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 2007/08 500 6,780 7,496 450 466 # of Injuries, Claims & LTI's 400 403 5,019 381 350 300 250 200 406 348 336 150 100 128 103 91 50 0 2005-06 2006-07 2007-08 # of Injuries # of Claims # of LTI's # of Lost Days Source: Sedgw ick CMS data valued 6/30 of each yr Lost days are for claims that occurred in t

FSB Claims Total Paid and Claims Total Incurred Year FY 05/06 - FY 07/08 Valued as of 6/30 Each Year $2,554,172 $3,000,000 $2,044,102 Claim Total Paid, Incurred $2,500,000 $1,526,635 $2,000,000 $1,500,000 $622,224 $585,384 $506,192 $1,000,000 $500,000 $0 2005-06 2006-07 2007-08 Source: Sedgwick CMS Claim Total Paid Claim Total Incurred

Summary by Injury Type FY 2007/2208 Valued as of 6/30/08 200 180 160 # of Injuries, LTI's 140 120 100 80 60 40 20 0 Carpal Tunnel Syndrome Cumulative Injuries Crushing Hernia (Rupture) Infection Inflammation Laceration Rupture Amputation Burn Concussion Contusion Fracture Meniscus Tear Arthritis Bursitis Dislocation Eye Injury Heart Attack Sprain/Strain Stress Source: Sedgw ick CMS # of Injuries # of Lost Time Injuries # of Lost Days

Average Cost of Top 4 Injuries by Injury Type FY 2007/2008 $6,000 $5,000 Avg Paid & Incurred $5, $4,000 $3,000 $2,000 $1,555 $1,000 $625 $1,735 $431 $321 $365 $254 $0 Burn Contusion Laceration Sprain/St Average Paid Average Incurred Source: Sedgw ick CMS

FY 2007/2008 Injuries and Lost Days by Cause 1810 100 # of Injuries and LTI's 90 91 80 70 1073 60 61 50 53 40 449 438 473 30 253 35 25 175 142 30 20 90 26 44 23 20 10 19 12 6 5 16 5 7 5 2 2 3 2 11 1 18 6 1 0 Bending Holding or Carrying Caught In or Between Fall, Slip or Trip Lifting Pushing or Pulling Twisting Hand Tool, Utensil Struck or Injured By Cut, Punctured or Scraped Strain or Injury By Strike Against on Stepping On Stress Repetit Source: Sedgwick CMS # of Injuries # of Lost Time Injuries # of Lost Days

# of Claims Reported 07/1/07 - 06/30/08 Claims Called Within 24 Hours = 53% 10% of Claims Automatic Loss 6 7 5 26 1% 2% 1% 6% 38 9% 225 75 57% 19% 21 5% 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

Employee ’ s Workers ’ Compensation Flow Chart Injured Yes Obtain 1 st Aid Return to Employee First aid? Treatment work immediately reports injury to manager No Obtain Dr. List from Med Provider Complete DWC1 / Immediately call manager with Network and give Obtain Medical Authorization work restrictions/status of injury. to employee Treatment Form (MAF) From Dr. Yes Yes Go to District Dr. Obtain Dr ’ s Off More For Clearance to Manager can Release/Work than 5 days? work with food accommodate Restrictions restrictions? No When work restrictions have be changed, contact MGR with Complete status. Transitional If off 20 days Work Assignment or more notify Plan MGR to send leave pwk. Employee Returns to Work

Manager � s Workers � Compensation Flow Chart Yes Employee Render 1 st aid Employee reports injury First aid? and give :Q&A Returns to manager sheet to work No Obtain Dr. List from Perform Med Provider Complete DWC1 / Obtain Witness Investigation Network and give Send Medical Authorization Statements (cause and to employee Employee Form (MAF) prevention) to Dr. 1) Report to FSB Hotline (213) 241-5293 Employee Contacted You 2) Call in Injury to Sedgwick (800) 528-7392 with restrictions? Incident Reporting Hotline Sheet 3) Fax Injury/Accident Investigation WC Injury Rpt to OEHS (213) 241-6816 Yes OEHS Accident Investigation Rpt No If off 20 days or more notify Yes CETSB to send leave pwk. When Employee Send AWOL notice to Off More is ready to return, than 5 days? AFSS for discipline. send employee to Pay WC. District Dr. For Employee Returns Clearance to Work No Yes Obtain Dr � s Complete Release/Work HR Employee Transitional Restrictions Disciplinary Returned? Assignment Plan No Action

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

State of California Relaciones Industriales Department of Industrial Relations DIVISION DE COMPENSACIÓN AL TRABAJADOR DIVISION OF WORKERS � COMPENSATION PETITION DEL EMPLEADO PARA DE COMPENSACIÓN DEL WORKERS � COMPENSATION CLAIM FORM (DWC 1) TRABAJADOR (DWC 1) Employer—complete this section and see note below. Sweet City School District 9. Name of employer.. _____________________________________________________________ Streetside High, 888 Rocky Road, Strange, CA 95412 10. Address.. _____________________________________________________________ 11. Date employer first knew of injury. July 24, 2008 ________________________________________________ 12. Date claim form was provided to employee. July 24, 2008 _________________________________________ 13. Date employer received claim form. July 28, 2008 _______________________________________________ 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 Cookie Jenkins representative._______________________________________________ School CM II 521-541-9988 17. Title.. _________________18. Telephone. ____________________________________

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

Chew, Wil MD (562) 463-4357 1011 Baldwin Park Blvd Baldwin Park, CA 91706

Sedgwickkaisercampn

888 Rocky Road Strange CA 95412

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

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. Ankle She Slipped on the step stool and fell X Sprain X Chew, Wil M.D. 1011 Baldwin Park Blvd Baldwin Park, CA 91706 (562) 463-4357 N/A N/A July 24, 2008 No School Cafeteria Storeroom None Employee was removing a box from a high shelf.

Cookie Jenkins, Cafeteria Manager Yes No The doctor stated that her ankle was sprained. 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 of a stool while holding a box of noodles.