Minnesota Department of Transportation

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MnDOT Policies

Workers’ Compensation Injury Reporting and Return-to-Work

MnDOT Policy HR012
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Policy statement

Employees are required to report all work-related injuries or illnesses immediately and not later than 24 hours.

When appropriate and in accordance with laws, rules, regulations, and collective bargaining agreements/plans, a qualified employee may be placed into another job or job assignment. Each return-to-work situation will receive careful review on a case-by-case basis and must take into consideration the varying factors of the injury and work place needs.

Reason for policy

  • Ensure employees with a work-related injury or illness are able to return-to-work safely
  • Ensure consistent reporting and return-to-work procedures for employees with work-related injuries or illness
  • Ensure secure and consistent record keeping
  • Ensure compliance with Mn DOT policies ADA Reasonable Accommodation and Family Medical Leave Act (FMLA), laws, rules, regulations, and collective bargaining agreements/plans

For employees who are returning to work from a non-work-related injury or illness, see the MnDOT Return-to Work Policy.

Who needs to know this policy

  • All employees
  • Managers/Supervisors
  • Office of Human Resources
  • Office of Equity & Diversity
  • Workers' Compensation Coordinators

Definitions

Acceptance of Claim

A determination by the Minnesota Department of Administration's Risk Management Division (RMD) that a workers' compensation claim is compensable.

Denial of Claim

A determination by the Minnesota Department of Administration's Risk Management Division (RMD) that a workers' compensation claim is not compensable.

Designee

For the purpose of reporting a work-related injury or illness, the individual selected to act on behalf of the supervisor when the supervisor is absent.

MnDOT Report of Work Ability for Work Injuries

A form to be completed by a healthcare provider on behalf of an employee with a work-related injury.

Occupational Illness

Any abnormal condition or disorder, other than one resulting from an occupational injury, caused by exposure to environmental factors associated with employment.

Significant Event

A work-related situation or circumstance to which employee exposure could potentially lead to injury or illness.

Significant Injury or Illness

A work-related injury or illness that results in death, days away from work, restricted work or transfer to another job, medical treatment beyond first aid, or loss of consciousness.

Transitional Work Assignment

A temporary position that permits an employee to return-to-work within the medical restrictions outlined by the treating health care provider.

Treating Healthcare Provider

For state employees entitled to workers' compensation treatment, a physician, chiropractor, osteopathic physician, podiatrist, or dentist directing and coordinating the course of medical care to the employee.

Procedures

The employee, supervisor and Workers’ Compensation Coordinator must take the following actions when a work-related injury or illness occurs, including when in travel status.

Employee required actions

  • In a medical emergency, call 9-1-1 for immediate medical attention
  • For all non-emergencies, the employee must contact CorVel (Managed Care Provider) at 844-235-2055 (24/7 Nurse Triage Line) for guidance and/or to find the nearest network medical provider, should further medical treatment be needed and/or recommended
  • The employee must immediately notify his/her supervisor or designee unless a significant injury, illness, or event prevents reporting
  • The employee must complete the following forms and submit to the supervisor (or supervisor's designee) immediately and not later than 24 hours after the event, unless a significant injury, illness, or event prevents reporting:

Supervisor required actions

If the event results in a significant injury or illness, the supervisor must notify the Workers' Compensation Manager as soon as possible but not more than eight (8) hours after the event has occurred. A significant injury or illness includes workplace events such as fatalities, serious or life-threatening injury or illness resulting in hospitalization.

If a significant event occurs, which the employee either witnesses or is a part of, the supervisor must contact the Workers' Compensation Coordinator immediately and not later than 24 hours. A significant event includes exposure to situations or circumstances that could lead to future injury or illness.

Workers' Compensation Coordinator required actions

  • The Coordinator must submit the Workers' Compensation forms to the Minnesota Department of Administration - Risk Management Division (RMD) for claims determination.
  • A copy of the employee's position description and/or essential job functions are submitted to CorVel (Managed Care Provider) in accordance with managed care rules, Minn. Rule 5218.0100.

A work-related injury or illness may run concurrently with Family Medical Leave Act (FMLA) and/or ADA Reasonable Accommodation.

Returning to Work With or Without Restriction

To ensure that it is medically appropriate for the employee with a work-related injury or illness to return safely to work, it is necessary for the treating health care provider to complete a Report of Work Ability form. The Report of Work Ability form must be submitted to the Workers' Compensation Coordinator prior to returning to work. The Worker's Compensation Coordinator and/or Office of Human Resources will review the Report of Work Ability and notify the employee of the status and plan to return to work. The employee may return to the position held prior to the time of injury or illness, or be placed in jobs for which they are qualified, consistent with laws, rules, regulations and collective bargaining agreements/plans.

In the event the employee is able to return-to-work without restrictions, the employee must obtain a completed Report of Work Ability form from the treating health care provider documenting the employee's ability to return to-work with no restrictions. The employee must submit the statement to the Workers' Compensation Coordinator prior to returning to work or upon receipt from the treating health care provider.

Temporary Work Restrictions

If the healthcare provider recommends temporary work restrictions, the Workers' Compensation Coordinator, in consultation with the supervisor and/or Office of Human Resources/Office of Equity & Diversity, will determine whether the employee can return safely to his/her current position or if a suitable transitional work assignment is available. Any transitional duty assignment must comply with applicable laws, rules and regulations.

The employee must obtain a completed Report of Work Ability form from the treating health care provider indicating the following:

  • Nature and expected duration of the temporary restrictions
  • Date of re-evaluation and return-to-work date with or without restrictions

The Workers' Compensation Coordinator, in consultation with the supervisor and/or Office of Human Resources/Office of Equity & Diversity, determine the availability and suitability of a transitional work assignment for the employee, based on the Report of Work Ability provided from the treating health care provider.

Permanent Work Restrictions

If the treating health care provider's Report of Work Ability form indicates that the employee has a permanent work restriction, the Workers' Compensation Coordinator, in consultation with the Office of Human Resources and the Office of Equity & Diversity, will evaluate whether the restriction prevents the employee from performing essential functions of his/her job.

If the restriction(s) prevents the employee from performing essential functions of his/her job, the Workers' Compensation Coordinator, in consultation with the Office of Human Resources and the Office of Equity & Diversity, will initiate the Reasonable Accommodation Interactive Process.

  • The employee must obtain a completed Report of Work Ability form from the treating health care provider indicating the nature of the permanent work restrictions.
  • If the employee is unable to return to his/her former position, the Office of Human Resources and the Workers' Compensation Coordinator will determine the availability and suitability of an alternative position with MnDOT, in compliance with collective bargaining agreements/plans.

Agency Recordkeeping

The Workers' Compensation Coordinator maintains the official agency records documenting the internal return-to-work efforts, ensuring that:

  • Agency injury or illness correspondence, injury or illness paperwork, and other pertinent documents are saved and maintained in the current electronic document management system
  • All electronic documents are properly secured and access is limited to maintain confidentiality and privacy

Responsibilities

Employees

  • Report and complete paperwork documenting injury or illness and submit to supervisor
  • Promptly provide a completed Report of Work Ability received from the treating health care provider to the Workers' Compensation Coordinator
  • Actively participate in the return-to-work process

Managers/Supervisors (or Designee)

  • Complete all agency claims investigation forms immediately but not later than 24 hours
  • Maintain regular contact with the employee
  • Actively participate in the return-to-work process

Workers' Compensation Coordinators

  • Coordinate with the Minnesota Department of Administration - Risk Management Division (RMD) to facilitate the management of a claim from initial filing to final closing
  • Facilitate the return-to-work process for injuries or illnesses involving temporary and/or permanent work restrictions
  • Work with the Office of Human Resources and Office of Equity and Diversity to evaluate the need for reasonable accommodation where applicable

Office of Human Resources

  • Collaborate with and advise the Workers' Compensation Coordinator and Office of Equity and Diversity regarding:
    • FMLA qualifying leave
    • Job opportunities within the agency when permanent restrictions are determined
    • Leave of absence and separation issues

Office of Administration, Workers' Compensation Manager

  • Serve as MnDOT's internal consultant to offices/districts regarding specific workers' compensation claims and case management
  • Develop, conduct and coordinate training, provide information regarding the claims process to office/district Workers' Compensation Coordinators, safety administrators, managers, supervisors and employees
  • Act as the primary point of contact for Minnesota Department of Administration - Risk Management Division (RMD) and the Department of Labor and Industry Workers' Compensation Division when a significant injury occurs

Office Directors/District Engineers

  • Be familiar with this policy

Forms/Instructions

Forms that must be completed immediately and not later than 24 hours after incident:

Forms required for every incident receiving medical attention:

Process

Related information

History

Amended/Revised

  • Fourth Revision March 18th, 2019; Page 2, under 'Procedures,' added clarification re:travel status
  • Third Revision August 18th, 2018; Updated Template, updated Employee required actions in non-emergency/telephone number page 3.
  • Second Revision March 19th, 2015
  • First Revision September 18th, 2008

Effective

April 7th, 1998

Supersedes

  • Policy 3.98.2 - Administration No. 98-2, Workers' Compensation
  • Guideline 3.98.2-G1 - Administration No. 98-2-G1, Workers’ Compensation Return to Work Guidelines

Ownership

Please go to the MnDOT Org Chart to find specific contact information: Org Chart.

Responsible Senior Officer

Deputy Commissioner/Chief Engineer

Policy Owner

Office Director
Office of Administration

Policy Contact

Workers’ Compensation Program Manager
Office of Administration