DEPARTMENT OF FINANCIAL SERVICES



Department of Management Services

Division of Administration

[pic]

Return-to-Work Program

Guidelines

December 1, 2010

TABLE OF CONTENTS

I. TITLE 3

II. AUTHORITY 3

III. PURPOSE 3

IV. DEFINITIONS 3

V. ROLES AND RESPONSIBILITIES 7

A. DMS Employees 7

B. Department of management Services (Agency) 7

C. Medical Case Management Provider (Optacomp) 8

D. Division of Risk Management (DFS) 8

VI. DMS PROCEDURES 8

A. Awareness and Accountability 9

B. Safety Advisory Board (SAB) 8

C. alternate duty or modified duty tasks 9

D. communications, monitoring, and coordination 9

E. Employee Notification letter 9

F. Exit Process 10

G. Recordkeeping 11

H. General provisions 11

VII. ATTACHMENTS 13

Department of Management Services

Division of Administration

Return-to-Work Program Guidelines

I. TITLE

Return-to-Work Program Guidelines

II. AUTHORITY

DMS Workplace Safety and Loss Prevention Program (ADM-08-105)

Section 440.15 (4) Florida Statutes (F.S.)

Click to view Section 440.15 (4)

Section 216.251(b)2, F.S.

Click to view Section 216.251 (b) (2)

Section 60L-34.0061, Florida Administrative Code (F.A.C.)

Click to view Section 60L-34.0061

III. PURPOSE

The purpose of these guidelines is to promote successful employee re-integration into the work environment as quickly as medically possible. These guidelines apply to all DMS employees who sustain a workplace injury.

IV. DEFINITIONS

Accident: An unexpected or unusual event or result that happens suddenly. It does not include mental or nervous injury due to stress, fright, or excitement.

Adjuster: Division employee from the Department of Financial Services with overall responsibility for the handling of workers’ compensation claims files including coordinating lost-time benefits when an injured person is unable to work and an employer resource for questions and issue resolution.

Agency: The Florida Department of Management Services (DMS).

Alternate Duty: Temporary duties established away from employee’s regular work area/responsibilities and within the “functional limitations and restrictions” stated on the DWC-25. Alternate duty is evaluated with each subsequent physician visit when functional restrictions are updated.

Annual Evaluation Report: Annual agency assessment of its return-to-work program based upon Division measures.

Approving Authority: An agency official, such as a Division Director, Bureau Chief, Select Exempt Service (SES) Manager, Senior Management Service (SMS) Manager, or comparable level manager.

Authorized Treating Physician: A physician authorized by a nurse case manager or adjuster to provide medically necessary treatment to an employee who sustains a job-related injury.

Days: Calendar days.

Division: The Division of Risk Management within the Department of Financial Services (DFS).

Employee: A state agency employee who is covered under the Division’s workers’ compensation program.

Essential Functions: The basic job duties that an employee must be able to perform with or without reasonable accommodation.

First Report of Injury or Illness (DWC-1): The Division of Workers’ Compensation Form used to report a worker related injury or death.

Functional Limitations and Restrictions: Identification of the employee’s ability or lack of ability to perform stated activities and the degree to which these activities may be performed. Functional limitations and restrictions as documented on the DWC-25 are identified by the authorized treating physician based upon objective relevant medical findings. According to agency or university direction, consideration shall be given to upgrading or removing the functional limitations or restrictions with each employee exam, based upon the presence or absence of objective relevant medical findings.

Injured Worker or Employee: Any agency employee who sustains a job-related injury or illness; and who has the responsibility of meeting all scheduled medical appointments and returning to work following each appointment, except when the authorized treating physician provides a medical diagnosis that prevents the employee from returning to work and is documented on the DWC-25.

Injury: Personal injury or death by accident arising out of and in the course of employment and any diseases or infections naturally or unavoidably resulting from such injury.

Maximum Medical Improvement (MMI): The medical condition at which further recovery from, or lasting improvement to, an injury or disease can no longer reasonably be anticipated, based upon reasonable medical probability.

Medical Case Management Provider: A vendor contracted by the Division to provide medical case management services for the workers’ compensation program. The current vendor is Optacomp.

Medical Documentation: DWC-25 forms, treatment notes, work status slips or discharge notes provided by the authorized treating physician.

Medical Emergency: Conditions which are severe enough that the lack of immediate medical attention would result in: patient’s life or health being in serious jeopardy; vital bodily functions being seriously impaired; and/or serious and permanent dysfunction of a bodily organ or part.

Modified Duty: Temporary duties established within the employee’s regular position and within the functional limitations and restrictions as reflected on the DWC-25. Modified Duty is evaluated with each subsequent visit to an authorized treating physician when functional restrictions and limitations are updated.

Nurse Case Manager: A nurse employed by the Medical Case Management Provider that is responsible for coordinating medical treatment, obtaining the completed DWC-25 after each medical appointment, verifying the form is properly completed, and forwarding the form to a Division adjuster and the designated agency representative.

Permanent Impairment Rating: Any anatomic or functional abnormality or loss which results from the injury, determined as a percentage of the body as a whole, that exists after the date of maximum medical improvement.

Personnel Liaisons: Unit or facility contact person for human resource issues.

Return-to-Work Employee Notification Letter: An acknowledgement between the employee, applicable supervisor and agency workers’ compensation coordinator that: provides for the specific standard alternate/modified duty tasks within the limitations and restrictions established on the DWC-25 Form; provides time frames for execution and completion of the program; delineates the roles of all persons involved with the program; makes clear to the employee that he or she must actively participate in the program, perform all duties assigned, keep all clinician appointments as scheduled and that failure to comply may result in termination of the program and appropriate agency action.

Safety Advisory Board (SAB): A group of employees at DMS that meets on a regular basis to review employee accident and claim information, to discuss safety-related issues, and to consider corrective actions. At a minimum, safety committees should include the agency safety coordinator or designee, the agency workers’ compensation coordinator or designee, and agency legal counsel or designee. These individuals should be represented by their counterparts at the program unit or local level.

Temporary Partial Disability: A partial disability that is temporary in duration and allows the employee to work in a limited capacity during the recovery period.

Temporary Total Disability: A disability that prevents an employee from working in any capacity during a temporary period of time.

Treating Physician (Also Authorized Treating Physician): Medical provider responsible for completion of the DWC-25 Form at each appointment, with a degree of reasonable medical certainty and based on objective relevant medical findings, and discussing same with injured employee.

Triage Nurse: A nurse employed by the Medical Case Management Provider who performs the initial employee assessment following a reported injury, determines the most appropriate medical care, and arranges the initial medical treatment. This is not the nurse case manager and does not manage cases on an on-going basis.

Waiting Period: The first seven calendar days of an employee’s disability. Employees are allowed to charge 40 hours of Administrative Leave (code 0065) during this period. OPS employees are not compensated for this period unless they are medically disabled for more than 21 days, at which time the Division will pay the employee retroactively.

Workers’ Compensation Benefits: Insurance benefits that replace part of an employee’s wages if the employee is unable to work due to a work-related injury or illness. Benefits include all medical expenses from injuries, illness or accidents considered work-related and compensable.

Workers’ Compensation Coordinator: A DMS agency representative who coordinates workers’ compensation claims and based on the information provided by the treating physician from the DWC-25, makes a determination if the employee is able to return to their regular job, a modified job, an alternate job, or is unable to work. The workers’ compensation coordinator (WCC) also notifies the employee’s supervisor, the nurse case manager and a Division adjuster when the employee is unable to work.

Work Restrictions: The authorized physician’s description of the work an employee can and cannot do based on the DWC-25 functional limitations and restrictions. Work restrictions help protect employees from further or new injury.

V. ROLES AND RESPONSIBILITIES

A. DMS Employees

1. The employee is responsible for attending all appointments with the authorized treating physician, and for returning to the work site after each appointment, except when the authorized treating physician provides a medical diagnosis that prevents the employee from returning to work and that the physician has properly documented on the DWC-25.

2. When a workplace injury prevents an employee from performing regular work assignments, they must read and sign the Employee Notification Letter. If the employee has questions regarding any of the provisions in the Letter, they must clarify immediately with the supervisor.

3. The employee must perform the assigned alternate duties satisfactorily and, if the employee has difficulty performing duties, they must report same to the supervisor immediately.

B. Department of Management Services (Agency)

1. Permanent or Temporary Supervisor ensures attendance and leave is recorded on the employee’s timesheet as required by 60L-34, F.A.C.

2. The Safety Coordinator or Designated Representative ensures the annual evaluation of the agency’s return-to-work program is completed as needed.

3. The DMS workers’ compensation coordinator relies on the information provided by the treating physicians on the DWC-25 to determine if the employee is able to return to the regular job, a modified job, an alternate duty job, or is unable to work; notifies the employee of the decision; and notifies the DFS Division adjuster when the employee is unable to work.

C. Medical Case Management Provider (Optacomp)

1. The Nurse Case Manager obtains the completed DWC-25 after each authorized medical appointment, verifies the DWC-25 is properly completed, and forwards the DWC-25 to the DFS Division adjuster and the DMS Worker’s compensation coordinator. The Nurse Case Manager arranges and authorizes appointments to meet the treatment plan outlined by the authorized treating physician, including but not limited to, referrals to specialists, testing and therapies, and ensuring functional limitations and restrictions listed on the DWC-25 are clear and measurable.

2. The authorized treating physician completes the DWC-25 after each medical appointment with a degree of reasonable medical certainty based on objective relevant medical findings, and discusses the medical findings with the employee.

3. The Triage Nurse receives the initial injury call, assesses the injury from information provided, arranges initial medical referral, and thereafter turns the claim over to the assigned Nurse Case Manager.

D. Division of Risk Management (DFS)

1. An Adjuster from DFS is responsible for the overall handling of workers’ compensation claims reported by employees. An adjuster determines compensability and coordinates lost-time benefits when the injured person is unable to work. The DFS adjuster is an employer resource for questions and issue resolution.

2. State Loss Prevention Program is the administrative unit within the Bureau of Loss Prevention in the Division of Risk Management (DFS) that manages the review and evaluation process for agency return-to-work programs. This office will develop a set of data metrics and provide them to all state agencies so that data collection will be consistent.

VI. DMS PROCEDURES

A. Awareness and Accountability

 

1. Return-to-work program guidelines will be incorporated into required personnel training, such as new employee orientation (NEO) and basic supervisory training.

2. Return-to-work program guidelines will be incorporated into any annual loss prevention training requirements.

3. Return-to-work program guidelines will be posted on the DMS Workplace.

B. Safety Advisory Board (SAB)

1. Workers’ Compensation Data Reports are reviewed on a regular basis at the monthly SAB meetings to ensure all listed employees are correctly identified.

2. Individual lost time claims should be carefully reviewed on a consistent and regular basis to determine if an employee can be returned to work.

3. Claims data should be stratified monthly and on-going during the fiscal year to determine any trends.

C. Alternate Duty or Modified Duty Tasks

1. As needed, the DMS workers’ compensation coordinator, human resources manager, and program management will work together to develop standard tasks and job descriptions based on the DWC-25 (Section IV) functional limitations and restrictions.

2. Documentation of standard alternate duty/modified duty tasks and job descriptions will be maintained in a central location.

D. Communications, Monitoring, and Coordination

1. The DMS workers’ compensation coordinator, immediate supervisor, or designated employee will reach out to the employee immediately following notice of injury to determine the employee’s status and to promote the employee returning to work as quickly as possible.

2. Tracking logs will be reviewed monthly at the SAB Meeting and concerns will be discussed with the unit or facility where the employee is assigned to work.

3. The employee representative will maintain close contact with the nurse case manager to determine the earliest opportunity to bring the employee back to work.

4. DMS will notify the DFS Division adjuster that the employee is returning to work. This notification will be done the same day the employee signs the Return-to-Work Employee Notification Letter, and will include the employee’s start date and agreed upon completion date in the return-to-work program.

5. Supervisory and/or management contact lists will be maintained for the medical case management provider and the Division of Risk Management at DFS. If difficulty is encountered contacting or receiving follow through from the nurse case manager, and delays result in scheduling appointments and/or clearance for surgery, a DMS representative will contact the DFS Division adjuster. The DFS Division adjuster will either resolve program issues with the nurse case manager or contact a manager with the medical case management provider to resolve the problem. The DMS representative will provide details of the concern or complaint to a DFS Division adjuster.

6. The DMS representative will coordinate with the medical case management provider to ensure that the DWC-25 is completed accurately, and that the authorized treating physician provides the functional limitations and restrictions with sufficient detail. DMS representatives will not contact physicians directly regarding problems with the DWC-25. If the nurse case manager is not adequately resolving problems with the authorized treating physician, the DMS representative should contact the DFS Division adjuster.

E. Employee Notification Letter

1. A written Employee Return-to-Work Program Notification Letter will be developed that requires the employee’s signature.

2. Prior to having the employee sign an Employee Return-to-Work Program Notification Letter, the DMS representative will determine from the information provided on the DWC-25 whether the employee’s condition is temporary and not permanent; and that enough information is provided to determine the employee can perform work that is beneficial to the agency and contribute to the agency’s operational needs.

3. The Employee Return-to-Work Program Notification Letter will specify that the alternate duty or modified duty job will be determined by the workers’ compensation coordinator and the supervisor to comply with the functional limitations and restrictions on the current DWC-25.

4. If shift work is applicable, a clause will provide that the appropriate agency staff consider the times of day or night that would best accommodate the employee’s medical functional restrictions and limitations.

5. If an alternate duty assignment involves a single task or a combination of tasks that do not fill the specified work day, a provision will be in the Employee Return-to-Work Program Notification Letter for the appropriate agency staff to add tasks as needed that accommodate the injured employee, or identify and assign another alternate duty job.

6. An Alternate Duty Cover Letter will be attached to the Employee Return-to-Work Program Notification Letter that specifies the date and time of the assignment, the location and supervisor (if different from immediate supervisor) of assignment, the work schedule for the assignment, and some reference to effective period of the assignment, i.e., the employee can assume work duties of the permanent position or the employee reaches maximum medical improvement.

F. Exit Process

1. The employee will exit the program when the employee is placed at maximum medical improvement by the authorized treating physician or the current functional limitation and restrictions no longer prevent the employee from performing his or her normal job.

2. The supervisor, DMS workers’ compensation coordinator or designated human resources official will meet with the employee to notify employee of program ending and to review employee progress. This meeting will cover employee options for continued employment or transition to permanent disability status.

G. Recordkeeping

1. A file will be created and maintained for each employee in the return-to-work program.

2. Any confidential information will be securely maintained in a locked cabinet or in a locked room.

3. A listing will be maintained of employees on workers’ compensation to include employees on out of work status, on temporary total disability status, on temporary partial disability status, or employees on full duty who have not reached MMI.

4. A listing will be maintained of employees currently on alternate or modified duty and should indicate their next follow-up medical examination date.

H. General Provisions

1. An employee will report an accident immediately to his supervisor. If the immediate supervisor is not available, the employee will report the accident to the next level supervisor or to any available supervisory personnel.

2. The immediate supervisor, other supervisor, or, in case of an accident that occurs away from the regular work location, a site-based supervisor or lead employee will report the accident either to the DMS workers’ compensation coordinator or directly to the medical case management provider.

3. In cases where accidents are severe or traumatic and require ambulatory care, any available and responsible party will call immediately to emergency authorities at 911 first, then immediately thereafter identify available supervisory personnel to call either the medical case management provider directly or the DMS workers’ compensation coordinator.

VII. ATTACHMENTS

Attachment 1: DMS Step by Step Guide for Reporting Injuries or Illness

Attachment 2: Reporting an on the Job Injury or Illness (OptaComp)

Attachment 3: Supervisor’s Accident Investigation Report Form

Attachment 4: Chapter 440.15 (4), F.S.

Attachment 5: Section 216.251 (2) (b) 2, F.S.

Attachment 6: Section 60L-34.0061, F.A.C.

Attachment 7: Section 69H-2.007, F.A.C.

Attachment 8: DWC-25 Form

Attachment 9: DMS RTW Notification Letter

ATTACHMENT 1

Step by Step Guide for Reporting Injuries or Illness

Injuries or Illness while on the job – All injuries or illness MUST be reported even when you do not seek medical attention.

Step 1: Call 911 if it is a true emergency and then call OptaComp @ 877-518-2583

Step 2: Supervisors should call in all injuries when possible or have someone in your area trained to call in your absence.

Step 3: The HR Office will be glad to call in injuries when a supervisor is not available.

Step 4: When calling in the injury you will need the following information on the employee

• The 4-digit location code

• The injured employee’s full name

• The injured employee’s Social Security number

• The injured employee’s home address, telephone number and birth date

• The injured employee’s rate of pay

• The injured employee’s employer, address, phone number and contact person

• The date the employer had knowledge of the accident or injury

• The location of the accident (i.e. premises, job-site, on route, in field, etc.), including the address and county in which the accident or injury occurred

• The date and time of the accident or injury

• The description of the accident. (How it occurred? What was the cause?)

• The description of injury. (Describe the injury and part of body, which is affected.)

(HR can provide the information above if you do not have access. (HR: 850-488-2707))

Step 5: As soon as possible the supervisor should complete the Supervisor’s Accident Investigation Report (ADM-105-F3) and send it to the Safety Coordinator’s Inbox (DMS.SafetyCoordinator@dms.). See Attachment 3.

Helpful Contact Information

Gail Steinkuehler: 413 -4715 – Risk Management

Terry Mandigo: 800-545-6565 ext. 37858 - OptaComp Nurse Supervisor

Judy Cagle: 800-545-6565 ext. 25511 - OptaComp Nurse Case Manager

ATTACHMENT 2

Urgent: Attention All

State Agencies and Universities:

Reporting an on the Job

Injury or Illness

IMPORTANT NEWS from

THE DIVISION OF RISK MANAGEMENT

Dear Agency/University Partner,

Effective on January 1, 2009 we are introducing a new workers’ compensation business model that brings better alignment to all aspects of workers’ compensation claim management. With this new model, we have implemented a change in our process for Reporting an on the Job Injury or Illness. We are hopeful that the documents being provided will be helpful to you in educating and informing those within your agency who need to be engaged in this process.

The document that follows will explain the New Reporting Process. Please review these documents and if you have any questions or concerns regarding the new On the Job Injury or Illness Reporting Process, please contact Denzil Weimorts at 850-413-4801 or Denzil.Weimorts@.

We appreciate your continued dedication to provide the best service to our injured workers. Thank you for being an engaged partner in this process.

Best regards,

Denzil Weimorts

Division of Risk Management

Reporting an on the Job

Injury or Illness

In the event of a job related injury or illness, OptaComp staff will assist the injured employee in receiving prompt, quality and medically necessary care as well as maintaining the employee in an active work status, either in modified or transitional duty.

What happens in the first 2-4 hours following a work-related accident, will determine overall success in both human (medical outcomes) and financial (claims cost) terms.

OptaComp provides 24/7/365 claim reporting through our Triage Unit. The role of the triage nurse is a key component of OptaComp’s unique and proactive claim management program. At the time the claim is reported, the triage nurse will orient the employee to the workers’ compensation system, demonstrate concern regarding the injured employee’s well being, determine the level of medical care required and make the necessary medical referral. After the employee is directed for medical care, the claim will be assigned to the nurse case manager and adjuster team who will manage the claim to conclusion.

What are the employer’s responsibilities and what can be expected following an on the job injury or illness?

▪ In the case of a medical emergency, call 911 and then immediately contact OptaComp at 877-518-2583 to report the claim.

▪ If the injury is not an emergency, the supervisor should immediately report the claim to OptaComp. Whenever possible, please have the injured employee present with the supervisor when the claim is reported. The triage nurse will then be better able to assess medical needs and arrange for immediate medical treatment.

“Patients First, Paperwork Later”

The needs of your injured employees always come before the paperwork.

▪ Once OptaComp has taken care of the injured employee, the intake specialist will then collect the Florida First Report of Injury claim information. Upon completion of the initial tasks:

1. assessing the employee’s medical needs and;

2. directing and facilitating the medical treatment

▪ The triage nurse will immediately transfer the case to the nurse case manager and adjuster team for continued handling.

▪ The telephonic nurse case manager, following the clinician visit, will obtain the results of the initial medical encounter including diagnosis, treatment plan and any injury related restrictions. This information will be provided to the supervisor immediately after the clinician visit in order to support our stay at work strategy. Injured workers are generally instructed to return to work immediately following each visit. Please be prepared to speak with and collaborate with the telephonic nurse case manager regarding stay at work/return to work matters, such as transitional duty.

ATTACHMENT 3

|[pic] |Supervisor’s Accident Investigation Report |

|If the injury requires medical attention, call 911 immediately. |

|If the individual is an employee, the supervisor must complete this form. If the supervisor is not available, notify the supervisor’s designee or |

|the next person in charge or the nearest supervisor/manager. If medical attention is required for an employee, contact OptaComp (the state’s |

|managed care provider) who will complete a First Report of Injury or Illness Form (DFS-F2-DWI-1). When a death occurs, the FL Division of Risk |

|Management (DFS) must be contacted within 24 hours. |

|OptaComp: 1-877-518-2583 FL Div. of Risk Management: 1-800-219-8956 |

|Complete all areas of this form for each injured person. |

|Name |      |Employee |Visitor |

|Address |      |

| If an Employee |      |Date of Accident |      |

|People First ID | | | |

| | |Time of Accident |      |

|Facility / Building |      |

|Location/Address of accident |      |

|Individual’s description of |      |

|the accident and injuries | |

| | |

|Name of person injury reported|      |Date Reported |      |

|to | | | |

| | |Time Reported |      |

|Employer’s/ |      |

|Bldg Manager’s understanding | |

|of the accident and injuries | |

|Witness’ description of the |Witness’ |

|accident and injuries |Name |

|What acts, failures to act and/or conditions contributed most directly to this accident? |

| |

|      |

|What are the reasons for the existence of these acts and/or conditions? |

|      |

|What corrective action(s) have been taken? If no action has been taken, explain why. |

| |

|      |

|Name of healthcare provider. |      |

|Was treatment given off-site? |Yes No |Treatment Facility |      |

|Was employee hospitalized overnight? |Yes No |Address |      |

|Did death occur? |Yes No |City, State, ZIP |      |

|THIS INFORMATION IS REQUIRED |Date of Birth: |      |

|BY OSHA FOR ANY INJURY REPORTS|Date of Hire: |      |

|FOR EMPLOYEES |Male: |      |

| |Female: |      |

| |Employee’s |      |

| |Occupation: |      |

|REQUIREMENT: Within 24 hours of the accident, e-mail this report to: |

|DMS’ workers’ compensation coordinator (Lila.Dyer@dms.), |

|DMS’ safety coordinator’s Inbox (DMS.SafetyCoordinator@dms.) |

|Employee’s division’s risk manager. |

|Was this reported to Worker’s Compensation by Employer? Yes No |

|Investigated by | |Date | |

|Supervisor: | | | |

|Investigated by | |Date | |

|Other: | | | |

ATTACHMENT 4

440.15  Compensation for disability.--Compensation for disability shall be paid to the employee, subject to the limits provided in s. 440.12(2), as follows:

(4)  TEMPORARY PARTIAL DISABILITY.--

(a)  Subject to subsection (7), in case of temporary partial disability, compensation shall be equal to 80 percent of the difference between 80 percent of the employee's average weekly wage and the salary, wages, and other remuneration the employee is able to earn postinjury, as compared weekly; however, weekly temporary partial disability benefits may not exceed an amount equal to 662/3 percent of the employee's average weekly wage at the time of accident. In order to simplify the comparison of the preinjury average weekly wage with the salary, wages, and other remuneration the employee is able to earn postinjury, the department may by rule provide for payment of the initial installment of temporary partial disability benefits to be paid as a partial week so that payment for remaining weeks of temporary partial disability can coincide as closely as possible with the postinjury employer's work week. The amount determined to be the salary, wages, and other remuneration the employee is able to earn shall in no case be less than the sum actually being earned by the employee, including earnings from sheltered employment. Benefits shall be payable under this subsection only if overall maximum medical improvement has not been reached and the medical conditions resulting from the accident create restrictions on the injured employee's ability to return to work.

(b)  Within 5 business days after the carrier's knowledge of the employee's release to restricted work, the carrier shall mail to the employee and employer an informational letter, adopted by department rule, explaining the employee's possible eligibility and responsibilities for temporary partial disability benefits.

(c)  When an employee returns to work with the restrictions resulting from the accident and is earning wages less than 80 percent of the preinjury average weekly wage, the first installment of temporary partial disability benefits is due 7 days after the last date of the postinjury employer's first biweekly work week. Thereafter, payment for temporary partial benefits shall be paid biweekly no later than the 7th day following the last day of each biweekly work week.

(d)  If the employee is unable to return to work with the restrictions resulting from the accident and is not earning wages, salary, or other remuneration, temporary partial disability benefits shall be paid no later than the last day of each biweekly period. The employee shall notify the carrier within 5 business days after returning to work. Failure to notify the carrier of the establishment of an earning capacity in the required time shall result in a suspension or nonpayment of temporary partial disability benefits until the proper notification is provided.

(e)  Such benefits shall be paid during the continuance of such disability, not to exceed a period of 104 weeks, as provided by this subsection and subsection (2). Once the injured employee reaches the maximum number of weeks, temporary disability benefits cease and the injured worker's permanent impairment must be determined. If the employee is terminated from postinjury employment based on the employee's misconduct, temporary partial disability benefits are not payable as provided for in this section. The department shall by rule specify forms and procedures governing the method and time for payment of temporary disability benefits for dates of accidents before January 1, 1994, and for dates of accidents on or after January 1, 1994.

History.--s. 15, ch. 17481, 1935; CGL 1936 Supp. 5966(15); s. 4, ch. 20672, 1941; s. 2, ch. 22814, 1945; s. 1, ch. 23921, 1947; s. 11, ch. 25035, 1949; s. 1, ch. 26877, 1951; s. 10, ch. 26484, 1951; s. 1, ch. 29803, 1955; s. 3, ch. 29778, 1955; s. 1, ch. 59-103; s. 1, ch. 59-102; s. 2, ch. 61-119; s. 1, ch. 61-188; s. 1, ch. 63-235; s. 1, ch. 65-168; ss. 17, 35, ch. 69-106; s. 1, ch. 70-71; s. 1, ch. 70-312; s. 5, ch. 73-127; s. 9, ch. 74-197; s. 6, ch. 75-209; s. 1, ch. 77-174; s. 4, ch. 77-290; ss. 5, 23, ch. 78-300; ss. 10, 124, ch. 79-40; ss. 8, 21, ch. 79-312; s. 5, ch. 80-236; s. 5, ch. 81-119; s. 275, ch. 81-259; ss. 1, 3, ch. 82-237; s. 8, ch. 83-174; s. 5, ch. 83-305; s. 2, ch. 84-267; s. 3, ch. 86-171; s. 3. ch. 87-330; s. 4, ch. 88-203; ss. 12, 43, ch. 89-289; ss. 20, 56, ch. 90-201; ss. 18, 52, ch. 91-1; s. 20, ch. 93-415; s. 73, ch. 96-418; s. 1052, ch. 97-103; s. 47, ch. 97-264; s. 2, ch. 98-125; ss. 190, 261, ch. 98-166; s. 92, ch. 2000-153; s. 65, ch. 2001-62; s. 28, ch. 2002-194; s. 52, ch. 2003-1; s. 11, ch. 2003-36; s. 18, ch. 2003-412; s. 62, ch. 2004-5.

1Note.--Paragraph (4)(b) does not reference time periods for payment of benefits. The appropriate reference may be to paragraph (4)(e).

ATTACHMENT 5

216.251  Salary appropriations; limitations.--

(1)  The annual rate of salary of any officer or employee filling the position specifically named in an item in the appropriations acts shall be as provided in one of the following paragraphs:

(a)  In the amount appropriated for such position;

(b)  The amount appropriated in an item for the named positions in that item, shall be divided by the indicated number of such positions, and the resulting quotient shall be the annual rate of salary of each such position; or

(c)  Within the amounts appropriated where such salary may be otherwise fixed pursuant to law.

(2)(a)  The salary for each position not specifically indicated in the appropriations acts shall be as provided in one of the following subparagraphs:

1.  Within the classification and pay plans provided for in chapter 110.

2.  Within the classification and pay plans established by the Board of Trustees for the Florida School for the Deaf and the Blind of the Department of Education and approved by the State Board of Education for academic and academic administrative personnel.

3.  Within the classification and pay plan approved and administered by the Board of Governors or the designee of the board for those positions in the State University System.

4.  Within the classification and pay plan approved by the President of the Senate and the Speaker of the House of Representatives, as the case may be, for employees of the Legislature.

5.  Within the approved classification and pay plan for the judicial branch.

(b)  Salary payments shall be made only to employees filling established positions included in the agency's or in the judicial branch's approved budgets and amendments thereto as may be provided by law; provided, however:

1.  Reclassification of established positions may be accomplished when justified in accordance with the established procedures for reclassifying positions; or

2.  When the Division of Risk Management of the Department of Financial Services has determined that an employee is entitled to receive a temporary partial disability benefit or a temporary total disability benefit pursuant to the provisions of s. 440.15 and there is medical certification that the employee cannot perform the duties of the employee's regular position, but the employee can perform some type of work beneficial to the agency, the agency may return the employee to the payroll, at his or her regular rate of pay, to perform such duties as the employee is capable of performing, even if there is not an established position in which the employee can be placed. Nothing in this subparagraph shall abrogate an employee's rights under chapter 440 or chapter 447, nor shall it adversely affect the retirement credit of a member of the Florida Retirement System in the membership class he or she was in at the time of, and during, the member's disability.

(3)  An agency may not provide general salary increases or pay additives for a cohort of positions sharing the same job classification or job occupations which the Legislature has not authorized in the General Appropriations Act or other laws.

History.--ss. 15, 31, 35, ch. 69-106; s. 15, ch. 71-354; s. 3, ch. 80-404; ss. 2, 12, ch. 85-241; s. 1, ch. 85-336; s. 12, ch. 90-365; s. 67, ch. 92-142; s. 1172, ch. 95-147; s. 11, ch. 98-136; s. 31, ch. 2000-371; s. 246, ch. 2003-261; s. 36, ch. 2005-152; s. 34, ch. 2006-122; s. 26, ch. 2007-217.

ATTACHMENT 6

60L-34.0061 Disability Leave.

(1) The following provisions govern job-connected disability leave with pay:

(a) An employee who sustains a job-connected disability that is compensable under Chapter 440, Florida Statutes, shall be carried in full-pay status for up to forty work hours without being required to use accrued leave, beginning immediately following the onset of the injury. This leave may be used intermittently to cover appointments to health care providers, physical therapy, and similar activities provided that these activities are directly related to the employee’s Workers’ Compensation injury. An employee who returns to work and has exhausted the forty hours of disability leave will, upon presentation of written confirmation from the authorized physician, be granted additional disability leave not to exceed forty-eight hours for follow-up examinations or treatment required by the authorized treating physician for a particular injury.

(b) If, as a result of the job-connected injury, the employee is unable to resume work at the end of the forty-hour period provided in paragraph (a), the employee may continue on full-pay status while covered by Workers’ Compensation as follows. Continuing on full-pay status means receiving the salary being received before the disability. In no case shall the employee’s salary and Workers’ Compensation benefits exceed the amount of the employee’s regular salary payments:

1. The employee may elect to use accrued sick, compensatory, or annual leave in an amount necessary to achieve full-pay status. The employee’s annual hourly rate (annual salary/2080) shall be used to determine the number of leave hours needed to supplement the Workers’ Compensation payments.

2. If the employee elects not to use accrued leave, or after the employee has exhausted all earned leave in accordance with subparagraph 1. above, the employee shall be placed on leave without pay and shall revert to normal Workers’ Compensation benefits; provided, however, that the agency may petition the Department to continue the employee on full-pay status as follows:

a. The petition shall include a medical report that gives a current diagnosis of the employee’s physical condition and a prognosis regarding recovery and ability to return to work.

b. The petition shall describe (i) the type and extent of the injury, (ii) the circumstances of the injury, and (iii) the nature of the employee’s duties. The petition shall explain why, in light of the foregoing, it is in the best interest of the state to continue the employee at full-pay status.

(c) An employee covered by Workers’ Compensation shall continue to earn and accrue full leave credits.

(d) The following provisions apply when an employee on disability leave returns to alternate duty:

1. When the Division of Risk Management of the Department of Insurance has determined that an employee is entitled to receive a temporary partial disability benefit pursuant to Section 440.15, Florida Statutes, and there is medical certification that the employee cannot perform the duties of the employee’s regular position, but the employee can perform some type of work beneficial to the agency, the agency, if appropriate, will return the employee to the payroll at regular rate of pay to perform such duties as the employee is capable of performing even if there is not an established position in which the employee can be placed.

2. If an agency returns an employee to alternate duty, the agency shall advise the employee in writing of the alternate duties to be performed, hours of work, and the expected length of time of the alternate assignment. The agency shall review the employee’s performance at least quarterly. The agency shall maintain appropriate records of affected employees.

3. When the employee becomes able to perform regular position duties, the agency shall reassign the duties accordingly and return the employee to regular position. In no event shall the employee be allowed to continue performing the alternate duties once maximum medical improvement has been determined by the Division of Risk Management unless appointed to the position as provided in Chapter 60L-33, F.A.C. The agency shall maintain appropriate records of employees removed from alternate duty.

(2) The following provisions govern compulsory disability leave:

(a) An agency with reason to believe that an employee is unable to perform assigned duties, or is otherwise interfering with the operations of the work unit, due to physical or mental illness or injury, shall request a report from the employee’s doctor (including psychologist) concerning the employee’s abilities or require the employee to submit to an examination by a doctor selected and paid for by the agency. The agency may place the employee on compulsory disability leave pending the doctor’s report. If the examination confirms that the employee is unable to perform assigned duties, the agency shall continue or place the employee on compulsory disability leave or take action to remove the employee from the position, including dismissal. The employee shall be notified in writing of the duration of the disability leave and the conditions under which the employee will be allowed to return to employment.

(b) The employee may elect to use earned leave to cover the period of disability. If the employee does not have sufficient leave credits to cover the disability leave, or elects not to use leave credits, the leave shall be without pay.

(c) If the employee remains unable to perform at the end of an approved leave, the agency, based on a current doctor’s certification, shall either request the employee’s resignation for reasons of inability to perform assigned duties, or dismiss the employee for cause based on inability to perform assigned duties.

(d) If the employee refuses to submit to the doctor’s examination, the agency shall decide based on the available information whether to request the employee’s resignation for reasons of inability to perform assigned duties, or dismiss the employee for cause based on inability to perform assigned duties.

(e) In taking action with respect to compulsory disability, an agency shall ensure that it complies with the requirements of applicable federal and state laws.

Specific Authority 110.1055, 110.201, 110.219(5) FS. Law Implemented 110.219, 216.251 FS. History–New 1-22-02.

ATTACHMENT 7

69H-2.007 Loss Prevention Programs.

(1) The head of each insured agency shall appoint a Safety Coordinator who shall, at the direction of the agency head, develop and implement a comprehensive departmental safety program. The appointment shall be on Form Dfs-d0-858, “Safety Coordinators Appointment Form,” rev. 11/05, which is hereby adopted and incorporated by reference. In the event of a change, the agency head shall submit the name of the new Safety Coordinator within thirty (30) days of the vacancy on Form Dfs-d0-858.

(2) The appointed Safety Coordinator shall annually submit to the Division of Risk Management Form Dfs-d0-860, “Safety Program Evaluation,” rev. 11/05, which is hereby adopted and incorporated by reference.

(3) The appointed Safety Coordinator of each insured agency shall review each quarterly casualty report from the Division of Risk Management. The Safety Coordinator shall identify any discrepancies between the Division’s records and the agency’s records and shall report such discrepancies on Form Dfs-d0-859, “Casualty Report Series: Liability Change Form,” rev. 11/05, or Dfs-d0-1402 “Casualty Report Series: Workers’ Compensation Change Form”, rev. 8/09, which are hereby adopted and incorporated by reference, within 30 days after receipt of the quarterly report.

Specific Authority 284.39 FS. Law Implemented 284.50 FS. History–New 1-7-92, Amended 6-28-01, Formerly 4H-2.007.

ATTACHMENT 8

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ATTACHMENT 8 (Continued)

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ATTACHMENT 9

WORKERS COMPENSATION

RETURN TO WORK NOTIFICATION LETTER

|Employee Name |Employee ID |Date |

| | | |

| |

|As a result of a work related injury on ___________________ , I have received medical certification from |

|(date) |

|_________________________________________________, for the stated medical problem(s) which has resulted in |

|(health care provider name) |

|the following recommended restrictions (As reflected in DWC-25 Form Section IV): |

| |

|The alternate/modified restrictions are valid until I can perform my regular work assignments or until the terms of this agreement expires. I understand my|

|alternate/modified work assignments and alternative work performance standards are binding until I am relieved from my restrictions. |

|1. Work assignments under employee’s work restrictions: |

| |

| |

| |

| |

| |

| |

|2. Follow up period: |

|Note Section V Maximum Medical Improvement / Permanent Impairment Rating. Period of time will depend on the Attending Physician’s comments and, if |

|applicable, date next scheduled appointment date (Section VI Follow-Up). |

| |

| | |

|Employee Name (Please print and sign) |Date |

| | |

|Supervisor and/or Workers Compensation Coordinator Name |Date |

|(Please print and sign) | |

|Failure to comply with this Return to Work Notification Letter may result in disciplinary action |

|up to and including termination. |

| |

-----------------------

TIME IS OF THE ESSENCE

IMMEDIATELY REPORT ALL ON THE JOB INJURIES OR ILLNESSES.

TO REPORT A CLAIM, CALL TOLL FREE: 877-518-2583

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