Food Services Division Worker s Compensation Return to Work - - PowerPoint PPT Presentation

Food Services Division

Worker s Compensation Return to Work Accident Investigations

What We re Going to Cover

• Worker

s Compensation Claims

• Accident Reporting Flow Chart

– Completion of Forms – Accident Investigation

• Return to Work
• Questions and Answers
• Internet Solutions – Where to go for

answers.

FSB Workers' Compensation Claims Reported Lost Time Injuries/Lost Work Days FY 2005/06 - FY 2007/08

466 381 403 406 336 348 128 103 91 6,780 5,019 7,496

50 100 150 200 250 300 350 400 450 500

2005-06 2006-07 2007-08

# of Injuries, Claims & LTI's

# of Injuries # of Claims # of LTI's # of Lost Days

Lost days are for claims that occurred in t Source: Sedgw ick CMS data valued 6/30 of each yr

$585,384 $2,554,172 $622,224 $2,044,102 $506,192 $1,526,635

$0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 Claim Total Paid, Incurred

2005-06 2006-07 2007-08 FSB Claims Total Paid and Claims Total Incurred Year FY 05/06 - FY 07/08 Valued as of 6/30 Each Year Claim Total Paid Claim Total Incurred Source: Sedgwick CMS

Summary by Injury Type FY 2007/2208 Valued as of 6/30/08

20 40 60 80 100 120 140 160 180 200 Amputation Arthritis Burn Bursitis Carpal Tunnel Syndrome Concussion Contusion Crushing Cumulative Injuries Dislocation Eye Injury Fracture Hernia (Rupture) Infection Inflammation Laceration Meniscus Tear Heart Attack Rupture Sprain/Strain Stress # of Injuries, LTI's # of Injuries # of Lost Time Injuries # of Lost Days

Source: Sedgw ick CMS

Average Cost of Top 4 Injuries by Injury Type FY 2007/2008

$625 $1,735 $1,555 $254 $321 $5, $431 $365 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 Burn Contusion Laceration Sprain/St Avg Paid & Incurred Average Paid Average Incurred

Source: Sedgw ick CMS

FY 2007/2008 Injuries and Lost Days by Cause

91 61 53 6 16 30 5 23 3 11 18 19 26 20 12 5 5 7 2 2 2 1 6 1 1810 1073 449 438 253 175 90 25 35 44 142 473

10 20 30 40 50 60 70 80 90 100 Fall, Slip or Trip Lifting Struck or Injured By Bending Pushing or Pulling Strain or Injury By Twisting Strike Against on Stepping On Holding or Carrying Stress Cut, Punctured or Scraped Caught In or Between Hand Tool, Utensil Repetit # of Injuries and LTI's # of Injuries # of Lost Time Injuries # of Lost Days Source: Sedgwick CMS

# of Claims Reported 07/1/07 - 06/30/08 Claims Called Within 24 Hours = 53% 10% of Claims Automatic Loss 225 57% 21 5% 75 19% 38 9% 26 6% 7 2% 6 1% 5 1% 24 Hrs 2 Days 3-10 Days 11-29 Days 30-59 Days 60-89 Days 91-119 Days 120+ Days

Accident Reporting Flow Chart

Injured Employee immediately reports injury to manager Obtain 1st Aid Treatment First aid? Return to work Yes No Obtain Dr. List from Med Provider Network and give to employee Complete DWC1 / Medical Authorization Form (MAF) Obtain Treatment From Dr. Manager can accommodate restrictions? Off More than 5 days? Yes No Go to District Dr. For Clearance to work with food Obtain Dr’s Release/Work Restrictions Complete Transitional Work Assignment Plan Employee Returns to Work If off 20 days

• r more notify

MGR to send leave pwk.

Employee’s Workers’ Compensation Flow Chart

When work restrictions have be changed, contact MGR with status. Immediately call manager with work restrictions/status of injury. Yes

1) Report to FSB Hotline (213) 241-5293 2) Call in Injury to Sedgwick (800) 528-7392 3) Fax Injury/Accident Investigation to OEHS (213) 241-6816 Send AWOL notice to AFSS for discipline. Pay WC.

Employee reports injury to manager Render 1st aid and give :Q&A sheet First aid? Employee Returns to work Yes No Obtain Dr. List from Med Provider Network and give to employee Complete DWC1 / Medical Authorization Form (MAF) Send Employee to Dr. Perform Investigation (cause and prevention) Obtain Witness Statements Incident Reporting Hotline Sheet WC Injury Rpt OEHS Accident Investigation Rpt Employee Contacted You with restrictions? Yes No Employee Returned? Yes No Off More than 5 days? Yes No When Employee is ready to return, send employee to District Dr. For Clearance Obtain Dr s Release/Work Restrictions Complete Transitional Assignment Plan HR Disciplinary Action Employee Returns to Work If off 20 days

• r more notify

CETSB to send leave pwk.

Manager s Workers Compensation Flow Chart

WORK COMP FORMS

• 1. DWC1
• 2. Medical Authorization Form (MAF) /Doctor List
• 3. FSB Incident Reporting Hotline Sheet
• 4. WC Injury Report worksheet
• 5. OEHS Injury/Accident Investigation Report

Employer—complete this section and see note below.

• 9. Name of employer..

_____________________________________________________________

• 10. Address.. _____________________________________________________________
• 11. Date employer first knew of injury.

________________________________________________

• 12. Date claim form was provided to employee.

_________________________________________

• 13. Date employer received claim form.

_______________________________________________

• 14. Name and address of insurance carrier or adjusting agency.

Sedgwick CMS, Inc. P.O. Box 14623 Lexington, Kentucky 40512-4623

• 15. Insurance Policy Number. _N/A Self-Insured
• 16. Signature of employer

representative._______________________________________________

• 17. Title.. _________________18. Telephone. ____________________________________

State of California Department of Industrial Relations DIVISION OF WORKERS COMPENSATION WORKERS COMPENSATION CLAIM FORM (DWC 1) Relaciones Industriales DIVISION DE COMPENSACIÓN AL TRABAJADOR PETITION DEL EMPLEADO PARA DE COMPENSACIÓN DEL TRABAJADOR (DWC 1)

Sweet City School District Streetside High, 888 Rocky Road, Strange, CA 95412 July 24, 2008 July 24, 2008 School CM II 521-541-9988 Cookie Jenkins July 28, 2008

Carmen Finestra Streetside High, 888 Rocky Road, Strange, CA 95412 July 24, 2008 July 24, 2008

Cookie Jenkins

Chew, Wil MD 1011 Baldwin Park Blvd Baldwin Park, CA 91706

(562) 463-4357

Sedgwickkaisercampn

888 Rocky Road Strange 95412 CA

Los Angeles Unified School District Workers’ Compensation Injury Report Worksheet Call 1-800-LAUSDWC Employee’s Assigned Location

• Streetside High

Location Code 4506 Date of Incident : July 24, 2008 Time of Incident 1:21 PM Date Incident Reported to District July 24, 2008 Time Incident Reported to District 1:45 PM Caller’s Name/Title Cookie Jenkins, CMII Caller’s Phone Number 521-541-9988 Claimant Information Employee ID # 123456 Employee Name Carmen Finestra Employee SS # 987-65-4321 Home Address 2121 Glad Street, Strange CA 78549 Work Phone 521-541-9988 Home Phone 521-852-4878 Gender M F Date of Birth 3 / 13 / 1980 mm/ dd/yyyy Date of Hire 12 / 2 / 2006 mm/dd/ yyyy Date of Termination (If Any) / / mm/dd/yyyy Employee Title Food Service Worker I Full Time Part Time PT Average number of hrs per day 4 M T W Th F Sa Su Supervisor’s Name/Title Cookie Jenkins/CMII Supervisor’s Phone Number 521-541-9988

Employee was holding a box of noodles while stepping down on a stepstool. She couldn’t see the steps, and missed The stair and fell off the step stool onto the floor. She Slipped on the step stool and fell Ankle Sprain X X July 24, 2008 School Cafeteria Storeroom No None Employee was removing a box from a high shelf. Chew, Wil M.D. (562) 463-4357 1011 Baldwin Park Blvd Baldwin Park, CA 91706 N/A N/A

Cookie Jenkins, Cafeteria Manager Yes The doctor stated that her ankle was sprained. No No No 10:30 AM

LAUSD FSB Incident Reporting Hotline Sheet

• All Incidents are to be called into the Incident Reporting

Hotline Sheet

• Complete when where, what happened who/what was

injured, how it occurred and treatment rendered.

• Call in to 213-241-5293 or fax to 213-241-8476 within 24

hours.

LAUSD FSB INCIDENT REPORTING HOTLINE SHEET

All industrial injuries/illnesses (regardless of the severity) and vehicular (automobile) accidents are to be reported to the Injury Reporting Hotline within 24 hours of the incident or accident. This Hotline notifies: the Area Food Services Supervisor, Senior Food Services Supervisor, Human Resources and members of the Food Services Branch Corporate Safety Team as deemed appropriate. Within 24 hours of the incident or accident, dial (213) 241-5293, if no one answers, please leave your message. The details needed are listed below:

Your Name and Job Title: Cookie Jenkins, SCM II Today’s Date and Time:_ _July 24, 2008 1:45 PM Location: Streetside High Date & Time Accident Occurred: July 24, 2008 1:21 PM_ Injured Employee/Individual’s Name: _Carmen Finestra How the Accident Occurred: Employee fell while attempting to step off

• f a stool while holding a box of noodles.

Description of Injury/Illness: _Employee injured her ankle. She was unable to stand securely on her ankle after the fall. Medical Treatment Rendered : ___X_Yes _____No If yes, what was done_ Employee was given an ice pack to put on her ankle and driven to the doctor by her daughter at her request. Reported to Sedgwick? ___X_ Yes _____ No Claim # AQ9884712356 Other Comments: The employee was conscious after the incident. The Office Manager wanted to take her to the selected physician’s office but the employee refused and insisted her daughter drive her.

Streetside High School 4506 Cookie Jenkins

JenkinsC@cc.net 521-541-9988 07/24/2008

X

Carmen Finestra 2121 Glad Street Strange 78549 521-852-9641 X 03/13/1980 12345678 4506 Food Service Worker I

AQ9884712356

07/24/2008 1:21 pm 07/24/2008 N/A N/A X Injury occurred in the school cafeteria storeroom. Employee fell attempting to step off of a stool while holding a box of noodles. Employee sprained her ankle when she fell.

Employee was alone in the storeroom but called for help when she could not stand on her injured ankle. I heard her call for help, entered the storeroom, helped her up from the floor and to walk to the cafeteria office and sit in a chair. N/A X I gave her an ice pack to put on the injured ankle. X Employee’s ankle was put in a soft cast by the doctor. X

x Chew, Wil MD (562) 463-4357

Employee attempted to step off of a stool while holding a box she had removed from a high shelf and fell. In January of 2008 all employees were taught to hand off items on high shelves to co-workers or to place them on a lower shelf for removal. The employee did not have a co-worker help her to retrieve the box. When asked why not, she stated, ”It would have taken too long.” She also did not place the box on a lower shelf then step off of the stool to retrieve the box *. See below . I issued the employee a counseling for not following the proper procedure for removing items from high shelves. I recommend this topic be included in the branch safety training we receive every quarter. N/A

* The employee knew she could not see her feet while holding the box.

X X X X X X X X X X X

X X

Cookie Jenkins 455666 07/24/2008 X

Summary

• Render First Aid to Employee (or send to

nurse)

• Give DWC-1 Form/Medical Authorization

Form to employee (keep copy)

• Complete FSB Hotline, Injury Worksheet

Report to Sedgwick, Accident Report to OEHS within 24 hours.

• Ensure employee brings doctor

s release

– See District Doctor > 5 days – Send FMLA if absent 3 days or more – Must receive leave paperwork 20 days or more.

• Complete Transitional Work Assignment