Section 2 Legal Services
Policy 2-3 WORKERS' COMPENSATION PROGRAM
POLICY 2-3 WORKERS COMPENSATION PROGRAM
DISTRIBUTION: ALL DEPARTMENTS
DATE: May 2, 2005
SUBJECT: Workers Compensation Program
PURPOSE: To provide Workers Compensation and injury management
claiming job related injury or illness. Included are procedures for obtaining medical treatment,
injury reporting, contested and uncontested claims, returning employees to work, monitoring
employees in On-the-Job Injury leave status and processing of medical bills. The provisions
Title 85 Oklahoma Statutes and the Lawton City Code shall apply in addition to the provisions of
BACKGROUND: The City of Lawton desires to standardize the various aspects
Workers Compensation Program. In the past, departments may not have been consistent
application of procedures for obtaining medical treatment for injured employees, charging lost
work time due to an employee s injury or preparation for a court hearing, contesting a claim,
returning an employee to work on full or light (limited) duty. Further, employees needed a source
of information that would answer their questions concerning their benefits, rights and
responsibilities under the Oklahoma Workers Compensation Act and the City s program.
DEFINITIONS: Claim - A request for benefits under the Workers Compensation Act.
Compensable Injury - An injury for which benefits are payable under provisions
Oklahoma Workers Compensation Act.
Contested Claim - A claim the employer considers to be not compensable
under the Workers
Compensation Act. Generally, benefits, including On-the-Job Injury leave, will not be paid
contested claim unless the or until the Workers Compensation Court finds the claim to be
Court - The Oklahoma Workers Compensation Court.
Division Supervisor - Division Superintendent, Deputy Fire Chief, Police
Major, or similar
level supervisory personnel.
Form 2 - Entitled Employer s First Notice of Injury,
this is the document that employer
must file with the Workers Compensation Court and the third party administrator when an
employee is injured, contracts an occupational disease in the course of his employment for which
medical treatment is obtained away from the work site or dies as the result of a compensable
injury or illness.
Form 3 - The document an injured employee may file with the court to
compensation benefits due to an accidental injury. The Form 3 is also called the Employee
First Notice of Accidental Injury and Claim for Compensation.
Form 3A - The document that a dependent of a deceased worker may file
to request workers
compensation death benefits. The Form 3A is also called the Claimant s First
Notice of Death
and Claim for Compensation.
Form 3B - The document that an injured employee may file with the court
to request benefits
due to an occupational disease. The Form 3B is also called the Employee s First Notice
Occupational Disease and Claim for Compensation.
Functional Capacity Evaluation (FCE) - A medical evaluation conducted
by a qualified physician or occupational therapist designed to
quantitatively measure and record an employee s physical abilities to perform job activities
required in a specified position or job.
Immediate Supervisor - The Field Supervisor, Lieutenant, or other supervisor
directly overseeing the day-to-day job related activities of the employee.
Light (Limited) Duty - Jobs or tasks that can be safely performed by
an employee who is
restricted from performing all tasks associated with the employee s permanently assigned job
due to physical restrictions imposed by a qualified physician for a compensable injury. Also
referred to as limited or restricted duty. See Administrative Policy 3-19.
Maximum Medical Improvement (MMI) - No further material medical improvement
reasonably be expected with additional medical treatment or the passage of time.
Occupational Illness - A disease or illness which is due to causes and
of or peculiar to the particular trade, occupation, process or employment in which the employee
is exposed to such disease. As used herein the term injury or illness are interchangeable unless
On-the-Job Injury (OJI) - As used in this policy, means a compensable
Supervisor - Either the immediate or division supervisor who may be designated
department director to carry out the responsibilities of the Supervisor as indicated in
Workers Compensation Claims Administrator - A firm under
contract with the City of
Lawton to provide third party administration of the City s own-risk Workers Compensation
Program. The administrator is responsible for processing claims and issuing checks in payment
of workers compensation benefits.
PROCEDURES: A. Employee Rights - Notification
1. Employees must be notified of their rights and benefits prescribed by the
Compensation Act. If they have not received such notice, the time limits imposed by the
may be tolled. Thus, an employee lacking such notice may be able to file a claim and collect
benefits without regard to the statute of limitations. NOTICE will be done by posting in each
department, in conspicuous locations, Workers Compensation Form 1A Workers
Compensation Notice and Instructions to Employers and Employees. Form 1A must be posted
so that all employees will have access to it. Department directors and division supervisors must
ensure that the Form 1A is posted and accessible to all employees.
2. The reverse side of the City s Report of Injury form also
contains notification to injured
employees of their rights and responsibilities under the Workers Compensation Act.
Medical Treatment for Injured Employees.
1. The primary consideration whenever an employee is injured is to obtain the
medical treatment for the employee as soon as possible. The injured employee should be
provided a signed medical treatment authorization form by his/her supervisor and seek treatment
from a provider chosen by the employee. If emergency treatment is required for an injury which
is threatening to life or limb, the injured employee should be transported to the nearest medical
facility than can provide the required treatment unless the injured employee specifies an alternate
provider. If an injured employee does not choose a provider, the employee s supervisor must
refer the employee to an appropriate source for treatment of the employee s injuries.
2. If medical progress of the injured employee becomes unsatisfactory to management
personnel, the employee will be referred to a physician selected by the Legal Services
Department Administrator in consultation with the City s Workers Compensation
Administrator, as appropriate, for a second opinion. Should the employee refuse to report to this
additional physician for evaluation or treatment as directed, payment of workers compensation
benefits may be suspended.
C. Accident Investigation. After ensuring that
the injured employee receives medical care, the
supervisor will immediately begin investigating the situation that caused the injury. The result
this investigation will be documented in the appropriate sections of the City s Report of
form. Additional documentation may be generated as warranted. If, after investigating, the
supervisor doubts that the injury is compensable, he/she should so indicate on the form and
inform the Legal Services Department Administrator that the validity of the claim is in doubt.
The Legal Services Department Administrator will notify the third party administrator to further
investigate the claim and contest it if appropriate.
D. Injury Reporting Requirements.
1. The Legal Services Department Administrator will be notified as soon as possible
of any injury involving a City employee by the employee s immediate supervisor, assistant
department director or department director. If the injury occurs on other than a normal business
day the injury will be reported on the next business day. If the injury results in the death of
employee the City Manager will be notified immediately. The notice will include the injured
employee s name, the nature of the injury and the severity of the injury. The Authorization
Treat form signed by a supervisor should be sufficient authorization for an employee to receive
treatment. However, many providers will still call the Legal Services Department Administrator
to verify that an injury is covered by workers compensation.
2. Upon being notified of an injury potentially compensable under the Workers Compensation
Program the immediate supervisor will complete a Report of Injury form. The immediate
supervisor will complete the form based on investigation, statements by the injured employee
and witnesses and any other source of information. The form will be forwarded to the Legal
Services Department Administrator NO LATER THAN THE NEXT BUSINESS DAY
FOLLOWING THE INJURY. The second copy of the form including all documentation
required for review by the Injury Review Board will be submitted to the Human Resources
Department within five (5) working days.
E. Workers Compensation Claim Processing.
1. As soon as practical after a compensable injury or illness occurs (normally
at the time the
Report of Injury is initiated) the injured employee shall be informed by his/her supervisor
the rights, responsibilities and benefits as set out in paragraph A.1. or A.2. of this policy. This
information is printed on the reverse side of the Report of Injury form. The injured
will be provided a copy of the Report of Injury. The injured employee does not have
to file a
claim form in order to have relevant medical expenses paid and to receive temporary
compensation for lost work days incurred due to the injury. These will be provided voluntarily
unless it is determined by the City that the injury did not arise out of and in the course of
employment. See contested claims paragraph F.
2. A Workers Compensation Court Form 2, Émployer s First
Notice of Injury, will be filed
by the City Attorney s office with the Workers Compensation Court and the City
Compensation Administrator for each injury. The Form 2 is generated based upon the
information contained in the Report of Injury. Submission of the Form 2 is required
or not the claim is thought to be valid.
3. The Form 2 is the Workers Compensation Administrator s authorization
medical benefits to the injured employee unless the administrator is notified at the time of filing
of the Form 2 or at some later date that the claim is contested. The injured employee has the
right to file a claim using Workers Compensation Court Form 3 or Form 3B. The forms are
available in the City Attorney s office.
4. Under no circumstances are Group Health Plan claim forms to be used to claim
are payable under the City s Workers Compensation Program.
1. Injuries or illnesses must arise out of and be in the course of employment
in order to be
compensable. Injuries or illnesses that are not work-related are not covered. This means that
injury must occur at work and while the employee is performing activities that the employee was
hired to perform or which benefit the employer.
2. The City will conduct an inquiry to determine if the injury or illness is
compensable. If the
results of the inquiry indicate that a particular injury or illness is not compensable, the City
Manager, after consulting with the employee s department director and the City Attorney, will
determine if the claim should be contested. If contested:
a. The Legal Services Department Administrator will notify the employee that
the claim has
been contested. If the injury or illness is determined not to be a compensable job-related injury
or illness the claim will be referred to the City s health insurance program or if the employee
chosen not to be covered by the City s health insurance program the employee will be
responsible for all costs and he/she will not be eligible for On-the-Job Injury Leave or
Temporary Total Disability benefits.
b. The Legal Services Department Administrator will notify the Workers Compensation
Administrator that the claim is contested. However, as required by law, a Form 2 will be filed
with the Workers Compensation Court.
c. Once a claim is determined not to be work-related and is contested workers compensation
benefits will not be paid unless the Workers Compensation Court determines that the claim is
compensable. However, a claim previously contested may at any time be reconsidered and
accepted as a valid claim. Reconsideration will only be approved at the direction of the City
Attorney after approval by the City Manager. The Legal Services Department Administrator will
inform the claimant and the claimant s department director of any change in the status of the
If the claim is later determined by the City or the Court to be compensable, the employee is
entitled to be placed on on-the-job injury leave or temporary total disability and receive benefits
from either the City or by Court order. If the employee used sick leave, vacation leave or flexible
holiday hours, all payments received by the employee for these hours from the City will be
reimbursed to the City. After the employee reimburses the City for these hours they will be
restored to the employee s appropriate leave accounts.
a. Information for Medical Services Provider: An injured employee who feels
are compensable will provide a signed Authorization to Treat form to the provider.
b. Payment Process for Medical Treatment: All statements or invoices (bills)
processed for payment by the City s Workers Compensation Administrator. These may
through the Legal Services Department Administrator or sent directly to the workers
compensation claims administrator by the physician or the medical facility providing treatment.
However, if sent in error to the injured employee, the employee is to immediately forward them
to the Legal Services Department Administrator. (Note: Some physicians and medical facilities
send information or courtesy statements to the injured; these statements do not demand payment
and are to be retained by the employee.) If an employee becomes aware that medical bills that
should have been processed by the Workers Compensation Claims Administrator have been
processed by the Group Health Plan Claims Administrator, the employee must immediately
report the error to the Human Resources Department and the City Attorney s office.
c. Reimbursement of Employees for Expenses Paid: If the injured employee
pays for any
portion of expenses for treatment, prescription drugs, medical supplies, or equipment
necessitated by a compensable injury, he/she will be reimbursed by the City s Workers
Compensation Claims Administrator. Any receipts for such payment must be turned in to the
Legal Services Department Administrator in order for the employee to be reimbursed. Employees
should mark all such receipts indicating job injury and the date of the injury.
d. Unauthorized Second Opinions: Treatment provided from sources
to which the injured
employee was not properly referred by the initial treating physician are not covered expenses.
Second opinions are not covered unless they are directed or authorized by the City. Injured
employees not satisfied with the treatment they are being provided should seek authorization for
a change in physicians from the Legal Services Department Administrator.
Total Disability (TTD) Benefits:
a. In general, all regular employees will be provided their full salary through
the City s payroll
system during the first twenty six (26) weeks an employee is required to miss work because of a
compensable injury or illness. This benefit will be paid from the first day of lost time for up
twenty six (26) weeks unless the employee is authorized to return to work earlier.
b. After twenty six (26) weeks, payment of salary through the City s payroll
system will cease.
Any additional time off will be considered as Temporary Total Disability benefits and will be
paid through the Workers Compensation Administrator at the rate mandated by law. The
s payroll system will carry the employee in Leave Without Pay status.
c. Employees will not be allowed to use their accrued leave (vacation,
sick, flex or comp time)
to augment TTD benefit payments or in lieu of TTD while on leave without pay as a result of an
d. If an employee should return to work in a light duty status any subsequent
doctor or physical
therapy appointments will be considered as on-the-job injury leave, however the total number of
on-the-job injury leave hours shall not exceed four (4) hours in any one work day unless the
appointment is not in Lawton, in which case the injury leave shall not exceed travel time to and
from the appointment location plus four (4) hours.
e. An employee who terminates employment with the City while temporarily totally
will continue to received TTD benefits for as long as and at the rate required by law.
3. Determination of Employee Fitness for Duty after Injury: An employee
who is released to
return to full duty by his/her treating physician will be returned to full duty as soon as possible.
When an employee has reached maximum medical improvement but is released by the treating
physician with limitations the Legal Services Department Administrator will refer the employee
to the Human Resources Director who will arrange for the employee to be evaluated by another
physician or arrange for a Functional Capacity Evaluation (FCE) to determine if the employee is
able to return to his/her position. Should the employee be determined to be physically unfit to
continue in his/her assigned position due to permanent physical restriction they will meet with
their department director and the Human Resources Director to discuss the possibility of
allowing the employee to continue to work in the position. If this is unfeasible, the Human
Resources Director will work with the employee in trying to find a vacant City position
consistent with the employee s permanent restrictions and for which the employee may be
qualified. After a physician has determined that the employee has achieved maximum medical
improvement from treatment for a compensable injury the employee is no longer eligible for any
additional TTD benefits including On-the-Job Injury leave.
4. Permanent Partial Disability (PPD) Benefits: PPD benefits are paid only
upon order by the
Workers Compensation Court based upon the percent of permanent partial disability sustained
by the employee as a result of a compensable injury.
H. Preparation for Workers Compensation Court. Charging
lost work time due to preparation
for Workers Compensation Court hearing:
If the employee has returned to work in either a full duty or light duty status any:
1. Time lost while the employee is undergoing an Independent Medical Examination
by a physician selected by the employee or the employee s attorney is to be charged against the
employee s accrued leave balance (vacation, flex or comp time) or leave without pay.
2. Time lost while the employee is undergoing an Independent Medical Examination
by a physician selected by the City s Workers Compensation Administrator or attorney is
considered normal work duty for the employee and is not to be charged to any type of leave.
3. Time lost due to the court hearing itself is to be charged to the employee
s accrued leave or
leave without pay.
1. Information Systems (IS) will provide the Legal Services Department Administrator
Human Resources Director a report listing employees who are losing time from work due to an
on-the-job injury and are on On-the-Job Injury Leave or leave without pay status.
2. When an employee is listed on the report as missing more than eight (8) hours
because of an on-the-job injury, the Legal Services Department Administrator will send a letter
to the injured employee explaining the employee s rights, responsibilities and reporting
requirements. Copies of the letter will be forwarded to the director of the department to which
the employee is assigned.
3. The injured employee will be required to contact his/her immediate or division
less than once each week during the period of temporary total disability to report his/her status.
4. The injured employee, if physically able, will report to his/her immediate
division supervisor immediately after each doctor s appointment. The injured employee will
provide a doctor s written excuse keeping him/her off work or a written authorization allowing
the employee to return to work with or without restrictions. The injured employee will also
report to the supervisor the date and time of the next scheduled medical appointment, if any. If
the injured employee is not physically able to report in person to the supervisor, the employee
will provide the above information by telephone, mail or messenger. Failure to comply with
these requirements will result in disciplinary action be taken which may include termination from
employment for a third or subsequent violation. ON RECEIPT OF THE INFORMATION
THE DEPARTMENT WILL IMMEDIATELY FORWARD THE INFORMATION TO
THE LEGAL SERVICES DEPARTMENT ADMINISTRATOR.
5. The supervisor will monitor to ensure that the injured employee does not miss
appointments. Benefits may be discontinued for missed appointments with the medical care
provider. In addition disciplinary action will be taken which may include termination for a third
or subsequent violation.
6. The supervisor, in coordination with the Legal Services Department Administrator,
maintain communication with the medical care provider to encourage release of the injured
employee to full or restricted duty as soon as it is prudent to do so.
J. Workers Compensation Claims Administrator s Responsibilities. The
1. Set up a file for each Form 2 submitted by the City. This file must
be established before any
expenses related to a claim can be paid. All documentation from the injured employee, the
employer, medical care providers, attorney s representing the employee or the City and any
other relevant information will be maintained in the file.
2. Arrange for services, such as medical case management, second opinions, claims
investigation, vocational evaluations and vocational rehabilitation, directed or authorized by the
City Attorney s office or as ordered by the Workers Compensation Court.
3. Provide expert advice to the City concerning validity of claims, appropriateness
treatment and costs, appropriate settlement methods and amounts and other workers
4. Coordinate with and assist the City s workers compensation
attorney in defending litigated
5. Respond to inquiries from employees concerning claims, benefits or workers
rules or procedures.
6. Negotiate and arrange permanent disability settlements with employees not
attorneys to the limits provided in the agreement between the administrator and the City. All
other will be referred as directed by the City Attorney.
7. Pay all workers compensation expenses from a checking account
maintained by the City
and provide weekly listings of all checks written against the account.
8. Provide monthly listing of all claims filed in the various claim years and
workers compensation costs by expense category, i.e. medical, indemnity, legal and other.
L. Inquiries. Any questions concerning the
status of a particular claim or any aspect of the
claims procedure should be directed to the Legal Services Department Administrator or the
Workers Compensation Administrator.
REFERENCES: Title 85, Oklahoma Statutes and the Lawton City Code
RESCISSION: This policy becomes effective May 2, 2005 and supersedes Administrative
Policy 3-16, dated October 1, 1998. This policy will remain in effect until rescinded.
DEPARTMENT: Legal Services
May 2, 2005
(2-3, Added, 05/02/2005)