Workers Compensation

1
Workers Compensation

• Presented by
• Central Accident Reporting Office
• (CARO)
• August, 2005

2
CARO

• Self-insures and self administers workers
  compensation claims for most state employees
• Covers approximately 63,000 state employees
  excluding MoDOT, MSHP and the University of
  Missouri

3
Changes in Workers Compensation

• New Legislative Changes 2005 Session
• SB 1 signed by Governor in March, 2005
• AG Office provides legal interpretation and
  advice

4
New Legislative Changes

• Accident
• traumatic event or unusual strain identifiable
  by time and place
• caused by specific event during a single work
  shift
• accident is prevailing factor defined as the
  primary factor causing medical condition and
  disability

5
New Legislative Changes

• Idiopathic Events no longer compensable
• Cardiovascular, pulmonary, respiratory or other
  disease suffered must be the prevailing factor in
  causing the medical condition
• To and From Work injuries while in employer
  owned or subsidized vehicles while traveling from
  home to work and back to home, not compensable.
  Injuries while en-route to place of employment on
  property not owned/controlled by employer, not
  compensable

6
New Legislative Changes

• Bennett, Kasl and Drewes cases overturned
• Notice employer liable for employee who exposed
  to hazard prior to evidence of disability
• Prevailing factor applies to occupational disease

7
New Legislative Changes

• Notice Employee still has 30 days to give
  notice of an accident and the claim is barred
  unless they can show the employer was not
  prejudiced by the employees failure to give
  timely notice. The good cause exception no
  longer exists.
• Communication is the key. Obtain a written
  statement by the employee describing the injury
  in detail. CARO has a form available.

8
New Legislative Changes

• Occupational disease ordinary, gradual
  deterioration or progressive degeneration caused
  by aging or normal daily activities, not
  compensable
• Safety failure of employee to use safety device
  provided by employer or failure to obey safety
  rules, compensation reduced to 25 to 50 (was
  15) provided employee had knowledge of rule and
  employer made reasonable effort to enforce

9
New Legislative Changes

• Drugs/Alcohol employee failure to obey policy,
  compensation reduced by 15 if injury sustained
  in conjunction with use of drugs/alcohol
• Drugs/Alcohol if the employers policy was
  violated and the use of drugs/alcohol is the
  proximate cause of injury, compensation is
  forfeited.

10
New Legislative Changes

• Drugs/Alcohol if employer suspects or policy
  dictates testing, employee refuses testing,
  benefits are forfeited
• Recreational activity is prevailing cause,
  benefits are forfeited
• Fraud now a class D felony subject to a fine up
  to 10,000

11
Suspect Fraud?

• Obtain written statement from witnesses and
  supervisors
• Call your CARO adjuster for advise on how to
  proceed
• Contact Fraud Unit at Division of Workers
  Compensation 1-800-592-6003

12
Division of Workers Compensation Fraud Unit

• Any person may file a complaint
• All investigations are confidential
• Allegations may be anonymous
• DWC Fraud Unit
• P O Box 1009
• Jefferson City, MO 65102-1009

13
New Legislative Changes

• Mileage for treatment outside of the employees
  principle place of employment
• Employer may require employee to use accumulated
  paid leave, personal leave or sick leave to tend
  to medical treatment including physical therapy
  or medical evaluations

14
New Legislative Changes

• Employee shall submit to vocational testing and
  assessment
• Employee cannot receive TTD for any period
  unemployment compensation is received
• Termination due to misconduct after an injury
  stops TTD

15
New Legislative Changes

• PPD shall be certified by a physician, if medical
  opinions conflict, objective medical evidence is
  considered over subjective
• PPD shall be reduced by pre-existing disease or
  natural aging to cause/prolong the disability

16
New Legislative Changes

• Statement shall not include videotape or pictures
  of employee
• Administrative Law Judge shall approve settlement
  agreements when employee understands rights

17
Questions?
18
What Are Your Concerns?

•      Process from start to finish
•   Scenarios if this happens, then this
•     How sick leave factors into the process
• Updated code list

19
Contact CARO

• CARO P O Box 809, Jefferson City, MO 65102
• Phone [phone]
• Toll Free 1-888-622-7694
• Hearing Impaired 1-800-735-2966
• Fax [phone]
• Email CARO _at_ oa.mo.gov

20
CAROs Home Page

• www.oa.mo.gov/gs/risk/work/work.htm