Minnesota Department of Transportation

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MnDOT Policies

Workers' Compensation Injury Reporting and Return-to-Work Procedures

For Workers' Compensation Injury Reporting and Return-to-Work Policy #WF012

Effective Date: September 11, 2020

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Introduction

This document is the technical companion to the Minnesota Department of Transportation’s (MnDOT’s) Workers’ Compensation Injury Reporting and Return-to-Work Policy.

Definitions

Designee

For the purpose of reporting a work-related injury or illness, the individual selected to act on behalf of the supervisor when the supervisor is absent.

MnDOT Report of Work Ability for Work Injuries

A form to be completed by a healthcare provider on behalf of an employee with a work-related injury.

Significant Event

A work-related situation or circumstance to which employee exposure could potentially lead to injury or illness.

Significant Injury or Illness

A work-related injury or illness that results in death, medical treatment beyond first aid, loss of consciousness, days away from work, restricted work, or transfer to another job.

Transitional Work Assignment

A temporary position that permits an employee to return-to-work within the medical restrictions outlined by the treating health care provider.

Travel Status

Applies to an employee when:

  • The supervisor has determined that the employee will remain away from home overnight because of the requirements of the job.
  • The employee is on authorized assignment more than thirty-five (35) road miles from their temporary or permanent workstation.

Treating Healthcare Provider

For state employees entitled to workers' compensation treatment, a physician, chiropractor, osteopathic physician, podiatrist, or dentist directing and coordinating the course of medical care to the employee.

Procedures

The employee, supervisor and Workers’ Compensation Coordinator must take the following actions when a work-related injury or illness occurs, including when in travel status.

Employee required actions

  • In a medical emergency, call 9-1-1 for immediate medical attention
  • For all non-emergencies, the employee must contact CorVel (Managed Care Provider) at 844-235-2055 (24/7 Nurse Triage Line) for guidance and/or to find the nearest network medical provider, should further medical treatment be needed and/or recommended
  • The employee must immediately notify his/her supervisor or designee unless a significant injury, illness, or event prevents reporting
  • The employee must electronically submit work injury data into eSAFE to generate the electronic Employee Statement Regarding Injury/Illness/Incident and electronic Information and Privacy Statement immediately and not later than 24 hours after the event, unless a significant injury, illness, or event prevents reporting. If eSAFE is unavailable, complete paper forms located under the Resources Tab of the agency Workers’ Compensation iHUB page and submit to the Workers’ Compensation Coordinator.

Supervisor required actions

  • The supervisor (or supervisor's designee) must electronically submit work injury data into eSAFE to generate the electronic First Report of Injury – Injury, Illness, Incident Data Form and Agency Claims Investigation Form, and notify the Workers' Compensation Coordinator immediately and not later than 24 hours after the event. If eSAFE is unavailable, complete paper forms located under the Resources Tab of the agency Workers’ Compensation iHUB page and submit to the Workers’ Compensation Coordinator.
  • If the event results in a significant injury or illness, the supervisor must notify the Workers' Compensation Manager as soon as possible but not more than eight (8) hours after the event has occurred. Examples of significant injury or illness include workplace events such as fatalities or serious or life-threatening injury or illness resulting in hospitalization.

    If an employee is a witness to or a part of a significant event, the supervisor must contact the Workers' Compensation Coordinator immediately, but not later than 24 hours after the event occurred. Examples of significant events include exposure to situations or circumstances that could potentially lead to future injury or illness (e.g. a chemical spill or vehicle crash).

Workers' Compensation Coordinator required actions

  • The Coordinator must submit the Workers' Compensation information that was entered into eSAFE to the Minnesota Department of Administration - Risk Management Division (RMD) for claims determination.
  • Submit a copy of the employee's position description and/or essential job functions to CorVel (Managed Care Provider) in accordance with managed care rules, Minn. Rule 5218.0100.

Note: A work-related injury or illness may run concurrently with Family Medical Leave Act (FMLA) and/or ADA Reasonable Accommodation.

Returning to Work With or Without Restriction

To ensure that it is medically appropriate for the employee with a work-related injury or illness to return safely to work, the treating health care provider must complete a MnDOT Report of Work Ability for Work Injuries form. This form must be submitted to the Workers' Compensation Coordinator prior to returning to work. The Worker's Compensation Coordinator and/or Office of Human Resources will review the Report of Work Ability for Work Injuries form and notify the employee of the return-to-work status and plan. The employee may return to the position held prior to the time of injury or illness, or be placed in a job for which they are qualified, consistent with laws, rules, regulations and collective bargaining agreements/plans.

In the event the employee is able to return-to-work without restrictions, the employee must obtain a completed Report of Work Ability for Work Injuries form from the treating health care provider documenting the employee's ability to return to-work with no restrictions. The employee must submit the statement to the Workers' Compensation Coordinator upon receipt from the treating health care provider and prior to returning to work.

Temporary Work Restrictions

If the healthcare provider recommends temporary work restrictions, the Workers' Compensation Coordinator, in consultation with the supervisor and/or Office of Human Resources/Office of Equity & Diversity, will determine whether the employee can return safely to his/her current position or if a suitable transitional work assignment is available. Any transitional duty assignment must comply with applicable laws, rules, regulations and collective bargaining agreements/plans.

The employee must obtain a completed Report of Work Ability for Work Injuries form from the treating health care provider stating the following:

  • Nature and expected duration of the temporary restrictions
  • Date of re-evaluation and return-to-work date (with or without restrictions)

The Workers' Compensation Coordinator, in consultation with the supervisor and/or Office of Human Resources/Office of Equity & Diversity, determine the availability and suitability of a transitional work assignment for the employee, based on the Report of Work Ability for Work Injuries form provided by the treating health care provider.

Permanent Work Restrictions

If the treating health care provider's Report of Work Ability for Work Injuries form indicates that the employee has a permanent work restriction, the Workers' Compensation Coordinator, in consultation with the Office of Human Resources and the Office of Equity & Diversity, will evaluate whether the restriction prevents the employee from performing essential functions of his/her job.

If the restriction(s) prevents the employee from performing essential functions of his/her job, the Workers' Compensation Coordinator, in consultation with the Office of Human Resources and the Office of Equity & Diversity, will initiate the Reasonable Accommodation Interactive Process.

  • The employee must obtain a completed Report of Work Ability for Work Injuries form from the treating health care provider stating the nature of the permanent work restrictions.
  • If the employee is unable to return to his/her former position, the Office of Human Resources and the Workers' Compensation Coordinator will determine the availability and suitability of an alternative position with MnDOT, in compliance with laws, rules, regulations and collective bargaining agreements/plans.

Agency Recordkeeping

The Workers' Compensation Coordinator maintains the official agency records documenting the internal return-to-work efforts, ensuring that:

  • Agency injury or illness correspondence, injury or illness data, and other pertinent information or data are saved and maintained in the current electronic document management system
  • All electronic documents are properly secured and access is limited to maintain confidentiality and privacy