Section 21.8 Workers' Compensation Leave - November 1, 1995
TO: Agency Personnel Officers
This bulletin covers the following subjects: updated benefit chart, communication with the State Insurance Fund concerning employee absences, use of leave accruals, restoration of leave accruals - proration and timing, and change in employees' status after 12 months of absence.
Updated Benefit Chart
The attached Workers' Compensation Benefit Chart has been revised to include the benefit changes negotiated in the 1995-99 agreements between the State and CSEA and the State and PEF. These changes include (1) extending the Mandatory Alternate Duty Program assignment period from 45 to 60 days and (2) for accidents on or after April 2, 1995, extending the benefit continuation period under the PEF Medical Evaluation Program from 9 to 12 months. This chart provides a brief summary of the major components of each benefit and replaces the chart distributed with General Information Bulletin 94-03.
Communication with the SIF
When an employee is allowed to charge leave credits for work-related absences, regardless of which benefit program the absence is under, New York State, as the employer, is obligated to make a claim with the Workers' Compensation Board for a credit for wages paid. The State Insurance Fund (SIF), as our representative, files this claim on our behalf. It is critical, therefore, that the employing agency keep the SIF up-to-date on an employee's status during the absence. Please advise the SIF of each employee's exact dates of absence and the person's status on those dates, e.g., leave with pay, charging credits, leave without pay, etc. The SIF cannot file a claim for reimbursement with the Board without this information, nor can the SIF's hearing representatives properly present our claim before the Board if they don't have up-to-date, accurate information in the file.
Each of you has established working relationships with the SIF's claims examiners who process claims for your agency. We encourage you to discuss the issue with them to come to a mutually acceptable method of exchanging information on employee lost time and pay status during those absences so that information is timely and accurate. Establishing these procedures should reduce the potential for Board awards for wage replacements being issued to the wrong party.
Along these same lines, it has come to our attention that in the pay period that an employee returns to work, the number of days of disability as determined by the SIF may not correspond to the actual number of days lost. The SIF is working from the information available to them at the time of the injury that, in many cases, has now changed. The most common situation brought to our attention is the employee whose regular days off (pass days) are different when he/she returns to work than they were at the time of the accident. Another situation generating discrepancies is the employee on a compressed workweek who has more than two days off each week.
The SIF has instituted a procedure to correct these situations so that the number of days paid and the number of days lost are reconciled. When this situation arises, please contact your SIF representative and advise him/her of the problem. Please provide the exact details on the actual days of disability and work days in the applicable pay period. The SIF will make the necessary corrections and, if an additional payment is due, you will receive a Form C-8 EMP indicating the change.
Finally, please remember when an employee charges leave credits during a period of compensable absence, New York State, as the employer, is obligated to make a claim for reimbursement for wages paid. Upon receipt of that credit for wages paid (the Notice of Decision from the Workers' Compensation Board), we are obligated to restore those credits in accordance with the applicable benefit. Under normal circumstances, agencies and employees do not have any options in this matter.
Use of Leave Accruals
Each workers' compensation program that is available currently to State employees has different provisions concerning the use of leave accruals during absence due to a work-related disability. Please refer to this section of the Manual and the applicable policy bulletins for a complete description of the various benefits and appropriate use of credits under those benefits.
The Statutory Benefit Program (applies to accidents of CSEA-represented employees on or after July 1, 1992) and the Medical Evaluation Program (applies to accidents of PEF-represented employees on or after July 1, 1993) allow charging of leave accruals during the first five work days of absence and for partial day absences after the employee returns to work. Generally, all other absences for disabilities subject to these benefits are without pay for the employee's entire disability. Agencies are encouraged to review their procedures for the reporting of workers' compensation accidents and the processing of those reports so that employees are removed from the payroll in a timely manner and placed in the correct payroll status (pursuant to Comptrollers' instructions) to ensure benefit continuation.
Restoration of Leave Accruals
Some current workers' compensation programs available to New York State employees provide for full restoration of leave accruals used by an employee during absence due to work-related disability; some benefits provide for a proration of these restored credits. A complete explanation of restoring credits is found in each benefit description. This memorandum provides further clarification on some issues and is in addition to those explanations.
Regardless of which program applies to the particular absence, credits are restored only following a notice of decision (NOD) from the Workers' Compensation Board crediting New York State for wages paid. In addition, for those benefits that require prorated restoration of accruals, the agency needs the C-8 EMP that is issued by the State Insurance Fund to implement the NOD in order to determine the net credit to New York State on which to base the prorated restoration. We recommend that agencies wait for the C-8 EMP in all cases to ensure that the payments made by the SIF are in concert with the NOD and therefore the restoration is correct.
Prorated restorations are based on the actual amount of the credit to New York State for wages paid. The C-8 EMP reports this exact amount of State credit and the period of time covered by the credit. The agency does not need to do any calculation to determine the amount of the credit. The only calculation necessary is the determination of the percentage of accruals to be restored. If an agency has a question about reading the C-8 EMP, either the SIF representative or this office should be contacted.
Under the provisions of some benefits, timely removal of employees from the payroll will serve to limit the amount of accruals that need to be restored. For example, as noted above, the Statutory Benefit Program and the Medical Evaluation Program allow charging of leave accruals during the first five work days of absence and for partial day absences after the employee returns to work. The potential for errors and overpayments is reduced proportionally to the extent agencies process status changes for employees in a timely fashion.
This paragraph refers only to the restoration of credits under the PEF Medical Evaluation Program, which is applicable to PS&T Unit employees whose injuries occurred on or after July 1, 1993. Under this benefit, credits restored are prorated based on the award credited to New York State for wages paid or 60 percent of the employee's gross salary, whichever is greater. To determine what percentage of credits to restore, identify the employee's gross salary and calculate the percentage of this gross salary which is represented by the SIF net monetary award (as shown on the C-8 EMP). If it's greater than 60 percent, restore the percentage of credits used, to a maximum of 100 percent. If it's less than 60 percent, restore 60 percent of the credits used. The remainder of the explanation on restoration of credits...
...found on pages 13-16 of Policy Bulletin 93-04 continues to apply to the PEF Medical Evaluation Program.
Employee Status After 12 Cumulative Months of Absence
This paragraph updates the information provided in General Information Bulletin 93-02 which discussed employee status for CSEA-represented employees only.
CSEA-represented employees whose accidents occur on or after July 1, 1992, M/C designated employees whose accidents occur on or after September 1, 1994, and PEF-represented employees whose accidents occur on or after April 2, 1995, have certain benefits available to them during their first 12 cumulative months of absence. (PEF-represented employees whose accidents occur on or after July 1, 1993, and before April 2, 1995, have these benefits for the first nine cumulative months.) Briefly, these include continuation of accrual of biweekly leave credits, continuous service and seniority credit, retirement service credit, Employee Benefit Fund contributions (as applicable) and health insurance. Detailed information is in the various bulletins describing these benefits.
At the end of this period, if the employee has not returned to work or has not been separated, it is necessary to change the employee's payroll status to notify the various agencies providing continuation of benefits that eligibility has ceased. The employee's status needs to be changed from workers' compensation disability leave without pay to regular sick leave without pay. Refer to the Office of the State Comptroller's Payroll Bulletins for details concerning the processing of this transaction at the end of 12 cumulative months of absence and prior to termination.
For CSEA- and PEF-represented employees, this change is to sick leave without pay since there is no entitlement to charge leave accruals for these full day absences, even after a year of absence. For M/C employees this is a change to one of several appropriate states, depending on the individual's circumstances, for example, sick leave at half-pay or long term disability leave or sick leave without pay.
Please call the Employee Relations Section at (518) 457-5167 for assistance or further information on any of these issues or other workers' compensation benefit related matters.