HomeMy WebLinkAboutN-250 - Workers Compensation CITY OF PASCO
ADMINISTRATIVE ORDERS
Administrative Order No. 250
Personnel Policies & Procedures
Subject: Workers Compensation (Industrial Insurance) Initial Effective Date :
June 1 , 1982
Revised / 11
Approved
The following Administrative Order is effective February 10, 2011 and replaces Administrative
Order No . 37, dated June 1 , 1982 .
I. PURPOSE:
This Administrative Order is issued to establish a policy and expectations regarding the
use of Workers Compensation through the State of Washington Industrial Insurance
program administered by the Department of Labor and Industries.
II. DEPARTMENTS AFFECTED :
All
III. REFERENCES:
• RCW Chapter 51
• Washington Administrative Code 29644
IV. POLICY ,
The City of Pasco shall participate in a workers ' compensation plan for all employees
with the exception of those covered by the Department of Retirement Services LEOFF I
plan . Employees off work due to an on-the job injury accepted by L&I may be eligible
for wage loss assistance. The first three (3 ) days off immediately following the date of
injury are considered a waiting period for which L&I wage loss assistance is not
available.
Employees with accepted claims for time loss may chose one of three (3 ) options for
wage loss assistance:
1 . Request an unpaid leave of absence and accept the Industrial Insurance payment in
full .
2 . Use accrued vacation leave for the absence and keep both the Industrial Insurance
payment and the vacation pay.
3 . Claim non-taxable disability for time lost and forfeit the Industrial Insurance payment
checks to the City (payroll) upon receipt. Sick leave will be adjusted to equal the
difference between the non-taxable disability paid by the City and the industrial
insurance forfeited to the City.
V. PROCEDURE :
A. Employees who are injured on the job are to complete an incident form noting the
details of the injury within 24 hours of the occurrence .
B . Employees who are injured on the job and will need time loss must complete the
Industrial Accident Leave Request noting one of the three options for wage
replacement.
C . Employees who are on time loss and select Option 3 on the Industrial Accident
Leave Request form must turn in to payroll all time loss checks received from L&I
or any other workers ' compensation carrier along with the notifications applicable
to those payments .
D . Payroll will process time loss checks and adjust the employee ' s sick leave balance
accordingly .
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Administrative Order No. 250 — Workers Compensation — Page 2
City of Pasco
INDUSTRIAL ACCIDENT LEAVE REQUEST FORM
I, became temporarily unable to work on
as a result of an on-the-job injury/illness.
During the period of time that I am unable to work because of this occurrence, I request to be
paid by (select one) :
1 . State of Washington Industrial Accident Fund (L& I) only . I understand and agree
that I will not be accessing any of my leave balances or requesting non-taxable
disability through the City.
2 . Use of accrued Vacation Leave plus receipt of wage replacement (time loss) from
the State of Washington Industrial Accident Fund (L&I). I understand this pay is in
addition to, and separate from, the State Industrial wage loss payments.
3 . Non-taxable disability through the City. I understand and agree that I will forfeit to
the City all wage replacement/time loss checks I receive from the State of
Washington, Labor & Industries. I further understand that due to a difference
between the monies I receive from the City and the checks I will receive from L&I,
my sick leave will be adjusted accordingly.
Employee Signature Date
Received by Human Resources Date
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Administrative Order No. 250 — Workers Compensation — Page 3