SYSTEM POLICY

Category: Human Resources Policy #: PH-130-0031

Employee Health Services

Policy Title: Workers Compensation Policy Page: 1 of 6

Executive Owner: Chief Human Resources Officer

Original Policy Date: 04/18/2013

Current Policy Effective Date: 10/30/2014
Last Review Date: 10/28/2014
Next Required Review Date: 10/28/2015

Policy Applies To: All Presence Health System Personnel and Entities

I. POLICY STATEMENT

It is the policy of Presence Health to compensate employees who are injured in the course and
scope of their employment and to provide information about employee responsibilities for
preventing and addressing work-related injuries.

II. PURPOSE

The purpose of this policy provides information with regard to reporting and addressing a work-
related accident and/or illness under the provisions of the Illinois Workers Compensation Act.

III. MISSION / VALUES RATIONALE

Our value of People calls us to ensure Presence Health protects and promotes the health and
safety of its employees, and adheres to the provisions of the Illinois Workers Compensation Act.
It is expected that all employees who suffer a work related injury follow the established policy
consistent and aligned with the Mission, Vision, and Values of the Catholic Ministry Identity.

IV. DEFINITIONS
None

V. PROCEDURE / PROCESS

A. INITIAL NOTIFICATION OF INJURY BY EMPLOYEE

1. Reporting Work Related Injury/Illness. Employees must report all work-related

injuries or illnesses, no matter how minor, to their manager/designee as soon as
possible, no later than 24 hours after the occurrence. Such an injury/illness must
be documented on an Employee Incident Report form, completed and signed by
the employee and manager/designee, then submitted to Employee Health Services
(EHS).
PRESENCE HEALTH SYSTEM POLICY

Category: Human Resources - EHS Policy #: PH-130-0031

Policy Title: Workers Compensation Policy Page: 2 of 6

2. Examples of injuries/illnesses requiring an Employee Incident form include, but are

not limited to, the following:

a. Work-related Injury. A work-related injury on the premises during the

employees work shift;

b. Blood or Body Fluid Exposure. A blood or body fluid exposure (e.g. needle
stick, human bite, or body fluid splash) on the premises during the
employees work shift;

c. Infectious Illness/Disease Exposure. Infectious illness/disease from a

patient/resident, another employee, or visitor on the premises during the
employees shift;

d. Off-site Location Injury. If any of the above occurs to an employee while at a

location to which he/she was required to travel in the course of their duties
(e.g. during a Home Health Care visit or during a patient transport

B. ASSESSMENT

Managers will direct the employee for assessment as follows:

1. Work-related Injury/Illness during EHS Operating Hours. If an employee

experiences a work-related injury or illness Monday through Friday during EHS
operating hours, the manager/designee should contact EHS immediately for
instruction on evaluation and treatment. The employee must bring the completed
Employee Incident Report form with him/her to the EHS office, the Emergency
Department (ED), or clinic, consistent with EHS directions.

2. Work-related Injury/Illness after hours. If an employee experiences a work-related

injury or illness during times the EHS office is closed (e.g., nights, weekends or
holidays) the manager/designee can refer the employee to the facility Emergency
Department (ED), Occupational Health clinic, or preferred physician provider for
evaluation and treatment as appropriate. A completed Employee Incident Report
form is required and should accompany the employee to the treating site, except in
a life-threatening situation. The manager/designee should leave a message for
EHS that an employee required treatment and indicate where and when treatment
was rendered, along with work status, if known.

3. Severe Injury Sustained. If an employee sustains a severe injury, the

manager/designee should send him/her to the ED as soon as possible. Completion
of the Employee Incident Report form and informing EHS should occur immediately
thereafter, no later than the next business day.

4. Blood or Body Fluid Exposure. If an employee experiences a blood or body fluid

exposure, the employee should be sent to the ED for immediate medical care with
a completed Employee Incident Report form as required and inform EHS.
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Policy Title: Workers Compensation Policy Page: 3 of 6

5. Employee Incident Report. Failure to provide an Employee Incident Report form at

the time of ED registration may result in the employees health insurance carrier
being billed.

C. PREFERRED PROVIDER PROGRAM NOTIFICATION

All employees receive written notification of the following:

1. Presence Health has a Preferred Provider Program (PPP) for medical treatment for
workers compensation.

2. Employees may decline participation in the PPP, but the declination must be in
writing.

3. Declination of the PPP constitutes one (1) of the employees two (2) choices of
workers compensation medical providers.

4. How to obtain documentation of medical providers participating in the PPP.

5. For additional information and assistance, employees should contact EHS.

D. CASE MANAGEMENT

Employees Health Services will case manage all work-related injuries as follows:

1. Investigating the Incident. Once the injury/illness is reported to EHS, EHS will
conduct an investigation. The purpose of the investigation is to provide facts for the
determination of whether the injury/illness is compensable under the Illinois
Workers Compensation Act. It is also used to identify causes of an incident that
may be related to the work environment and to assist in further prevention of any
future occurrences.

2. The Workers Compensation Third Party Administrator (TPA) will determine if the
injury or illness is compensable.

3. Required Medical Reports/Work Status. Employees are informed they are required
to provide medical reports/work status updates to EHS immediately following each
provider visit, which will be forwarded to the TPA.

4. Employee Status. The employees Manager will be provided with work status notes
during the recovery period and prior to the employees return to work.

5. Initiating FMLA Request. If an employee is expected to be out more than three (3)
days, the employee should initiate a request for leave under the Family Medical
Leave Act (FMLA) through the medical leave Third Party Administrator whenever
applicable. Generally, an employees FMLA will run concurrently with any time
away due to the work-related injury.
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E. COMPENSATION

1. An employee who has a compensable work-related injury or illness and has been
taken off work will be compensated as follows:

a. Employee Health Service Notification Process. Employee Health will notify

the injured employees manager that the employee must be paid for his/her
full, regularly scheduled work shift on the day of injury or illness. For
example, if a day shift employee is injured and sent home from work at
noon by the ED physician, the employee is to be paid for the duration of
his/her regularly scheduled shift.

b. The first three (3) scheduled work days missed due to a work-related
incident are paid using paid time off (PTO) hours. If there are no available
PTO hours, the time will be unpaid. The first three scheduled days missed
are the waiting period prior to the commencement of Workers
Compensation benefits. It is important to note that the claim must be
accepted as a compensable work injury by the Workers Compensation TPA
in order for Workers Compensation benefits to be paid. On the 4th
scheduled day missed, the employee will begin receiving appropriate
benefit payments from the WC TPA.

c. If the employee is off work for more than 14 calendar days, there will be no
waiting period, and the employee will be paid Temporary Total Disability
(TTD) for all work days missed.

d. The amount of compensation is variable for each employee under the

provisions of the law and is based on historical wages. However, the weekly
TTD benefit rate is equivalent to 66-2/3% of the employees average weekly
earnings for the period worked 52 weeks prior to the date of injury, illness or
exposure. There is a maximum rate set by the Illinois Workers
Compensation Commission, which may be recalculated yearly, based upon
Illinois state average weekly wages.

e. Accruals of PTO and Extended Illness Bank (EIB) hours cease at such time
the employee is no longer receiving regularly paid hours.

f. Employees on leave due to a work-related injury are not eligible to receive

holiday pay. If the employee has been approved for Workers Compensation
benefits, the employee may be paid Workers Compensation benefits for
that holiday.

2. Return to Work Program (Modified). Presence Health retains the right to determine
when modified duty is appropriate. A modified return to work program may be
coordinated by EHS to assist employees who have sustained work-related injuries.
This program utilizes existing functions within a particular department(s) that allow
an employee who has temporary physical limitations and who is temporarily unable
to return to his/her position to work in another productive capacity.
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a. The modified work program is available for such employees only while
further rehabilitation/treatment takes place, or as further improvement in
physical status occurs.

i. Employees who refuse or dont follow the rehabilitation/treatment

plan may jeopardize their Workers Compensation benefits.

ii. For employees who are no longer advancing in their

rehabilitation/treatment and are unable to perform the essential
functions of their current position, alternate department or shift
options may be explored.

b. Any period of modified work does not count toward an eligible employees
12 week FMLA entitlement.

c. A reduction of hours may count toward an eligible employees12 week

FMLA entitlement.

d. The employees primary department is responsible for compensation while

the employee is on modified work, whether the assignment is within or
outside of the employees primary department.

e. Priority is given to identifying and providing modified duty assignments

within the employees primary department.

f. The maximum allowable time working in a modified duty capacity is

generally six (6) months. Exceptions will be addressed on a case by case
basis.

g. It is preferable for employees on modified duty to work an eight (8) hour day
shift, Monday through Friday. Exceptions will be addressed on a case by
case basis.

h. Employees who choose not to participate in a modified duty assignment are

not eligible for EIB, are required to contact the FMLA TPA and utilize their
PTO time. If PTO time is unavailable, the employee will not be paid. Time
away from work when modified duty is available, will count toward an
eligible employees FMLA entitlement.

i. Employees working in a modified duty capacity are to be left out of the low
census pool. EHS or HR can assist with alternate assignment or placement,
if needed.

3. Appointment Scheduling for Outpatient Services. Physician appointments, physical

therapy, occupational therapy or any other outpatient treatment that is required
should be scheduled outside the employees regularly scheduled hours. If the
employee chooses to attend an appointment during their regularly scheduled hours,
they should be instructed to use PTO time to cover any time missed from work.
Advance notice must be provided to the manager and department when scheduling
appointments during work hours and must be approved by the department prior to
attending the appointment.
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Category: Human Resources - EHS Policy #: PH-130-0031

Policy Title: Workers Compensation Policy Page: 6 of 6

VI. IMPLMENETATION FORMS AND OTHER DOCUMENTS

Employee Injury Report Form
WC PPP Advisory form

VII. REFERENCES
Illinois Workers Compensation Commission, Handbook on Workers Compensation and
Occupational Diseases
http://www.iwcc.il.gov/