Personnel

SICK LEAVE INJURY

PURPOSE: To require employees to report any employment related injury/illness to be eligible to receive salary and/or compensation rights. The employee must be seen by the Medical Director, or his/her designate, within the tour that the injury/illness occurred.

DEFINITION:

Sick Leave Injury (SLI) is defined as the granting of time and the provision for monetary compensation, to any employee, due to a medically verified disability resulting in injury/illness sustained as a direct result of employment. SLI is limited to a time period not to exceed one year from the date of the injury/illness:

GENERAL:

A. To ensure that the NJ Veterans' Memorial Home Facilities incur monetary expenses for the injury/illness, the employee must follow the instructions of the Medical Director.

B. An employee must have been in compliance with all rules and regu lations of the facility to be eligible for SLI benefits.

C. Authorization for outside/private medical services must be granted, in advance, by the Medical Director, of the facilities.

D. When an employee refuses the opportunity for medical services from the facility, he/she must sign a certificate indicating that the facility is released from all medical/financial responsibility not authorized, in writing, by the Medical Director.

E. While under SLI status, the employee may not engage in any form of employment outside the facility. To do so may aggravate the injury/illness and subsequently allow the State of New Jersey to refuse all responsibility and terminate SLI.

F. If an employee fails to comply with the procedures and its' provisions, he/she must submit, in writing, reasons for the non-compliance. Further, the employee may be subject to disciplinary action, by his/her department head, if it deemed warranted.

PROCEDURE:

A. Employee Responsibilities:

1. Report the injury/illness, immediately, to the supervisor on duty.
NOTE: Once the injury/illness is reported, the employee must fill out the Accident-Injury Report Form.

2. Fill out the Accident-Injury Report Form for (Employee's First Report of Accidental Injury or Occupation Disease) for all sections coded 1. After completing the form, give it to the supervisor who will review it for completeness.

3. The supervisor will complete their section of the form and return it to the employee, with a Medical Referral Form.

4. The employee will proceed to the Medical Office within the earliest possible time frame. If the injury/illness occurs within the normal working hours of the staff physician, the staff member will be examined within the facility. If the injury/illness occurs during the evening/night/weekend and/or holiday time frame, then the nursing supervisor in-charge shall contact the on-call physician to report and consult as to the disposition of the staff member. Emergencies shall be referred to the local hospital for medical evaluation and treatment. If the employee has been referred to a local hospital, he/she must report back to the Medical Director's Office on the next regular day of business, if medically able, to be reviewed by the Medical Director or his/her designate. Non-emergencies shall be required to report back to the staff physician on the first day of business during "normal working hours." The physician shall examine the employee and complete the medical portion of the Accident-Injury Report Form.

5. When the employee has been examined/reviewed by a staff physician, he/she shall be referred to the Personnel Office, with the completed Accident-Injury Report Form and a Certificate of Examination Form. The Personnel Office shall complete their portion of the Accident-Injury Report Form and inform the employee as to their temporary approval of SLI benefits. The employee will then proceed in accordance with the directive of the Personnel Office.

6. Once the employee is granted SLI, through the physician and by the Personnel Office, the employee may go home under SLI status. However, they must understand that final approval for SLI status and associated benefits, must come from N.J. Department of Personnel. Only N.J. Department of Personnel CAN GIVE FINAL APPROVAL FOR SLI. If the employee is refused SLI, either by the facility or the N.J. Department of Personnel, the employee retains his/her right to appeal.

7. The employee must report to the medical clinic every day or as ordered by the attending physician to continue to receive SLI benefits. Employees who cancel their appointment with the attending physician, must re-schedule an appointment only after approval by the Medical Director or his/her designate of the facility.

8. When the attending physician makes a decision for the employee to return to work, his/her decision shall be considered as final.

B. Supervisor Responsibilities

1. Upon receiving a report of injury/illness from an employee, the supervisor shall provide the employee (if available) with an Accident-Injury Report Form, (Employee's First Report of Accidental Injury or Occupational Disease).

2. When the employee returns the completed Accident-Injury Report Form, the supervisor will review it for accuracy and completeness. Then the supervisor will fill in all sections coded 2.

3. After completing their portion of the form, the supervisor will return it to the employee along with a completed and signed Medical Referral Form. The employee will then be referred either to the Medical Director's Office of the Nursing Supervisor, if the MD is on-call). If the Supervisor of Nursing Services is one in the same, as when the employee is a member of the nursing department, the supervisor shall establish phone contact with the on-call physician. Based upon phone consultation, the employee may be referred to a local hospital, (emergency status) or be requested to report back to the Medical Director's Office on the first day of business during "normal working hours" (non-emergency status).

4. Once the supervisor receives a report from the Medical Director's Office, as to the status of the employee, he/she shall proceed accordingly. In addition to the report from the Medical Director's Office, the supervisor shall also receive a written report from the Personnel Office as to the official status of the employee relative to SLI. If the employee is placed on SLI status, the supervisor shall record the time accordingly. It is the supervisor's responsibility to investigate the accident/incident to ensure no violation of rules and regulations or policy occurred.

C. Medical Responsibilities:

1. The Medical Director, or his/her designate, will complete the medical portion of the Accident-Injury Report Form (Employee's First Report of Accidental Injury or Occupational Disease) for all sections coded 3. Prior to completing these sections, the staff physician must ensure that the employee's and supervisor's sections have been properly completed.

2. The Medical Director, or his/her designate, will review the staff member and provide a diagnosis and recommendations for treatment.

3. The physician shall then complete the Certification of Examination Form.

4. The physician shall provide feedback to the employees’ supervisor as soon as possible. Feedback shall include diagnosis and what recommendations will be made in terms of time off from work.

5. After the Accident-Injury Report Form is completed, medical will make and retain one copy for their records. Then they will return the form to the employee with a Certificate of Examination form and refer the employee to the Personnel Department for determination of SLI benefits.

6. In those situations where the physician requires a consultation from an outside agency or specialist, he/she shall refer the employee with a Referral To Outside Physician Form. A copy of this form shall be retained by the facilities staff physician.

7. When the employee has been reviewed by an outside physician, he/she will report back to the staff physician of the facility, for determination of disposition, with the completed consultation form.

8. When an employee is reviewed by a local hospital, he/she will report to the Medical Director or his/her designate on the first business day after the examination. The attending staff physician will contact the local hospital to obtain all necessary documents relative to their clinical evaluation of the employee.

D. Personnel Responsibilities:

1. When the employee is referred from the Medical Department, with the Employee's Accident-Injury Form, (Employee's First Report of Accidental Injury or Occupational Disease) and a Certificate of Examination Form, the Personnel Officer will review both forms for completeness. He/she shall complete the portion coded 4 on the Accident-Injury Report Form.

2. Based upon a review of the above two forms, the Personnel Officer shall inform the employee of his/her decision with regard to granting SLI. If the Personnel Officer grants temporary approval of SLI, he/she must inform the employee, the employee's supervisor and the timekeeper, in writing, on a Notification of SLI Status Form. If SLI is not approved, the Personnel Officer must inform the employee, in writing, on a non-compensable form. In addition, the employee must receive counseling as to his/her right to appeal.

3. When temporary approval of SLI is granted, the Personnel Officer must submit a CS-40 Form to the New Jersey Department of Personnel within 30 days from the date of the initial employee absence. In addition, the Personnel Officer shall counsel the employee on the provisions for SLI benefits and provide the employee with a copy of the Work Injury Employee Information Form.

4. When the Personnel Officer is notified of approval/disapproval of SLI benefits by the New Jersey Department of Personnel, he/she shall inform the employee, in writing, as to their final decision.

E. Accidents Involving Outside Third Parties

Any injury to an employee which is caused by a third party, (i.e., where an employee is struck by a car not owned or operated by the State of New Jersey) is to be reported as set forth above. However, no State employee is to discuss the accident with any outside parties other than Police Officers, representative of the Bureau of Risk Management, or representatives of the State's automobile insurance carrier. If there is any doubt concerning whether cooperation may be extended in any particular situation, the Bureau of Risk Management shall be contacted for their advice and assistance.

F. When SLI is originally authorized, a statement of justification is not required of the treating physician. However, a statement of justification will be required in the following cases:

1. Whenever an employee has returned to work following termination of SLI and subsequently has returned to SLI status.

2. Any SLI granted for nontraumatic injuries (heart attack, stroke, hypertension, ulcers, dizziness, chest pains, shortness of breath, tuberculosis, hepatitis, etc.) will be accompanied by a medical justification.

3. Whenever there is an extension of SLI, no statement is required for original SLI time; however, justification shall be processed each time there is an extension of SLI status for the same injury.

a. The statement may be written on the Authorization for SLI Form by the treating physician.

G. Bills or treatment provided by anyone other than the authorized treating physician will not be accepted for payment by the Center.

PERSONNEL - 43-03-009

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