SOP: Workers Compensation

Question 1

Notice of injury or occupational disease/Incident report is what numbered form?

Answer 1

C-1

Question 2

Employers report of industrial injury or occupational disease is what numbered form?

Answer 2

C-3

Question 3

Employees claim for compensation/report of initial treatment is what numbered form?

Answer 3

C-4

Question 4

A certificate of recovery and fitness is described as what form?

Answer 4

Medical release

Question 5

What is defined by NRS as an unexpected or unforeseen event happening suddenly and violently, with or without human fault and producing at the time objective symptoms of an injury?

Answer 5

Accident

Question 6

What is defined by NRS as a sudden and tangible happening of traumatic nature producing an immediate or prompt result which is established by medical evidence, including injuries to prosthetic devices?

Answer 6

Injury and Personal Injury

Question 7

Who maintains a self-insured and self-administered program for industrial claims?

Answer 7

City of Las Vegas

Question 8

Who is responsible for managing claims for all city employees?

Answer 8

The workers comp administrator

Question 9

Personnel are responsible to know and follow SOP 100.12 ______ ______ ______ regarding modified duty/ light duty release by a treating physician.

Answer 9

Transitional Work Assignment

Question 10

All _______ shall assist their subordinates in obtaining medical care, if needed, and complete the _______ portion of all workers comp forms.

Answer 10

Supervisors, supervisors

Question 11

Supervisors shall submit all paperwork and forms in a timely manner, within ______ days, not ______

Answer 11

7, shifts

Question 12

Who shall co-ordinate with Human Resources and/or workers comp administrator to ensure compliance with city policies?

Answer 12

Deputy Chief of Admin

Question 13

Who shall manage appropriate payroll processes in compliance with city policies

Answer 13

Payroll Assistants

Question 14

Who shall maintain an employee injury log and route forms and paperwork to Human Resources or the workers comp administrator?

Answer 14

Payroll Assistants

Question 15

Who shall communicate as needed with the injured/ill employee regarding items related to the injury such as paperwork, schedules and time keeping?

Answer 15

Payroll Assistants

Question 16

All work related injures/illness should be reported to their immediate supervisor within _____ calendar days, not _____.

Answer 16

7, shifts

Question 17

When reporting a work related injury/illness, the employee shall fill out a _____ form.

Answer 17

C-1

Question 18

Submitting a C-1 does not initiate a _____ ______ ________

Answer 18

worker comp claim

Question 19

Submitting a C-1 is only an incident report until ______ _______ is sought.

Answer 19

medical treatment

Question 20

The injured/occupationally diseased employee has _______ calendar days after the date of injury to seek medical care.

Answer 20

90

Question 21

If no medical attention is sought for the injury, the competed C-1 remains on file for ________ years and then is destroyed.

Answer 21

3

Question 22

If medical treatment Is sought, a ______ claim for compensation and supervisor investigation form must be completed and submitted.

Answer 22

C-4

Question 23

If ______ is completed and submitted, the workers comp administrator will complete the ______

Answer 23

C-4, C-3

Question 24

The design and information required on the C-1, C-3 and C-4 forms is mandated by who?

Answer 24

The state of Nevada

Question 25

If a claim is denied, instructions and appeal rights are provided to the employee by who?

Answer 25

Workers comp administrator

Question 26

Transitional work assignments are commonly referred to as what?

Answer 26

Light/Modified Duty

Question 27

Transitional work assignments shall be offered to employees with valid workers comp claims and if authorized by who?

Answer 27

The employees physician

Question 28

Taking a vacation during a workers comp claim is _____________

Answer 28

Discouraged

Question 29

If an employee goes on vacation while on occupational disease or injury, there timecard must be changed to what?

Answer 29

vacation leave

Question 30

City approved forms and information related to workers comp are available electronically where?

Answer 30

City HR Intranet

Question 31

If an injured/ill employee in in need of medical attention, they will seek treatment at an ___________ occupational clinic.

Answer 31

Approved

Question 32

For true medical emergencies, the employee may report to a ________

Answer 32

Er

Question 33

Going to an unapproved provider may ________ the employees claim.

Answer 33

Jeopardize

Question 34

The initial treating medical facility or physician must compete which form?

Answer 34

C-4

Question 35

The employee must sign the ______ section of the C-4 otherwise it is not valid.

Answer 35

Middle

Question 36

On the C-4 the treating physician completes what portion?

Answer 36

Bottom

Question 37

Typically, the treating physician sends the C-4 to the city of Las Vegas ________.

Answer 37

Directly

Question 38

Who is responsible to ensure that the C-4 is submitted and received by human resources?

Answer 38

The employee

Question 39

Human Resources receipt of the C-4 ________ the employees claim.

Answer 39

Initiates

Question 40

Who is responsible for providing his/her supervisor a copy of the completed C-4 after initial medical treatment.

Answer 40

The employee

Question 41

Due to the importance and time sensitivity of workers compensation forms, it is recommended that injured/ill employees and supervisors submit forms _________ and/or _______

Answer 41

electronically, hand deliver

Question 42

Electronically submitted workers comp forms should be sent to what email group?

Answer 42

Fire Payroll

Question 43

Who completes time cards for employees entirely off work due to occupational disease or injury?

Answer 43

Workers comp administrator

Question 44

Time off shall be coded as what?

Answer 44

Admin OJI-W

Question 45

Paid coverage of ______% is provided to IAFF employees for _______ calendar days if the claim is accepted.

Answer 45

100, 60

Question 46

After 60 days has elapsed and the employee is not able to return to work, the workers compensation fund pays approximately _______ of their monthly salary.

Answer 46

2/3

Question 47

When full pay coverage expires, the employee may use what to receive a full pay check.

Answer 47

Sick, VL

Question 48

The city will not take any _________ from the workers comp check.

Answer 48

Deductions

Question 49

What is not available if the employee is only being paid their 2/3 salary from the worker comp fund?

Answer 49

Direct Deposit

Question 50

Employees off duty for more than ______ days since their last regular worked day shall submit a fitness for duty form.

Answer 50

90

Question 51

Return to duty must be completed before the employee is assigned to the ___________

Answer 51

Training Center

Question 52

The employee is assigned to the training center to complete what?

Answer 52

Return to duty task book