HomeMy WebLinkAbout0614 Worker's Compensation Pool Policy91
614 Workers’ Compensation Pool Policy
The purpose of this policy is to preserve an employee’s economic viability, which
would otherwise be endangered because of the employee’s job related
catastrophic injury or disease.
.01 Contributions to the Pool
(1) Contributions to the Pool will come from excess sick leave that would
otherwise be lost to maximum carry-over limits and termination of
employment. The Workers’ Compensation Leave Pool (W CP) will be
secondary to the Sick Leave Pool (Policy 613). Excess leave will
automatically accrue to the Sick Leave Pool (SLP) until the SLP has 6,000
hours in it. Excess sick leave hours, which are then available, will accrue to
the WCP. No more than 6,000 hours of total accrual will be allowed to the
WCP.
(2) Should an employee not use all of the time allocated for his/her use, the
unused time will revert back to the pool at the end of the calendar year in
which he/she returns to work. Throughout the remainder of the calendar
year, the employee can only use the remaining Pool time for absences due
to the catastrophic occupational injury or disease for which the pool time
was originally allocated. A licensed practitioner approved by the City and
the Texas Workers’ Compensation Commission (TWCC) must provide a
statement indicating the date(s) and duration of these absences and the
condition for which the absence is necessary.
.02 Applying for Pool time.
(1) Regular, full-time non-probationary employees who meet the following
criteria are eligible to apply for the contributed time for their own
catastrophic work related injury or occupational disease.
The employee must provide a statement from a licensed physician
approved by the City and the Texas Workers’ Compensation Commission
that the injury or disease will require the employee to remain off work for at
least two consecutive calendar weeks, following the exhaustion of workers’
compensation supplemental pay eligibility (reference Policy 903.04).
(2) A written request for Workers’ Compensation Pool Time must be submitted,
along with a signed Statement of Physician or Practitioner form to the Risk
Management Division.
(a) The physician’s statement must be signed by a licensed practitioner
approved by the City and the Texas Workers’ Compensation
Commission who furnishes health care services under a license,
certification, registration, or other similar evidence of regulation,
issued by this state or other state of the United States.
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(b) The physician’s statement must include the date that the on the job
injury/illness related medical condition began and the probable
duration of disability; an estimate of time that the employee will be
unable to perform work of any kind; or, whether it is necessary for
the employee to work a reduced schedule. If the physician confirms
the employee’s need for a reduced work schedule, the statement
must include the duration of the reduced schedule and any work
restrictions.
(5) A renewal application form and physician’s statement form must be filled
out and signed by a physician every 30 calendar days that the employee is
eligible for and requires the use of Workers’ Compensation Leave Pool time.
(6) If the employee is incapacitated so that he/she cannot provide the
application and/or physician’s statement, an employee spokesperson
(family member or physician) may provide this to the City.
(7) Where an employee’s absence due to a catastrophic on the job
injury/occupational disease also qualifies for Family and Medical Leave and
the employee has exhausted City workers’ compensation supplemental
pay, the employee can apply to use paid time from the Workers’
Compensation Pool. Use of paid Workers’ Compensation Pool time for the
employee’s catastrophic FLMA qualifying event will count against the FMLA
entitlement per year. All provisions of the FMLA policy will apply. If there are
any conflicts between the Workers’ Compensation Pool policy and the
FMLA policy, the FMLA policy shall take precedence.
.03 Catastrophic injury is one that:
(1) Is a compensable injury or occupational disease that arose out of and in the
course and scope of employment with the City of Grapevine and;
(2) Affects the mental or physical health of an employee to the extent that
he/she is unable to fully perform his/her job and;
(3) Occurred while on duty and is qualified by state workers’ compensation
regulations and;
(4) Is not caused by willful misconduct, is not purposely self-inflicted, does not
occur while on leave without pay or absence without leave, or is not
acquired as a result of another job and;
(5) Poses a threat to life and;
(6) Requires in-patient or hospice care or extensive outpatient treatment or
care and;
(7) Requires the services of a licensed physician for an extended period of time,
and;
(8) Causes the employee to need additional time off from work after exhaustion
of the 90-day workers’ compensation supplemental pay period.
(9) Examples of injuries generally considered severe enough to be considered
catastrophic include, but are not limited to:
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(a) Severe incapacitating injury resulting in paralysis;
(b) Permanent partial or complete loss of a limb, sight, hearing, ability to
speak, which hampers the ability of the affected employee to perform
his essential job functions.
(c) Permanent loss of the ability to stand or sit for extended periods of
time such that the affected employee cannot perform his/her
essential job functions;
(d) Life threatening stabbing or gunshot wounds;
(e) HIV infection contracted while on duty;
(f) Cancer contracted due to recognized occupational carcinogenic
exposure;
(g) Other catastrophic injury as may be determined by the City Manager
or his designee.
(10) Examples of injuries not categorized as catastrophic include but are not
limited to:
(a) Broken limbs;
(b) Allergic reactions;
(a) Muscle strains or sprains;
(b) Bruises.
(11) An employee is not eligible for use of Workers’ Compensation Pool time if
the employee has reached the earlier of the point in time when their work-
related injury or illness has improved as much as it is going to improve as
certified by a physician who is approved to assess maximum medical
improvement (MMI) by the Texas Workers’ Compensation Commission or
104 weeks from the date the employee became eligible to receive workers’
compensation income benefits.
(12) When an employee has reached maximum medical improvement (MMI) for
a particular injury as determined by the State Workers’ Compensation
Commission the employee is not eligible for Workers’ Compensation Pool
use for that injury.
.04 Approval Process
(1) The City Manager or designee will review all applications and certifications
for use of Workers’ Compensation Leave Pool time and his decision as to
eligibility shall be final.
(2) Application for pool leave is on a first-come first-served basis and is
contingent upon the available balance in the pool at the time of application
as well as the employee’s ability to meet the criteria listed in Section .03.
(3) No more than 30 calendar days will be granted at one time. The employee
must reapply and resubmit appropriate forms every 30 calendar days after
the initial two-week period.
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(4) The maximum that can be awarded per qualifying event is 640 calendar
days.
(5) The lifetime maximum that can be received by any employee is 1280
calendar days.
(6) After five working days from submission of the application and required
documentation to the Risk Management Division, a decision granting or
denying Workers’ Compensation Leave will be made.
.05 Use of Workers’ Compensation Leave Pool Days
(1) Awarded Workers’ Compensation Pool pay will make up the difference
between Workers’ Compensation temporary income benefits and net base
pay. The total amount paid to an injured employee while losing time from
work will not exceed the full net pre-tax base pay he or she would have
received for such period at his or her regular rate of base pay. In the event
the Workers’ Compensation Pool pay results in an overpayment, an
employee shall repay the overpayment amount. Unless the employee
initiates repayment, a repayment schedule will be set up by Risk
Management in order to deduct the overpayment amount from the
employee’s future checks.
(2) Regardless whether an employee works a 24-hour shift, 8-hour shift or 4-
hour shift, any portion of a day used will count as one calendar day used for
Workers’ Compensation Leave Pool time.
(3) In accordance with vacation and sick leave policies, while out on Workers’
Compensation Pool time, employees will continue to accrue sick and
vacation time.
(4) The amount of time an employee may remain on the health plan (flex-
med/care, medical, dental, vision, life, disability and voluntary supplemental
plans) while not actively at work is determined by the guidelines set by the
insurance carriers the City contracts with. Employees should review their
summary plan descriptions or contact Risk Management for more
information regarding timeframes and/or coverage continuation eligibility
under COBRA. In the event an employee is on the health plan paying active
employee rates and reaches Maximum Medical Improvement (MMI) and
does not return to work upon reaching MMI, COBRA will be offered at that
time. Employee and City contributions to retirement will continue while the
employee is on Workers’ Compensation Pool time.
(5) If an employee returns to work after using Workers’ Compensation Pool
time and their anniversary date fell during the period of leave, the annual
merit/step increase will not be awarded until 30 calendar days after the
employee returned to work. If an employee is absent on Workers’
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Compensation Leave Pool time for two consecutive anniversary dates,
merit/step increases for both years will be awarded after the employee has
returned to work for 30 calendar days. The merit/step increase will be
awarded at this time even if the employee’s return to work after the
anniversary date is on an intermittent or reduced schedule, so long as the
employee receives a passing score on his/her performance evaluation. This
delay will not alter the employee’s anniversary date in subsequent years.
Periods of absence which are covered by FMLA will not delay anniversary
merit/step increases.
(6) While out on Workers’ Compensation Pool time, any across the board
salary increases, COLA’s, market adjustments, etc., which are independent
of performance, will be awarded to the employee.
(7) If an employee is off work using Workers’ Compensation Pool time and is
found to be receiving pay for working another job, including self-
employment, which violates the employee’s treatment plan as prescribed
by the treating physician or is found to be participating in any outside
employment/activity that impedes the employee’s progress or recovery or
any work for pay including self-employment that is not approved by the Risk
Manager will be subject to the loss of the paid leave time, the employee will
lose all remaining Workers’ Compensation Leave Pool time, and will be
subject to appropriate disciplinary action (in accordance with the Fair Labor
Standards Act), up to and including termination.
(8) Holidays that fall during the time an employee is being paid from the
Workers’ Compensation Leave Pool will be charged to Holiday Pay. Holiday
pay shall take precedence over all other paid leave accruals.
(9) Employees seeking to return to work after more than 3 consecutive
days’/shifts’ absence must provide a doctor’s statement indicating that the
employee is able to return to work. The statement will specify any required
work restrictions.
(10) Employees returning to work after more than 10 consecutive work
days’/shifts’ absence due to an on the job injury must have a physical if
required by the nature of the employee’s job; and, must have a drug screen
regardless of the job held by the employee. Return to work will be delayed
and the employee will continue to draw from the Workers’ Compensation
Leave Pool if eligible until the doctor’s certification is provided; and, the
results of the drug screen and physical, if applicable, have been received
by the Human Resources Department.
(11) If the approved physician releases the employee to return to work before
the end of the approved Workers’ Compensation Leave Pool period
(whether for initial two-week period or the 30 calendar day period) the
employee must notify his supervisor and the Risk Management Division and
make arrangements to return to work as soon as possible.
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(12) When possible, the employee will be returned to their former position if it
has not been filled. Otherwise, they may apply for other vacancies and be
considered for those positions along with other applicants.
.06 Property Rights
No property rights or entitlements exist to Workers’ Compensation Pool leave
contributions provided by this policy. The City reserves the right to change modify,
amend, revoke or rescind all or part of this policy at the discretion of the City
Manager.
Revised 02/24/2014