WORKERS’ COMPENSATION

CARRIER: CRS

COMPREHENSIVE

RISK

SERVICES, INC.                                                                                                                                           

Comprehensive Risk Services, Inc. is the workers’ compensation claims administrator for McLaren Health Care Corporation.

We have recently been notified that you have made a claim for benefits due to a work-related injury and this letter should help you understand how the claims process works.

YOUR RIGHTS

MEDICAL

You are entitled to reasonable and necessary medical care to cure or relieve the effects of your work related injury.  This includes medical, surgical, nursing and hospital services; and under certain conditions dental care and prosthetic devices.

McLaren Health Care Corporation is required to provide these services through the Occupational Health Center, but 10 days after beginning your medical care, you may elect to treat with a doctor of your choice.  If so, you must, inform us your intent (in writing) the name of the doctor you wish to see.  Regardless of your physician choice, you must contact me following each appointment to keep me informed of your progress.

If Comprehensive Risk Services believes that the physician you have chosen is inappropriate and can show why, a magistrate at the Bureau of Workers’ Compensation may order you to discontinue treatment with that physician or order you to personally pay for any treatment subsequent to the date of the Order.

During the course of your recuperation, you should submit your mileage associated with your medical care including physician, physical therapy and rehabilitation appointments for reimbursement.

PAYMENT OF BENEFITS

Workers’ Compensation is paid in accordance with the Workers’ Disability Compensation Act.  Your compensation rate is determined by taking your highest 39 weeks gross wages of the last 52 weeks worked.  A copy of Form 701 showing our computations will be forwarded separately.

You maximum allowable compensation rate based on your earnings and filing status will be $(unknown).

If medical disability does not extend beyond 7 days, you will not receive lost wage work comp benefits.  If disability extends beyond 7 consecutive days, but does not exceed 13 days from your last day worked, workers’ compensation is paid from day 8 on a day-to-day basis, through day 13.

If disability reaches the 14^th day after your last day worked, compensation payments will go back to your 1^st day of work lost and will pick up from day 1 through day 7 and continue for the duration of your disability.

If during this initial period and after you have reached the 14^th day of disability, you have used time from your PTO bank; it will be necessary for you to reimburse your PTO bank through a payroll deduction.  Enclosed are forms which you must sign and return to Comprehensive Risk Services, Inc.

MORE THAN ONE EMPLOYER

If you work for more than one employer, you will receive credit for all wages earned and reported to the Internal Revenue Service as well as employment covered by the Workers’ Compensation Disability Act.

VOCATIONAL REHABILITATION

If it is medically determined that you are unable to perform work you were hired to do, you are entitled to vocational rehabilitation including specialized job placement or short term retraining.  Vocational rehabilitation consideration is made only after all treating or evaluating physicians conclude that you will be unable to return to your previous occupation.

While the above explains your basic rights under the Workers’ Compensation Act, you also have certain responsibilities. 

YOUR RESPONSIBILITIES

THE TRANSITIONAL WORK PROGRAM

Employees with temporary work related disabilities who would otherwise be on a leave of absence will be brought back to work into a temporary position having requirements matched to their level of ability as determined by physical examination.  Participation will be required.

All employees with a work related illness or injury which results in the restriction of regular work duties or causes the loss of one or more days of scheduled work will be evaluated in the Occupational Health Center and considered for placement in a transitional work position either in their department or in another department.  The Occupational Health Department will determine the scope and duration of restrictions from regular work duties and recommend transitional work placement consistent with activity limitations, tolerance level and transferable skills.

All temporarily disabled employees who cannot perform their regular jobs without restrictions but are capable of tolerating restricted work will be required to participate in the Transitional Work Program.  Employees refusing to be placed in transitional work assignments may be subject to termination of their workers’ compensation wage benefits.  Every effort will be made to arrange transitional work placements within the employee’s assigned work location and shift.

You are entitled to weekly compensation benefits as long as your disability, supported by medical documentation continues.  Documentation by a physician must be provided on the first day of disability to establish coverage.  “Back-dated” disability notices are not acceptable.  In the event you return to work at a job which pays you less than you were earning at the time of the injury, and the reason is you are physically unable to work at your previous job, you are entitled to “partial” compensation benefits.

During the time you are unable to work or are active in the Transitional Work Program, you must:

1. Notify Comprehensive Risk Services of wages earned (copy of check stub) at McLaren Health Care Corporation during the period of time you are in the Transitional Work Program, each pay period. (See Resource Fax Numbers below)
2. Notify McLaren Health Care Corporation/Comprehensive Risk Services of any wages earned during the period of time you are disabled, each pay period (see Resource Fax Numbers below).
3. Submit to reasonable periodic medical examination if required by Comprehensive Risk Services.
4. Cooperate with reasonable Transitional Work Program and rehabilitation efforts directed towards assisting you to return to appropriate employment.
5. If approved by your physician, accept a valid offer of employment from McLaren Health Care Corporation, other employers or through the Michigan Employment Security Commission.
6. If after one year’s medical or workers’ compensation leave, you have not returned to work, your active employment status with McLaren Health Care Corporation will cease.  Although your workers’ compensation benefits will continue until you are deemed able to work, your benefits, i.e., health, vision, dental, will stop.  A COBRA benefits package will be sent to you which will allow your benefits to continue at your expense for 18 months.

 **IF YOU RETURN TO WORK OR TO THE TRANSITIONAL WORK PROGRAM, NOTIFY COMPREHENSIVE RISK SERVICES.** (See Resource Fax Numbers below.)  AND notify your Clinical Manger of your planned return as soon as possible.

If you disagree with any decision made by the McLaren Health Care Corporation or Comprehensive Risk Services you may file an Application for Mediation Hearing with the Bureau of Workers’ Compensation.

This will entitle you to a hearing before a mediator if you request such a hearing in writing.

It is necessary that you complete the attached employee questionnaire, treating physicians, dependents information statement as well as sign the medical authorization and return them to me as soon as possible.

At the bottom of this letter you will find the claim number we have assigned to your file.

I look forward to the opportunity of assisting you during your period of recuperation.

Sincerely,

Jacki Dimitroff

Claims Adjuster

File #: XXXXXX

MMCM NURSE WORKERS’ COMPENSATION RESOURCE/CONTACT LIST

MMCM Workers’ Compensation (Human Resources)

PHONE 493-8654

Employee Health

PHONE 493-8662

FAX 493-2103

Corporate Workers’ Compensation Representative  

Jackie Dimitroff

P. O. Box 2415, Farmington Hills, Michigan 48333

PHONE 248 737-1888

FAX 248 737-4619