HB Bulletin #53-15
September 3, 2015
HEALTH BENEFITS BULLETIN
WHAT TO DO IF INJURED ON THE JOB
Section 6, Rule 602 of the Pacific Coast Marine Safety Code:
An injury of any kind, irrespective of its severity, shall be reported immediately to the foreman, walking boss, or man in charge of operations, by the injured person, if he is physically able to do so. If not, the injury shall be reported by any other person in possession of the facts.
LS201 – Notice of Employee’s Injury or Death: This form must be given to the injured union worker by their employer. The form should be completed by the injured worker, if they are physically able, whether they work their whole work shift or not. The employer should not deny an LS201- Notice of Employee’s Injury or Death if requested.
LS1 – Request for Examination and/or Treatment: the employer must give Form to the injured worker upon notification of injury. Submit copy of LS1 to the doctor at the time of examination. The injured worker has the right to receive medical treatment by any doctor of his/her choice.
If the employers refuse to provide you with a slip or LS1, call the Business Agent (310) 830-1877.
Beware of employers sending the union worker to the employer’s doctor:
State of California does permit the employer to control Medical Care for the worker on the first 30 days.
Federal Law (which is what the ILWU is under) permits the workers to choose their own doctor. Employers may counter that by having the injured worker attend a second opinion examination by a doctor of their choice.
Provide all medical reports, wage information, and other reports relevant to the claim to the Department of Labor.
LS207 – Notice of Controversion: If insurance carrier has any doubt on the injury or there is a delay from the doctor’s office, the employer will file an LS207 Notice of Controversion, until they receive the doctor’s report or whatever the circumstance might be. (80% of Controversion are rescinded following adjustor’s receipt of information they need to process the claims).
Employer may ask injured worker to sign two types of release forms, for the following reasons:
Release of Medical Records pertaining to injury
Release Wages for the year prior to the injury
(Pacific Maritime Association is a payment clearing house for wages. It is normal for the employer to request pay history from PMA. However, they are required to ask worker to sign release forms.)
An insurance adjuster may call the injured worker at home to schedule an appointment and interview him/her in regards to their injury. The injured worker may:
May refuse the insurance adjustor to come to his/her home
May refuse a recorded conversation
The injured worker may suggest meeting in a neutral location
The injured worker may suggest a phone interview
California is a ‘joint jurisdictional’ state (injured workers may file a claim under either or both jurisdictions). When in doubt about the Federal vs. State law, the union worker should seek information from his/her attorney or a Maritime Attorney, or the Department of Labor.
Call the U. S. Department of Labor for assistance if dispute arises during the course of the investigation conducted by the adjustor.
For any questions please contact the following:
Marco A. Adame II, District Director
18th Compensation District
U.S. Department of Labor
501 W. Ocean Blvd. #6230
Long Beach, CA 90802
Jerry Avila, Health Benefits Officer
ILWU Local 13
630 South Centre Street
San Pedro, CA 90731
On Friday, September 11, 2015, we will be having an informational workshop that will discuss the appeal process for the Plan. If you have any claim(s) that have been denied by Zenith and have been told that your option is to file a “full and fair review” this is the workshop for you. It will take place at the Local 13 Executive Board Meeting Room from 10:00 a.m. to 2:00 p.m. The intent is to help you understand the appeal process and get started with that process should you choose to do so.
SO. CALIFORNIA AREA WELFARE DIRECTOR – NEW ASSISTANT
Southern California Area Welfare Director, Sam Alvarado, has a new office assistant, Olivia Holton, formerly employed with Local 13. You may now schedule appointments with Sam, drop off any correspondence regarding your medical claims, full and fair reviews, pick up forms etc… Office hours and location; Monday through Friday, 9:00 a.m. to 5:00 p.m. with yet to be determined lunch hour, 28924 South Western Avenue, Suite #202, Rancho Palos Verdes, (310) 833-5144.
COASTWISE ZENITH UPDATE
Coastwise Zenith Representative, David Bisuano may be reached at (310) 830-6116 ext. 122, Monday through Friday, 8:30 a.m. to 4:10 p.m. or if you’d like to come into ILWU Local 13 – 630 South Centre Street, San Pedro, CA 90731 please sign in at Receptionist’s desk and patiently wait to be seen. While you wait make sure to have your claims/bills ready and out of the envelope.
Reminder: This service is available to Members and their family only, NOT PROVIDERS, please take advantage of this service while available at Local 13.
If you have any changes to your ADA accommodations you must attend the ADA JPLRC.
ADA JPLRC meetings are scheduled the 1st and 3rd Tuesday of each month at 9:00 a.m. at Pacific Maritime Association, 300 Oceangate, 12th Floor, Long Beach, CA 90802 (no parking validation).
APPOINTMENT WITH THE HEALTH BENEFITS OFFICER
The Health Benefits Officer maintains an open door policy, however, if you need special assistance, (i.e. retirement, disability or personal matter) we recommend that you schedule an appointment with Jerry Avila at (310) 830-6116.
LONG LIVE THE ILWU!
Health Benefits Officer
HB Bulletin #53-15
ILWU Local 13
630 Centre Street,
San Pedro, Ca 90731, USA
Local Office (310) 830-1130
Business Agent (310) 830-1877
Health Benefits (310) 830-6116
Dispatch Hall (310) 834-7213
Dispatch “The Tape” (310) 834-7217
PMA Training Center (310) 847-1600
Alcohol-Drug Recov. Prog.(310) 547-9966
Record Clerk (310) 834-7386
Casual Hall (Tape) (310) 607-4974
International (415) 775-0533
Clerks Local 63 (310) 521-636
Foremen’s Local 94 (310) 832-1109
Memorial Association (310) 830-3591
PMA (562) 495-7600