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PROGRAM SUMMARY
WHAT IS IT?
The State Employee Injury Compensation Trust Fund - SEICTF - was created by the
Alabama Legislature to be effective October 1, 1994. Its purpose is to provide
indemnity and medical benefits for injuries incurred on the job. Indemnity
benefits consist of lost wages caused by job injury, payment for permanent
partial and permanent total disability, and payments to dependents and for
burial expenses in the event of fatal injury.
The legislature observed that job injury compensation practices for state
workers needed much improvement. Some employees worked for departments that
self-insured benefits for injuries, with benefits much like those in the private
sector. Most others received benefits unevenly and with great uncertainty
through facilities such as the Special Leave Reimbursement Program for lost
time, and Board of Adjustment for permanent injury and shortfalls on deductibles
and co-pays. Medical costs were paid by the State Employees Insurance Board
(SEIB) for those employees covered by SEIB.
The net result of all this was that employees could not be certain of the level
of injury compensation they would receive for job injury costs, or when it might
be paid. The process of recovery of funds was complex and troublesome to
employees and expensive for the State to administer.
The SEICTF is a funded program that provides to eligible employees benefits that
are known and are secure. It replaces the complex procedures outlined above.
HOW DOES SEICTF WORK?
MEDICAL. Covered employees who are injured on the job secure medical care
from a health care provider (physician, hospital or clinic). SEICTF is
responsible for payment to the medical care provider. The employees will not
have to pay co-payments and deductibles.
LOST TIME. Here is an outline of the benefits applicable to on-the-job
injuries that result in lost work time.
1. Waiting Period. There is a three work day
period for which no lost time benefit is paid. Should the lost time reach
twenty one calendar days, the initial three day period is then paid. The
employee may elect to use sick or annual leave to cover the waiting period
or take leave without pay.
2. SEICTF 2/3 Amount Paid. When away from the job due to work injury,
employee compensation is two-thirds weekly wage subject to the maximum
compensation rate in effect at the time of the injury. The employee is paid
via SEICTF warrant.
There are no deductions for State or Federal income taxes, Social Security
or Medicare.
3. Duration of Payments. Payments for temporary disability continue as long
as the employee cannot work as a result of the covered injury and is
supported by medical and vocational opinions.
4. Option to Use Sick/Annual Leave. In lieu of the lost time benefit
outlined above, injured employees have the option to utilize personal
accumulated annual and sick leave. If this option is elected, SEICTF 2/3
lost wage benefits will start when personal leave is exhausted, or whenever
the employee chooses to accept benefits as opposed to using leave.
Before benefits can be paid, the injured
employee and the supervisor must complete the "Employee Election For Lost Time
Benefits" (SEICTF Form 2) form following a work-related injury requiring
lost-time from work (See the appendix).
SUMMARY OF KEY FEATURES
1. Medical Costs
- Co-pays and deductibles are covered.
- All reasonable and necessary medical
expenses are covered.
2. Lost Time
- Payment is tax-free - 2/3 current wage
subject to weekly maximum rate.
- Special Leave Reimbursement Program not
applicable.
- Injured employee remains on payroll as long
as permissible.
- Employee compensation is paid via SEICTF
warrant when electing 2/3 option.
- Employee
compensation is paid via state payroll check when electing Leave option.
3. Disability
- The degree of disability or vocational loss
is based on loss of access to jobs and loss of income as a result of a
covered injury.
- The amount of compensation awarded is based
on the degree of disability or vocational loss.
4. Death
- A maximum $5,000 for burial expenses is
provided.
- Benefit compensation payments made to
eligible dependents up to 500 weeks. Compensation consists of 2/3 of the
weekly salary tax free and subject to established minimum and maximum weekly
salary amounts.
THE ROLE OF THE PROGRAM
COORDINATOR
To a great extent, the success of the State Employee Injury Compensation Trust
Fund (SEICTF) will be determined by the involvement of the Program Coordinator
at the department or division level.
The Division of Risk Management (DORM) will rely heavily on these individuals to
act as liaison for this program. Their involvement and dedication for the
benefit of their departmental employees will be evident in the future.
What we at DORM see as the major roles of the Program Coordinator are to:
- Attend training conferences to master
program content and gain an understanding of the day-to-day operation of the
overall program.
- Assure SEICTF program and practices are
understood.
- Act as a conduit for communications between
DORM and departmental staff.
- Provide advice and guidance to DORM on
departmental-specific issues. Also the coordinator should work closely with
DORM on early return to work and injury prevention programs as this is
essential to a cost-effective program.
We at DORM will rely heavily on your input and
assistance. If you have changes in Program Coordinators, please notify SEICTF
immediately in writing at SEICTF, P.O. Box 303250, Montgomery, AL 36130-3250. In
addition, should you have any questions regarding your role as coordinator,
please contact us at 334-223-6162.
MAKING A CLAIM
How To Initiate SEICTF Benefits
- Injured employee notifies supervisor.
- Determine whether an employee needs medical
attention. Refer to your pocket guide card for the toll free telephone
number.
To avoid co-pays and deductibles, complete the Authorization for Initial
Treatment Form (SEICTF Form 3A) for the employee to take to the SEICTF Provider
Network physician. This form will allow the employee to receive treatment
without having to pay co-pays or deductibles. Use common sense. If employee is
severely injured, do not delay getting medical attention in order to complete
this form.
- Complete all items on the First Report
of Injury (SEICTF Form 1).
- Within 24 hours of notification of injury,
fax the completed Form 1 to Risk Management at (334)223-6170. If a fax
machine is not available, call in the information to (800) 388-3406.
- Retain the original Form 1 for your files.
File other copies with your Agency as required.
- Within 24 hours after the injury, the
employee must select a payment option under Item A and also under Item B on
the Employee Election for Lost Time Benefits (SEICTF Form 2).
Delay in option selection will delay compensation payment to the employee.
Item A concerns time lost from work up to three days and Item B time lost in
excess of three days. If the employee misses more than three days of work,
then:
- Immediately fax the completed Form 2
to (334) 223-6170.
- Mail the original form to SEICTF,
P.O. Box 303250, Montgomery, AL 36130-3250.
- Retain a copy for your files.
2/3 Option Bi-Weekly Payroll Period
Requirements
- Beginning with the payroll period in which
the employee was injured, as soon as possible after the payroll period ends,
but no later than 12:00 noon on the SEICTF cut-off date shown on the GHRS
Production-Merit Agencies Schedule, report via a fax to the Risk Management
Division, (334)223-6170, a statement giving the following information: the
name of the injured employee, their social security number, date of injury,
the number of hours the injured employee was scheduled to work during the
current payroll period, and the number of hours worked that payroll period
(if zero state zero). Include any leave taken in with the number of hours
worked. Also show return to work date when the employee returns to work.
EXAMPLE
| NAME |
SSN |
DATE Of
INJURY |
HRS SCHEDULED
TO WORK |
HRS WORKED |
RETURN TO
WORK DATE |
| John Doe |
000-00-0000 |
MM/DD/YY |
80 |
0 |
MM/DD/YY |
Note: As long as the employee is out of work
due to his or her injury, it is imperative that you provide and fax
this payroll information to Risk Management for each semimonthly
payroll cut off period. Your failure to do so will result in a delayed
compensation payment to the injured worker. Please notify SEICTF
immediately if the employee retires or is terminated from State service.
When the Employee is paid on SEICTF warrant, no deductions will be made.
Employee is responsible for dependent health coverage with state employees
insurance board and other payroll deductions. Employee should read SEICTF
pamphlet "SEICTF Guide to Benefits and Claims Filing" for important
information regarding benefits.
PREFERRED PROVIDER NETWORK
As part of our continuing effort to provide quality health care to employees by
the State Employee Injury Compensation Trust Fund, the Division of Risk
Management implemented a Preferred Provider Network effective March 1, 1996.
The Preferred Provider Network is an approved list of physicians that employees
must use in order to obtain medical care for an on-the-job injury.
The Network Primary Care Physician is essential in coordinating health care
needs and recommending an appropriate specialist if specialty care is needed.
The Network Physician will file claims for the employee and will not charge a
co-payment for services rendered.
If an employee has a work-related injury, he or she must take the following
steps:
1. Notify their supervisor as soon as possible.
2. The supervisor will direct the employee to a
Network Primary Care Physician who will provide any necessary medical care.
If the supervisor is unavailable, call Provider Relations at 1-800-977-0022 or
(334) 223-6177.
3. In case of an emergency, the employee should seek immediate care at the
nearest medical facility and notify their supervisor as soon as possible.
Follow-up care after an emergency must be coordinated through the Network
Primary Care Physician.
It is very important that each participating state agency take the necessary
steps to ensure that all covered employees know the procedures to follow in the
event of an on-the-job injury. If an employee has questions, he or she should
contact their supervisor or the State Employee Injury Compensation Trust Fund
Coordinator for their department.
SEICTF EMPLOYEE ELECTION OPTIONS
Here are some thoughts for you when choosing the compensation options as listed
on the SEICTF Election For Lost Time Benefits (SEICTF Form 2) Section B.
- If you choose to use your leave:
- You receive your usual net pay via
State payroll check. Payroll amount and
deductions remain the same.
- Two-thirds of your current wage would
not be taxed subject to the maximum compensation rate amount in effect
at the time of your accident.
- You continue to accrue Leave in
accordance with State Personnel Rules.
- You stay on the state payroll until
your paid leave is exhausted.
- You continue to accrue retirement
credit in accordance with governing laws.
- If you choose to use the SEICTF two-thirds
pay option:
- You receive two-thirds of your current
wage via SEICTF warrant, subject to the maximum compensation rate in
effect at the time of your accident. Payment of
SEIB dependent health care coverage and other preauthorized payroll
deductions are the responsibility of the employee.
- The two-thirds amount is not taxed.
- You accrue leave in accordance with
State Personnel Rules.
- You stay on the state payroll as long
as permissible.
- Ineligible to accrue retirement credit.
DISPUTE RESOLUTION
Disputes. There may occasionally arise a disagreement between the injured
worker and SEICTF relating to compensability of an injury, the nature of
treatment for the injury, or the amount of benefits payable for the injury under
the SEICTF Program. Should this occur, mediation, a Review Board, or an
Administrative Law Judge (ALJ) is available to consider the merits of the
issue(s) raised and provide a ruling to resolve the dispute(s).
Purpose. The SEICTF Program provides for an impartial Review Board or ALJ
to assure fair and equitable administration of benefits to injured employees. It
will resolve disputes with respect to entitlement to compensation and medical
benefits, including the amount of compensation, and will approve lump sum
settlements which have been agreed to by employees and SEICTF. The Review Board
Panel consists of three members for any case. Each member has knowledge of the
SEICTF Program.
Lump Sum Settlements. These type settlements must be by agreement of the
parties and arise normally with injuries that lead to permanent partial
disability. An example of such an injury is an injury to the hand that causes
the loss of use of a finger. The settlement amount is automatically reviewed by
the Review Board, which must approve the settlement before it becomes final.
Initiating Review Board or ALJ Consideration. No action is required for
lump sum agreements. For disputes as to compensability or amount of
compensation, the employee may contact the State Employee Injury Compensation
Trust Fund (334) 223-6162. You will be referred to a Claims Examiner who will
provide guidance on how to present the issue and will provide the employee with
an appropriate form to present facts to the Review Board or ALJ.
The Review Board panel meets as required and there will be no undue delay in
Board response.
For questions regarding the program including benefits or a specific claim,
call 1-800-388-3406 or 334-223-6162.
FREQUENTLY ASKED QUESTIONS
& ANSWERS
This set of questions and answers are intended to be the forerunner of a much
more complete set of Q and A as the SEICTF Program matures. Readers should
direct specific questions to those listed as "KEY STAFF." Meaningful issues will
be accumulated and detailed answers provided from time to time.
Who is responsible for notifying DORM of an employee
injury and how should that be done?
The injured employee should promptly notify his supervisor. The supervisor
should immediately complete the Employer's First Report (SEICTF Form 1) and fax
it to the number on the form. As an emergency exception, call 1-800-388-3406,
and fax or mail the completed form.
How do we initiate lost
time payments if the employee is unable to return to work?
If lost time of greater than three work days is expected at the time the First
Report is faxed, so indicate on the report. If the lost time beyond three days
becomes evident later, complete Employee Election For Lost Time Benefits Form
and fax to SEICTF at (334) 223-6170.
If an employee feels
has concerns or questions regarding SEICTF benefits, what should be done?
The employee should call SEICTF at 1-800-388-3406 or 334-223-6162.
If the supervisor is concerned that the injury was not
in the line and scope of employment, what should be done?
Be sure to fully complete the First Report. Indicate factual data that leads to
the concern.
If the supervisor is concerned that the employee has
not returned to work, what should be done?
The supervisor should validate the facts and contact SEICTF at 1-800-338-3406.
If the employee insists on medical care from
non-approved health care providers, what should be done?
Inform the injured employee to contact SEICTF immediately. Obtaining medical
treatment from non-approved health care providers may result in ineligibility or
termination of SEICTF benefits.
Is
there a Return to work Program included in the benefits of SEICTF?
SEICTF
assists agencies in developing and implementing an Early Return to Work Program.
For more information, please call (334) 223-6162.
How do I get additional
supplies of forms, such as SEICTF Guide to Benefits and Claims Filing, Posting
Notice, First Report of Injury, and Authorization for Initial Treatment to
Provide Medical Service?
Forms are available on our website (http://www.riskmgt.alabama.gov/Downloads.aspx#Forms).
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