Workers’ Compensation Injury Reporting and Return-to-Work
MnDOT Policy #WF012
Revised: September 11, 2020
View/print signed policy (PDF)
Workers' Compensation Injury Reporting and Return-to-Work Procedures
Please go to the MnDOT Org Chart to find specific contact information: Org Chart.
Responsible Senior Officer: Deputy Commissioner/Chief Administrative Officer
Policy Owner: Director, Office of Administration
Policy Contact: Workers' Compensation Program Manager
Policy statement
Employees are required to report all work-related injuries or illnesses immediately and not later than 24 hours after the injury or illness.
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 must 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 MnDOT 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.
Applicability
All MnDOT employees must comply with MnDOT policies.
Key stakeholders with responsibilities this policy include:
- All employees
- Managers/Supervisors
- Office of Human Resources
- Office of Equity and Diversity
- Workers’ Compensation Coordinators
- MnDOT Office of Administration
Definitions
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.
Significant Injury or Illness
A work-related injury or illness that results in death, medical treatment beyond first aid, loss of consciousness, days away from work, restricted work, or transfer to another job.
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.
Responsibilities
Employees
- Report and provide injury or illness information to supervisor (this is not done through eSAFE).
- Enter injury information electronically into eSAFE. If eSAFE is unavailable, complete paper forms located under the Resources Tab of the agency Workers’ Compensation iHUB page and submit to the Workers’ Compensation Coordinator.
- Promptly provide a completed MnDOT Report of Work Ability for Work Injuries 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 and submit all agency claims investigation information immediately, but not later than 24 hours, after the injury or illness.
- Enter injury information electronically into eSAFE. If eSAFE is unavailable, complete paper forms located under the Resources Tab of the agency Workers’ Compensation iHUB page and submit to the Workers’ Compensation Coordinator.
- 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
Office of Equity and Diversity
- Collaborate with and advise the Workers’ Compensation Coordinator and Office of Human Resources regarding reasonable accommodation, where applicable.
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, and 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
Policy Owner (Director, Office of Administration)
- Review policy every two years, or sooner as necessary, to ensure policy remains up-to-date.
- Ensure procedures, form, and training associated with the policy remain current.
- Be aware of state, federal, enterprise, agency, or other requirements that apply to the policy or procedures.
- Ensure the policy and procedures remain compliant with all state, federal, enterprise, agency, or other requirements and that necessary approvals by state or federal agencies are obtained before changes to the policy or procedures are implemented.
- Work with Policy Coordinator to revise policy and/or confirm its accuracy.
- Communicate policy revisions, reviews, and retirements to stakeholders.
Resources and related information
Agency Injury Website
- Workers' Compensation Injury Website (eSAFE electronic reporting)
- Workers’ Compensation Injury Website (paper forms – to be used if electronic reporting is not available)
Forms required for every incident receiving medical attention:
- MnDOT Report of Work Ability for Work Injuries Form – Health care provider completes
- Employee Information Packet and First-fill Prescription Information – Employee must print
- Leave Supplement Form – Employee completes for injuries involving medical or lost time claims
Processes, Procedures, and Instructions
Resources
- Americans with Disabilities Act
- Department of Administration- Risk Management (link to hard copy forms)
- Collective Bargaining Agreements/Plans
- Minnesota Government Data Practices Act (Minn. Stat. Chapter 13)
- Minnesota Statutes, §43A, State Personnel Management
- Minnesota Statutes, §176, Workers’ Compensation
- MnDOT Workers’ Compensation Program Contacts
- MnDOT Family Medical Leave Policy
- MnDOT Reasonable Accommodation Policy
- MnDOT Return-to-work Policy
- MnDOT Safety and Work Injuries Resources
- Workers’ Compensation Program, Minnesota Department of Labor & Industry
- Business Data Catalog (BDC) – accessible from employee Intranet
- MnDOT’s Policy Website
History and updates
Adopted
March 19, 2015
Superseded
- Policy 98-2, Workers' Compensation Return-to-Work
- Effective April 7, 1998
- Policy 3.28, Workers' Compensation Return-to-Work
- Effective September 18, 2008
Revised
- First Revision: August 14, 2018
- Second Revision: March 12, 2019
- Third Revision: September 11, 2020 (also renumbered as #WF012)
Policy Review
- August 18, 2022 - Made minor revisions to match updated policy template including adding two policy owner responsibilities
This policy's next scheduled review is due September 2024.