.
If the absence is expected to last more than one calendar week, the Leave Team contacts the Health Services Provider to initiate an STD claim. You must also contact the Heath Services Provider to provide injury/illness-specific information for the claim.
Note: Employees off work due to a work related illness/injury will continue to accrue Paid Time Off (PTO). Please refer to the PTO policy for additional information.
In most states, the examiner will send your time-lost payments to you.
If you are covered under the Joyner Group Long Term Disability Plan (LTD) and have been out for a workers compensation absence for 90 calendar days and are unlikely to return to work, please contact the Health Services Provider to file an LTD claim.
Supplemental Workers Compensation Payments (Work-Comp Joyner Paid)
For each workers compensation claim, Joyner will supplement an employee’s workers compensation benefits up to the employee’s full regular salary for a period of up to 26 continuous weeks through the payments of Supplemental Workers Compensation Payments.
Successive Absences An employee who receives workers compensation benefits for successive absences resulting from one covered workers compensation claim will be considered as being continuously absent but only those days the employee is absent will reduce the available Supplemental Workers Compensation Payments available for that covered workers compensation claim. Each full or partial day absence will reduce the employee’s available Supplemental Workers Compensation Payments by one day.
Partial or Reduced Schedule An employee who receives workers compensation benefits under a partial or reduced schedule will be considered as being continuously absent for the entire work week that is subject to the partial or reduced schedule. Full day and/or partial day absences (regardless of the number of days and/or hours absent in the week) provided under a partial or reduced schedule will reduce the employee’s available Supplemental Workers Compensation Payments by one week.
If an employee’s partial or reduced schedule ends during a week, only the days the employee was absent shall reduce the available Supplemental Workers Compensation Payments for that week.
Company Affiliation Joyner will provide company affiliation until the employee has been off work for 26 weeks unless required by law to continue further affiliation.
Health Care Provider Appointments When the employee is released to return to work without time restrictions, the employee schedules any subsequent visits to the doctor or physical therapist outside of working hours. The employee may also flex time off at management’s discretion. If the employee cannot schedule their appointments outside of working hours or flex their time, the workers compensation examiner will determine if they are required to pay the employee based upon state regulations. If so, the employee will be coded WC-Joyner Paid. If not, the employee may use PTO.
Workers Compensation Case Manager Assignment A workers compensation case manager may be assigned to:
See that you are getting proper treatment.
Check with your doctor on your progress or go with you to a doctor's appointment.
Analyze your job duties and develop a plan to help you return to work as soon as possible.
Returning To Work
In states handled by Sedgwick, work with your doctor, your supervisor, Safety & Insurance Services, the WCT, and your Sedgwick nurse case manager, if one is assigned, to plan your return to work.
If your doctor says you can return to work with modifications to your work hours or duties, contact your workers compensation examiner.
If you are released to return to work on a part-time basis, the vendor will determine if state regulations require you to be paid by workers compensation. If so, the vendor will pay you; If not, the portion of the day you are absent may be coded PTO.
When you are released to come back to work full-time, workers compensation benefits stop and you are expected to return to your job.
If You Have Questions Call your examiner about the claim process or for the status of a benefit payment.
State Workers Compensation Regulations
Each state sets its own regulations about the following:
The time limit for reporting a claim
The waiting period: the number of days an employee must be off work before lost time income benefits are owed.
The retroactive period: if the lost time days exceed the retroactive period, lost time income benefits are paid for all days off, including those from the waiting period.
The percentage of wage replacement paid by workers compensation.
The maximum and minimum weekly wage replacement benefit.
The method of calculating weekly wage replacement benefits.
The schedule of payments for permanent partial disabilities.
Call your workers compensation examiner with any questions about the regulations or changes in the regulations in your state(s).
Coordination of Benefits For claims accepted and managed by Sedgwick, the coordination of benefits works as follows:
The employee, or the employee’s supervisor, notifies the following:
Health Services Provider for FMLA and State Leave processing.
The WCT for absence tracking and OSHA recordkeeping.
The WCT notifies the Leave Team of all WC Joyner Paid absences.
Sedgwick requests itemized gross weekly wage information from HREC.
Sedgwick sends wage replacement to the employee and copies FS with payment information to Financial Services – Employee Compensation Services (FS-ECS)
If the employee goes into a non-paid status, the employee’s supervisor notifies the employee to contact the Joyner Benefits Center to arrange payment of Group Insurance premiums and to contact the Joyner Federal Credit Union for Credit Union payments.
Legal Postings Some federal, state, and municipal employment laws require each location to display certain postings that describe:
Employees’ rights
Duties incumbent upon the employer
Channels for handling complaints
These legal posting notices may be posted in various locations:
In the Human Resources Department reception area
On bulletin boards
In other locations where applicants and employees have ample opportunity to observe them
Safety & Insurance & Risk Management and the Human Resources Business Office coordinate employment postings, including workers compensation postings, with an external vendor, which services all Joyner locations nationwide.
The vendor is responsible for:
Monitoring legal posting requirements in all locations in which Joyner conducts business
Identifying and communicating new posting requirements to designated facility contacts in the impacted jurisdiction
Producing and shipping new or revised posters to the impacted locations, in sufficient time to meet all legal requirements.
Posting notices are sent to each Joyner location in March.
Corporate Insurance & Risk Management at (309) 763-6529.
For more information, see U.S. Legal Posting Notices
Athletic Activities Athletic activities, such as company-sponsored picnics and JEAA leagues and events, should be strictly voluntary and are not considered work-related activities.
However, if an athletic activity takes place during a required attendance event, such as a company conference, an injury occurring at this activity might be compensable depending on all of the facts and circumstances.
The WCT nurse will assist the employee in submitting a workers compensation claim. The workers compensation third party administrator determines the compensability of the claim.
Note: California has ruled that accidents occurring during employees' pursuit of educational activities beneficial to their employment are compensable under the California Act. Other states may have similar rulings.
State Variations The following states have laws that impact Joyer Workers Compensation policy. These state exceptions take precedent over comparable provisions outlined in the policy. State specific information follows.
California In the state of California, if an employee sustains a work-related injury or illness, the employee may be treated by the employee’s personal medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or medical group if:
the employee has group health coverage;
the doctor is the employee’s regular physician, who shall be either a physician who has limited his or her practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner, and has previously directed the employee’s medical treatment, and retains the employee’s medical records;
the employee’s “personal physician” may be a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group providing comprehensive medical services predominantly for non-occupational illnesses and injuries;
prior to the injury, the employee’s doctor agrees to treat the employee for work-related injury or illness;
prior to the injury, the employee provided the WCT with the following in writing: (1) notice that the employee wants his/her personal doctor to treat the employee for a work-related injury or illness, and (2) the employee’s personal doctor’s name and business address.
Notice of Personal Chiropractor or Personal Acupuncturist
This pamphlet must be given to all newly hired employees in the State of California. The content of this pamphlet applies to all industrial injuries that occur on or after January 1, 2013.
Hawaii When an employee has sustained a work injury, which arose out of and in the course of employment with the employer and which has been determined to be compensable, the employee is entitled to first preference of re-employment by the employer in any position which the employee is capable of performing and which becomes available after the discharge and during the period thereafter until the employee secures new employment. The former employee is not entitled to these provisions if the employee is no longer capable of performing the employee’s work as a result of the work injury and the employer has no other available work which the employee is capable of performing.
Maine When an employee has sustained a compensable injury, the employee is entitled, upon request, to reinstatement to the employee’s former position if the position is available and suitable to the employee’s physical condition. If the employee’s former position is not available or suitable, the employee is entitled, upon request, to reinstatement to any other available position suitable to the employee’s condition. In order to facilitate the placement of an injured employee as required, reasonable accommodations will be made for the physical condition of the employee as needed unless no reasonable accommodation exists or if the accommodation would impose an undue hardship to the employer. The employer’s obligation to reinstate the employee continues until one year, or three years if the employer has over two hundred employees, after the date of the injury. The Maine Workers Compensation Act does not obligate an employer to offer an injured employee employment or reemployment in supervisory or confidential positions or any position for which the employee is not qualified.
Texas The following notifications will be provided in writing:
Employer notification to the Texas Department of Insurance - Division of Workers Compensation if the employer elects not to obtain workers compensation insurance coverage.
Employer notification to the Texas Department of Insurance - Division of Workers Compensation -if the employer elects to terminate workers compensation insurance coverage. Employers are required to notify the Division of Workers Compensation within 10 days of notifying the carrier of cancellation of coverage.
Notification of existing workers compensation coverage to each newly hired employee. This notice should be conveyed when the newly hired employee completes W-4 and I-9 documents.
Notification of existing workers compensation coverage to each rehired employee. This notice should be conveyed when the rehired employee completes W-4 and I-9 documents.
Notification of existing workers compensation coverage to each newly hired and rehired employee – common law rights notice. This notice should be conveyed when the newly hired or rehired employee completes W-4 and I-9 documents:
NOTICE TO NEW EMPLOYEES "You may elect to retain your common law right of action if, no later than five days after you begin employment or within five days after receiving written notice from the employer that the employer has obtained coverage, you notify your employer in writing that you wish to retain your common law right to recover damages for personal injury. If you elect to retain your common law right of action, you cannot obtain workers’ compensation income or medical benefits if you are injured."
Employers are required to:
Notify the Texas Department of Insurance - Division of Workers Compensation of on-the-job injuries that result in absences of more than one day.
Notify the Texas Department of Insurance - Division of Workers Compensation of occupational disease of which the employer has knowledge.
Post workers compensation coverage notice at the employer's place of business
Washington
Claims are required to be filed directly with the State by either the health care provider or the employee: 1-877-561-FILE. http://www.lni.wa.gov/ORLI/ECS/default.asp?Pub=Worker
Complete the Incident/Accident Report
Inform WCT and Sedgwick claim adjuster of any absences related to claim
Keep supervisor informed of return to work plans
Sign Memorandum of Understanding and return as directed.