Safe-mail first Quarter 2012
STATE ACCIDENT FUND Workers’ Compensation: FAQs by Alexander Hamilton Institute on January 4, 2012 on Business Management Daily
Workers’ compensation premiums are based on the frequency of a company’s injury claims. So it’s critical to avoid paying claims for accidents that are not covered, as well as investigate potential cases of fraud. Also, return-to-work questions arise in situations where workers’ compensation interacts with the ADA and the FMLA. FAQs about workers’ compensa- and the employer derives a benefit from it beyond improved employee tion health and morale, then the employer 1. Is an employee who violates a will probably have to pay up for any safety rule covered by workers’ injuries that may arise. To prevent compensation? such extracurricular activities from Yes. Even if an employee is injured boosting your workers’ compensation while violating a work rule, he/she costs, try implementing these strateis usually covered by workers’ gies. comp. Ignorance or bad judgment alone will not usually lead to a denial of benefits. Repeated violations of safety rules, however, may lead to a denial of benefits, if the employer is able to show that the employee had been disciplined in the past. ** In SC, if an employee is in direct violation of specific policy and have been made aware to the employee on previous occasions, the claim can be denied under a line of cases starting with Black v. Town of Springfield. 2. Is an employee who injures him/ herself at a company-sponsored picnic eligible for workers’ compensation? If attendance is mandatory, the picnic is held during business hours,
Make attendance optional. If you don’t, you run the risk of making it a condition of employment and increasing your liability if someone gets hurt.
Fourth Quarter 2011 Table of Contents Workers’ Compensation: FAQ’s
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The Quality Connection for Safety
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CorVel: PT Cost Savings
What is a Premium Audit & Why Do We Do It?
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Meet the New Commissioner
Term of the Quarter
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Don’t demand that workers help with set-up and serving. Ask for volunteers. A “special job task” (one that is “concurrent” to the job even though it’s offhours) may also increase your WC liability.
Ban contact sports. Choose games and activities, which don’t significantly increase the risk of employee injury. And let employees organize the games and provide their own equipment. The more out of the loop you are, the less likely the company will be held liable for any resulting injuries.
“Protecting you since 1943.”
“Even if an employee is injured while violating a work rule, he/ she is usually covered by workers’ comp. Ignorance or bad judgment alone will not usually lead to a denial of benefits.” continued on page 5 …
State Accident Fund
Safe-mail first Quarter 2012
OSHA 300 Log By Ray Coleman Safety and Loss Control/Team Leader
Just a reminder that the OSHA 300 log is due February 1st. The following is the most often questions we are asked about the 300 log. When must you post the Summary of the 300 log? You must post the summary only, not the Log, by February 1st and keep it posted until April 30th. How long must you keep the Log and Summary on file? You must keep the Log and Summary for 5 years following the year to which they pertain. Do you have to send these forms to OSHA at the end of the year? No. You do not have to send the completed forms to OSHA unless specifically asked to do so. When is an injury or illness considered work-related? An injury or illness is considered work related if an event or exposure in the work environment caused or contributed to the condition or significantly aggravated a preexisting condition. Work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the workplace, unless an exception specifically applies. See 29 CFR Part 1904.5(b)(2) for the exceptions. The work environment includes the establishment and other locations where one or more employees are working or are present as
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a condition of their employment. Which work related injuries and illnesses should you record? Record those work related injuries and illnesses that result in: Death Loss of consciousness Days away from work Restricted work activity or job transfer Medical treatment beyond first aid. I know there are many other questions such as how to fill out the log, what is medical treatment and what is the 301 Form. To answer these questions or any other safety questions, you may go to www.osha.gov or contact the State Accident Fund and ask for Barney Derrick 803-896-5935 or myself, Ray Coleman at 803-896-5855.
“Safety and Loss Control— Encompassing all that a company does to reduce or avoid injuries, illness, property damage, and employee lost time-is one of the top priorities of the South Carolina State Accident Fund.”
State Accident Fund
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Safe-mail first Quarter 2012
State Accident Fund
Safe-mail First Quarter 2012
What is a Premium Audit & Why Do We Do It? Theresa Simmons, Premium Auditor
A premium audit is a reconciliation of the premium basis (for workers compensation, it is payroll) of an insurance policy. A premium audit is conducted because at the beginning of a policy period, we can only estimate what the payroll might be for your organization. At the end of the policy period, we can obtain the actual payroll records and determine whether the policy was overestimated or underestimated. If it was overestimated, we will owe you a refund if your policy is paid in full. If underestimated, you will owe an additional amount for coverage provided in excess of the original premium. An audit is completed after the policy expires or is for some reason cancelled. You will receive a “Payroll Report” via the mail. The report will ask you to provide the number of employees and the amount of Gross Payroll and Overtime in each Classification Code. The type of business operations determines the Classification Codes used which, in
turn, determine how each employee is classed based on his/her job duties. We ask for Total Overtime pay because a portion of it can be used to reduce your premium. Please be sure to let us know who completed the report and how to contact that person with any questions we may have. You will have a form to add any volunteers that should be covered on your policy. This may include, but is not limited to, volunteer firefighters, reserve police officers, board members, etc. There will also be an “Application for Drug and Alcohol Free Workplace Premium Credit Program”. If you have a Drug Free Program formally implemented at your workplace, please complete this form and return it with your audit for a 5% credit. Please be aware that this credit is added only to an audited policy period.
“A premium audit is conducted because at the beginning of a policy period, we can only estimate what the payroll might be for your organization.” 4
State Accident Fund
Safe-mail first Quarter 2012
Workers’ Compensation: FAQs … continued from page 1… Limit alcohol consumption. Or better yet, ban it altogether. If you want to allow some drinking, try limiting employees by using drink tickets or curtailing the amount of time in which alcohol is served. 3. Can employees collect workers’ compensation benefits for injuries sustained while they are off company premises? ** SC specific answer: Yes, as long as the accident arose out of and in the course of the injured worker’s employment. In SC, it’s not usually the location of the accident that is important. It’s what they were doing when the accident occurred and was it workrelated. 4. What is an employer’s responsibility if an employee cannot physically perform the job he/she was hired to do upon his/her return from workers’ compensation leave? Workers’ comp statutes vary from state to state regarding whether or not you must restore employees to their original jobs upon their return from WC leave. Some WC laws require that the employee be reinstated to a part-time or light-duty job until he/she can resume working in his/her old position. So it’s best to check with your state’s particular WC law. However, the WC law is not your only concern. If this employee’s injury qualifies as a disability or serious health condition, you may also have to contend with the Americans with Disabilities Act (ADA) and/ or the Family and Medical Leave Act (FMLA). According to the ADA, you have a responsibility to accommodate an employee with a disability who is returning from leave if an accommodation is available that would enable the employee to perform the essential functions of the job. Reassignment to another position may be considered an accommodation if the employee with a disability can no longer perform the essential functions of his/her original job.
“Workers’ compensation premiums are based on the frequency of a company’s injury claims.” 5
The FMLA, on the other hand, guarantees job protection. Thus, employees returning from WC leave, who also took concurrent FMLA leave, are entitled to their former (or equivalent) positions. However, the FMLA stipulates that if an employee is unable to perform an essential function of the same or an equivalent position because of a physical or mental condition, you aren’t required to reinstate him/her into another job. 5. What are some measures employers can take to minimize workers’ compensation fraud? Workers’ compensation fraud is definitely a major problem for today’s employers. Unfortunately, it isn’t always as obvious as, for example, an individual who claims to have been injured at work on a day that records show he/she was out sick. One way to help fight fraud in your workplace is to screen job applicants carefully. It’s illegal to ask applicants about WC claims or to refuse to hire someone because he/she has filed WC claims in the past. But analyzing WC records after a tentative job offer has been made can tell you about an applicant’s ability to handle physically demanding jobs, or for determining specific ailments that may keep the person from performing a job successfully. Another way to fight fraud is to hire an outside investigator to check out cases of possible fraud. Make sure the information you give the investigator is complete. Allow co-workers to be interviewed, turn over any documentation, and provide a photo of the employee, if outside surveillance is required. A third way to prevent fraud is to be aware of and watch for “red flags” of fraud, including inconsistency in medical records; injuries that take much longer to heal than predicted by a doctor; missed doctor appointments; or that the employee can’t be reached by phone during his/her normal working hours. But remember, these are just warning signs; they do not automatically indicate WC fraud. So investigate carefully.
State Accident Fund
Safe-mail first Quarter 2012
Commission Welcomes New Commissioner Gene McCaskill On December 22, 2011 Governor Haley appointed Gene McCaskill of Camden, South Carolina to the Workers’ Compensation Commission effective January 3, 2012. Mr. McCaskill fills the vacant Commissioner position created by the resignation of David Huffstetler in November. Mr. McCaskill has extensive private and public sector experience having served the previous nine years as Senior Executive Assistant at the Office of the Attorney General and two decades as a grocer in Camden. Prior to his employment with the Attorney General’s Office, Mr. McCaskill served as Director of Admissions for Camden Military Academy, a member of the SC Commission on Consumer Affairs, and with the SC Educational Television Commission. (From the website of the South Carolina Workers’ Compensation Commission.)
Term of the Quarter: Cumulative Injury Cumulative injury: An injury that was caused by repeated events or repeated exposures at work. For example, hurting your wrist doing the same motion over and over or losing your hearing because of constant loud noise. State Accident fund Post Office Box 102100 Columbia, South Carolina 29221 (803) 896-5800 http://www.saf.sc.gov/
South Carolina State Accident Fund “Protecting you since 1943.” 6