Risk-Sharing News

Risk-Sharing

First Report of Injury

The First Report of Injury is our first “look” into a claim. As routine as it may be, it is a very important form which gives our office initial insight as to the compensability of a claim and the extent of the injury.

The following are some items that are helpful to our office: j Ensure telephone numbers are legible; j Add the NCCI class code below the area “wage per hour;” j Add the supervisor’s name and telephone number if it is different than the general office number; j The area “Description of Injury” also means “What happened?” so please don’t indicate “broken arm.”

Instead, write “Fell from ladder and broke arm.’” j The employer must complete (with signature and date) the employer section. If this is blank, there is no indication that you are aware that the incident took place.

And as always…Submit them timely!

The sooner the better – Please! The sooner we can interact with employees and providers, the sooner we can investigate and begin resolution of the claim. If the employee is not available to sign the First Report of Injury, submit it anyway! Claims Associates, Inc. Mail: PO Box 1898, Sioux Falls SD 57101 Fax: 605-333-9835 Email: claims@claimsassoc.com Call a nurse: 877-899-9112

In addition to the form, we are thankful that you send the signed medical authorization. Other documents that may be sent with the First Report of Injury could include: j Volunteer Roster/Meeting minutes j Photos of equipment or area of accident

Most importantly to the process, please CALL us if you have ANY questions or concerns about a claim or the claims process. We thank you for the opportunity to serve as your claims administrators.

Jennifer Andrisen Selzler SCLA AIC CSRP SDWCS Claims Associates, Inc

Wage Calculations

In Spring 2014, the South Dakota Department of Labor and Regulation (SD DOLR) received a Petition for Declaratory Ruling regarding bonuses being included as part of an employee’s “earnings” when calculating Average Weekly Wage (AWW) for workers’ compensation indemnity benefits.

The SD DOLR has held that non-discretionary or earned bonuses that are based on an employee’s performance are included in the AWW calculation. The Department has also ruled that discretionary bonuses that are not tied to performance are generally not included as “earnings” when calculating AWW and compensation rate. Examples of discretionary bonuses include Christmas bonuses and quarterly or year-end bonuses that are paid to all employees and are not based on individual performance or merit.

It has been our experience that most members do not typically issue non-performance based bonuses, or if they do, the amounts are not very large. The outcome of ruling may have more bearing on private employers and employees.

Update: As of July 2015, the declaratory ruling was vacated and is under review of the South Dakota Supreme Court. Because there was no actionable dispute (an employer/insurer hadn’t denied benefits and an employee hadn’t filed a petition for hearing), it is questionable whether the Department of Labor and Regulation had the

authority to take such action.