1st Report of Injury Fact Sheet

It is the Philosophy of the Kanawha County Emergency Ambulance Authority (“KCEAA”) that Safety is number 1 and furtherance of this philosophy it is the responsibility of eachemployee to follow a Standard Work Practice of reporting injuries or discomfort as outlined in the employee manual and below:

  1. Reporting process
  1. Report immediately to a Supervisor any personal injury or illness no matter the severity.
  2. Incident Investigation will beinitiated.
  3. The employee will ensure all required paperwork is completed and returned to the Human Resources department within twenty-four (24) hours of the injury.
  4. This will include the following documents:
  5. Report in E-Pro
  6. Form OIC-WC-1
  7. Physicians Statement of Restrictions
  8. If the employee is unable to deliver the required paperwork to the Human Resources department it is the employee’s responsibility to notify Human Resources department immediately and other arrangements will be made.
  1. Workers’ Compensation

The KCEAA Workers’ Compensation administration is handled through Chartis insurance.

Chartis provides theKCEAA with an off-site Administrator and Case Management coordinator to assist in working with the employee and their attending physician(s) and the KCEAA’s return to work program.

Normal hours of operation for Chartis are 8:30am-4:30pm Monday thru Friday.A representative from Chartis can be reached at the following numbers:

Phone: (502) 561-8747

Toll Free:(800) 428-2422

Fax:(866) 420-0959

  1. Injury Case Management Facts

Management of any work-related injury or illness is based on applicablegovernmental regulations, Insurance regulations/guidelines and KCEAAPolicy and Procedures.

A. Filing a claim: Workers’ Compensation Claim forms can be obtained prior to treatment through the KCEAA. Forms are also located at many areas such as:

a.KCEAA stations.

b.Ambulance clip boards.

c.

d.Operations Supervisors.

e.Local Emergency Rooms and Urgent Care facilities.

B.Appointments/Treatment: All appointments should be coordinated between the employee’swork schedule, the attending physician, the KCEAA and Chartis.

  1. Restricted duty

Any job or duty restriction must be provided in writing to the KCEAA. Each duty restriction must be specific to the injury/illness at issue and the employee’s position. At no time will a physician’s note/order/return to work slip be accepted that states “light duty” only.

A.The KCEAA has in place Standard Operating Guidelineswhich provide all KCEAA employees with modified / alternative duty work which is temporary and transitional in nature and will be provided for seven (7) consecutive calendar days for any work related injury and illness and can accommodate all restrictions, excluding total bed rest .

B.Employees must report to the Human Resources Department with written restriction orders after each and every doctor’s appointment which is related to the injury or illness at issue. It is the responsibility of the employee to follow their attending physician’s orders in regard to restrictions at work and at home.

C.Employees should work closely with the KCEAA Human Resources Department once the employee has reached five(5) days of restricted duty to discuss available options in the event they reach their seven (7)day allotted days.

  1. Time Away From Work

A. Appointments: Time away from work for appointments (Doctor, Clinic, ER etc.) are considered excused absences (based on the Appointment Matrix) and are considered unpaid.

B.Lost time: Missed work days require a written order from the treating or referral physician(s). Missed work days will be reviewed and approved by a Chartis claims representative based upon documentation that has been provided by the employee and reviewed per the applicable guidelines.

C.FMLA: FMLA runs consecutively with leaves of absences such as Medical Leave of Absence, Short Term Disability, Long Term Disability and Workers’ Compensation.

D.Benefit Premiums: While a KCEAA employee is off work and receiving Workers’ Compensation benefitsthat employee is responsible for obtaining and maintaining optional benefits. The employee is also responsible for the employee’s share of major medical and dental/vision benefits provided through the KCEAA health benefit program. The KCEAA will bill the employee for the employee’s pro rata share of their benefit premium.

E.For optional benefits like Short Term Disability, Long Term Disability, Life Insurance, etc, the affected employee will need to contact those administrators directly.

  1. Return to work/Medical Pass

Employees returning to work from any “lost time” injury or illness must report to directly to their supervisorprior to reporting to their respective work area. Employees are not allowed to report for duty without first receiving a medical pass.

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