Seattle Police Manual

3.180 – Illness & Injury

Effective Date: 3/2/2011

I. Confidentiality of Medical Information

A. Medical Absence Reports (form 2.11) are personnel records and are afforded protection from unwarranted disclosure, under RCW 42.56.230. It is the responsibility of Department supervisors and administrators to ensure that employees' personal privacy is respected. It is necessary to regard an employee’s medical condition as confidential information, and such should not be disseminated without their permission. This includes notification about employee illness issues sent via radio, e-mail, or MDT. In any instance of a Department-wide notification being made, do not disclose medical information about an employee without their permission.

II. Definitions

A. “Eligible family member” for the purposes of sick leave usage means (SMC 4.24.005A):

 

1. The employee’s child, regardless of age (i.e. the biological, adopted, foster or step child of an employee or his or her spouse/domestic partner, or a legal ward or a child for whom the employee or his or her spouse/domestic partner stands in loco parentis).

2. The employee’s spouse or domestic partner designated by the employee in an Affidavit of Marriage/Domestic Partnership or otherwise as provided by SMC 4.30.020.

3. The grandparents of an employee or his or her spouse/domestic partner (i.e. the parent of an employee’s birth, adoptive, foster or step parent; or the parent of an employee’s spouse’s or domestic partner’s birth, adoptive, foster or step parent).

4. The employee’s birth, adoptive, foster or step parent or an individual who stood in loco parentis to the employee when the employee was a child; or a birth, adoptive, foster or step parent or individual who stood in loco parentis to the employee’s spouse or domestic partner when the spouse or domestic partner was a child.

5. The employee’s legally recognized spouse.

6. The employee's sibling or the sibling of the employee's spouse or domestic partner.

B. “Health care professional” means a person whose services are of a type for which compensation is paid under any City health care plan.

C. Place of recovery:

 

1. The residence at which the employee resides when commuting daily to work,

2. The hospital at which the employee is admitted, or

3. Any other address specifically identified by the employee as their residence during the recovery period.

III. Accumulation/Use of Sick Time - LEOFF II and non-sworn Employees

This manual subsection is meant to be a guide and is not meant to confer any rights independent of labor agreements, ordinances, civil service regulations or state statutes relating to sick leave. Sworn employees appointed after September 30, 1977, “and who are represented by the Police Officers' Guild will receive whatever benefits of the City's sick leave program as are established in the labor contract between the City and such organization.” (Reference: SMC 4.24.010, and SMC 4.24.035)

A. All classified Civil Service employees are eligible for cumulative sick leave per Civil Service regulations.

 

1. Exempt employees are eligible for cumulative sick leave per SMC Chapter 4.24.

B. Employees shall accumulate sick leave credits from the date of entering City service and shall be entitled to such leave with pay after thirty calendar days of employment.

C. In order to establish eligibility for the use of sick leave, funeral leave, or Family and Medical Leave for an employee’s spouse, domestic partner, or their spouse or domestic partner’s eligible family members, employees must:

 

1. File an Affidavit of Marriage/Domestic Partnership with the Human Resources Section within 30 days of the commencement date of his or her marriage or domestic partnership; or

2. File an Affidavit of Marriage/Domestic Partnership with the Human Resources Section during the regularly scheduled open enrollment for medical coverage.

D. Termination of marriage or domestic partnership.

 

1. Employees must file a Statement of Termination of Marriage/Domestic Partnership (City of Seattle form) with the Human Resources Section within 31 days of a divorce or termination. For domestic partnerships, a subsequent Affidavit of Marriage/Domestic Partnership may not be filed until 90 days have elapsed from the termination of the prior partnership.

E. Employees may use accumulated sick leave when the officer or non-sworn employee is required to be absent from work because of a personal illness, injury, or medical disability incapacitating the officer or employee for the performance of duty, or personal health care appointments.

F. Officers appointed after September 30, 1977 (LEOFF II) and non-sworn employees who accrue sick leave may use accumulated sick leave for the non-medical care of a child, as designated below, provided such leave may only be used prior to the first anniversary of the child’s birth or placement.

 

1. Non-medical care of a newborn child of the officer or employee or his or her spouse or domestic partner,

2. Non-medical care of a dependent child placed with the officer or employee or his or her spouse or domestic partner for purposes of adoption, including any time away from work prior to or following placement of the child to satisfy legal or regulatory requirements for the adoption,

G. Officers appointed after September 30, 1977 (LEOFF II) and non-sworn employees who accrue sick leave may use accumulated sick leave when an illness, injury, or health care appointment of their eligible family member requires the officer or employee’s absence from work, or when such absence is recommended by a health care professional. This ordinance imposes no limitation on the amount of accumulated sick leave that may be used for the care of dependent children and other authorized persons (See also Seattle Police Manual Section 4.030 - Family and Medical Leave).

H. Conditions that do not qualify an employee to use cumulative sick leave:

 

1. When an employee is suspended, on leave without pay, laid off, or on other non-pay status,

2. If an employee’s sickness occurs when off work, on weekends (furloughs), holidays, or at any other time outside the regular work schedule,

3. If an employee has a slight illness or indisposition which does not prevent the employee from performing their regular duties,

4. If an employee is injured or disabled while working for an employer other than the City of Seattle and the illness or disability arises there from.

IV. Sick Leave for LEOFF I Employees

A. LEOFF I employees are entitled to take up to six months of sick leave per indisposition.

B. Officers appointed prior to October 1, 1977 (LEOFF I) are not eligible for the benefits of the Family and Medical Leave Ordinance -in that they cannot use accumulated sick leave while on Family Medical Leave.

V. Disability and Ordinary Illness (Sworn and non-sworn )

A. All sick time will be assumed to be ordinary illness or off-duty incurred injury; and income tax will be withheld, unless:

 

1. The sick time involves an injury incurred during on-duty time, and all required and/or appropriate Industrial Injury forms are completed and submitted in a timely manner as provided for in Part VII of this procedure; or

2. The illness or injury can be clearly shown to be service connected, and all required and/or appropriate Industrial Injury forms are completed and submitted in a timely manner as provided for in Part VII of the procedure.

NOTE: Both 1 and 2 above must be properly documented.

B. Utilization of Long Term Disability for LEOFF II and non-sworn Employees

 

1. If the employee is utilizing the long term disability insurance provided by SMC 4.34.055 or current collective bargaining agreements, the employee will (after a 30 day elimination period for LEOFF II officers or a 90 day elimination period for non-sworn s) have the option whether to utilize sick leave, compensatory time, or vacation time prior to being placed on an unpaid leave of absence.

C. Where an employee has exhausted their sick leave balance, the employee may use vacation time for medical reasons only with prior approval of the Chief of Police or his designee.

D. Endorse any checks from the State of Washington, or any insurance companies (received as disability compensation for periods wherein City pay is received), as payable to the “City of Seattle Treasurer's Office.” Submit these checks to the Department's Fiscal, Property, and Fleet Management Section promptly upon receipt.

E. As soon as notification is received that an employee is requesting sick leave, the supervisor shall prepare a Medical Absence Report (form 2.11) and immediately forward the appropriate copy to the Employment Services Lieutenant.

 

1. A Medical Absence Report (form 2.11) is to be completed for all authorized use of sick leave that results in time loss.

2. A Medical Absence Report (form 2.11) is a confidential document that becomes part of the employee's personnel file. Therefore, the original and all copies shall be forwarded in a sealed envelope.

3. The original form shall be retained by the commanding officer of the absentee. When the employee returns to duty, the first line supervisor shall enter the date and time of return and sign it, obtain the employee's signature on the form, and forward it in a sealed envelope to the Employment Services Lieutenant.

4. A supervisor from the sick or injured person's unit of assignment shall contact the employee at least once every three days during the first two weeks of absence. Supervisors shall immediately notify their commanding officer of any suspected violation of sick leave regulations. After the first two weeks, future contacts shall be made by the Employment Services Lieutenant. Supervisors are encouraged to maintain contact with employees during lengthy absences.

5. During long-term absences due to sickness or injury, the Employment Services Lieutenant (or designated representative) is required to contact the employee periodically throughout the absence and shall report any unusual circumstances to the employee's Bureau Chief. The Employment Services Lieutenant shall keep records of contacts made with employees.

NOTE: Timekeeping - When an employee working other than a 5 and 2 schedule begins an anticipated or obvious extended sick leave (15 or more calendar days), they shall be placed on a 5 and 2 schedule. Employees and supervisors are reminded that should a LEOFF II or non-sworn employee use all of their accumulated sick leave, they must use any other accumulated time (vacation, comp, holidays, etc.) before they go to a no-pay status.

6. It is the responsibility of Human Resources, the employee’s supervisor or their designees to submit a change of status for the employee via the PEDS when the employee’s extended sick status goes beyond two weeks. The employee will then be placed into the “X” (unavailable personnel), org for their respective unit.

VI. Sick Leave Reporting Responsibility

A. Personnel who are requesting sick leave shall notify or have notification sent to their supervisors or commanding officers at the beginning of or prior to the start of their regularly assigned shift on the first day of their request to be absent from duty.

 

1. Notification of the employee’s supervisor shall be as soon as possible when an illness (or, for LEOFF II and non-sworn employees, care for an eligible family member’s illness) occurs while on vacation or compensatory time off and will extend into the period in which the employee is to return to duty.

2. A completed and approved Family and Medical Leave (FML) certification must be on file in order for a period of absence to be designated and reported as FML.

B Place of Recovery

 

1. While on sick leave, an employee shall not leave their place of recovery without prior permission from the Director of Human Resources or the Employment Services Lieutenant. Permission shall not be denied if the employee has a signed health care provider’s certification advising that the employee is unable to work and that recovery from the illness or injury will not be impeded by allowing the employee to leave their place of recovery.

 

a. Exceptions to the requirement for prior permission are visits for medical treatment, sudden unexpected personal emergencies, attendance at religious services, and voting.

2. Employees who change their place of recovery shall promptly notify the Employment Services Lieutenant. In any event, notification must be made within 48 hours.

NOTE: Employees who wish to recover at an address outside the Puget Sound Basin shall make a written request to the Director of Human Resources justifying the need to recover outside the immediate area. LEOFF I officers will be governed by the rules of the Seattle Police Pension Board when requesting out of state travel during sick leave.

VII. Return To Duty

A. The Washington State Insurer Activity Prescription Form (APF) replaced the Department’s Medical Certification for Work (form 2.15) as of February 19, 2008. This form is available through the SPD Web.

B. LEOFF I Employees

 

1. Sworn personnel (hired prior to October 1, 1977), before returning to duty from an absence due to illness or injury of more than five (5) consecutive days, shall submit a health care provider’s certification on a Insurer Activity Prescription Form (APF) to their supervisor and to the Employment Services Lieutenant attesting to their fitness for duty.

 

a. The Seattle Police Pension Board may require a separate examination. A Board Doctor shall conduct this examination.

b. The Director of Human Resources (or designee) shall then inform the employee via the chain of command, whether their return is to remain conditional or their return is to a full duty status.

C. LEOFF II and non-sworn Employees

 

1. All uses of sick leave, except for funeral leave, which exceed four (4) consecutive days and any illness or injury in which the health care provider’s certification approves return to work with medical or physical restrictions must be reported on a Insurer Activity Prescription Form (APF). Forward the completed form to the Employment Services Lieutenant.

VIII. Procedure for Reporting On-Duty Injury

A. All employees shall promptly report each occupational illness or injury to their immediate supervisor, regardless of the degree of severity.

B. An Investigating Supervisor's Report of Employee's Industrial Injury (form 2.22) must be completed by a supervisor for each incident of an employee injury (including verifiable occupational exposure or illness) not previously reported.

 

1. It shall include specific information that describes how and why the illness or injury is “service connected.” The completed form shall be distributed with the original to the Employment Services Lieutenant, and one photocopy each to the Safety Officer and the employee’s unit of assignment (2 copies).

C. If the illness or injury results in any work time loss, a Medical Absence Report (form 2.11) must be filled out for the injured employee by a supervisor. The supervisor shall note on the form the claim number, injury date, and General Offense Number or other pertinent information to establish the injury or illness as duty related.

D. The Insurer Activity Prescription Form (APF) must be completed whenever an employee receives medical attention from a health care provider for an on-duty injury, prior to their return to duty. This form is located as a PDF on the SPD Web.

 

1. This form requires completion and a signature from the attending health care professional, and must also be signed by the employee

E. Copies of accident reports, Officer Statements (form 9.27), and supervisor's reports pertaining to the employee's injury or illness shall be sent to the Safety Officer at the earliest date.

F. LEOFF II Officers and non-sworn Personnel - Report of Injury, Labor and Industries Self Insurer Accident Report (SIF-2)

 

1. Under State law an employee must file a claim within one year from the date of the accident or within two years from the date a health care provider has advised the employee that they have contracted an occupational disease.

2. Prompt reporting assures each worker that their injury will receive adequate medical attention and that other applicable benefits will be provided on a timely basis.

3. The first line supervisor must be notified of any industrial injury and shall be responsible for following through on further reporting requirements.

4. When to Report:

 

a. Where there has been a sudden unexpected and tangible event that results in injury to an employee, the employee is required to report the incident immediately to their supervisor. In no event shall the employee report the injury later than the scheduled end of the current work shift.

b. Where an employee is uncertain as to any particular event but has reason to believe the symptoms are related to on-the-job exposure, the employee shall report the symptoms and suspicion of industrial causation to their supervisor immediately. In no event shall the injury be reported by the employee later than after the start of the employee's next scheduled shift.

5. Reporting Procedures

 

a. The Supervisor upon receipt of such report shall always complete a Self Insurer Accident Report (SIF-2) for every injury or exposure to a LEOFF II or non-sworn employee if any medical treatment is required.

 

(1) Medical treatment is defined as care provided by a non-departmental medical clinic or personnel. For example, if the only medical treatment were by Medic I under a health care provider’s direction, a SIF-2 would not be necessary.

(2) If there is no medical treatment documented by a SIF-2 form, any time loss will be charged to the sick leave of the employee.

b. The top portion of the Self Insurer Accident Report (SIF-2) must be completed by the injured employee, or their representative if the injury is severe and the employee cannot personally complete the form.

c. The employee shall retain their copy of the form. Special attention should be directed to the reverse of this copy, which contains a statement of the worker's rights and obligations. The supervisor shall review this with the worker at the time the form is distributed.

d. The supervisor shall immediately provide the employee with printed or electronic copies of the brochure, “A Guide to Industrial Insurance Benefits,” and the card, “Help for Injured Workers of Self-Insured Businesses.” These documents can be found on the SPD Web.

e. The immediate supervisor shall complete the lower portion of the form (entitled “employer”) and may make a photocopy of the completed form for Unit records purposes.

f. The completed form shall be delivered to the Seattle Police Department’s Human Resources within 24 hours.

 

(1) If mailing or transportation of the report will exceed 24 hours, the supervisor shall fax a copy of the Self Insurer Accident Report (SIF-2) to Human Resources within 24 hours, and deliver the original as soon as possible.

(2) If the accident notification occurs on a weekend or holiday, the report shall be delivered by the next working day to Human Resources.

g. The supervisor should also obtain from the employee the details of the incident including, but not limited to:

 

(1) The date, time, and place where the incident occurred; names of witnesses and co-workers present,

(2) Identification of the vehicle(s) or equipment involved in the incident,

(3) History of prior similar incidents at this location or with this employee (if any),

(4) Immediate symptoms/signs of injury perceptible by the supervisor,

(5) Symptoms/signs reported by the injured employee, and

(6) The name and address of the health care provider who will be providing initial treatment.

h. The supervisor should review with the employee, all portions of the claim form and assist the employee with any questions on the manner of completing the form.

i. Whenever possible, the employee and the supervisor should complete the form at the initial meeting.

G. Additional Procedures for Processing On-Duty Injury/Return to Work for LEOFF II Officers (hired after September 30, 1977) and all non-sworn Employees

 

1. When an employee receives medical treatment or suffers time loss from work as the result of an occupational injury or illness, the State’s Insurer Activity Prescription Form (APF) must be completed. The State’s Insurer Activity Prescription Form (APF) MUST be completed by the employee and the health care provider at the time of treatment. Signatures of the employee, health care provider, and a supervisor are required prior to forwarding the form to the Employment Services Lieutenant.

IX. Sick Leave Abuse Investigations

A. The Employment Services Lieutenant shall report sick leave abuse cases in writing to the Director of Human Resources, who shall have the responsibility to forward this report to the employee's Bureau Chief for resolution.

 

1. The Employment Services Lieutenant is authorized to act as an agent of the Seattle Police Disability Board for the purpose of investigating and administering disability leave rules and regulations of the Disability Board.

2. The employee's supervisor and the Employment Services Lieutenant shall be alert for indications of sick leave abuse/violation. The employee's commanding officer shall be notified of any suspected abuse or violation of the sick leave rules.

 

a. Inquiries into an employee's status on sick leave shall normally be conducted via telephone.

b. The employee's supervisor or the Employment Services Lieutenant or their designee may visit an employee's place of recovery when an abuse or violation of sick leave rules is suspected or when attempts at telephone contact have been unsuccessful.

X. Mandatory Reporting Program

A. Employees who have been determined to have used an excessive amount of sick time that is not FML certified or indicates some pattern of sick time abuse, may at the discretion of the Director of Human Resources, be assigned to the Mandatory Reporting Program.

B. Employees assigned to the Mandatory Reporting Program shall be required to submit an Insurer Activity Prescription Form (APF) signed by their health care provider, before returning to work. This procedure must be followed for any absence that resulted in the use of sick time.

C. Sworn LEOFF I employees assigned to the Mandatory Reporting Program who return to work after more than five (5) consecutive days of sick leave shall be considered to have returned to duty on a conditional basis. The Director of Human Resources (or designee), after reviewing the employee's Insurer Activity Prescription Form (APF) will determine if a return to duty shall be granted.

XI. Referring Employees for Psychological Evaluation by a Consulting Psychiatrist/ Psychologist

A. An employee's Bureau Chief may make a request for referral to a psychologist by contacting the Director of Human Resources and providing documentation of the behavior affecting an employee’s ability to perform their duty. The Director of Human Resources shall make any referrals to an outside consultant, if deemed necessary. Psychological evaluations are to be conducted in accordance with the Americans with Disabilities Act.

B. If an outside consultant is used, a written evaluation of the employee shall be required from the consultant. The evaluation shall include the following:

 

1. An assessment of the employee's ability to perform full duties or a recommendation to place the employee on limited duty.

 

a. If the recommendation is for limited duty, an estimate of how long it will be necessary to keep the employee on limited duty and what limitations will apply. Normally limited duty shall not last longer than sixteen weeks, except for pregnant employees per SMC 4.10. See Seattle Police Manual Section 3.200 - Limited Duty Assignments.

b. If limited duty is recommended, the consultant shall specify what support services or follow-up visits may be needed.

C. The consulting psychologist, the employee's Bureau Chief, and the Director of Human Resources (or designee) shall review the evaluation and decide on a recommended course of action, which shall be forwarded to the Chief of Police for concurrence.

D. If limited duty is the selected course of action, the necessary paperwork shall be completed by the Employment Services Lieutenant and handled in accordance with the Department's limited duty policy.

XII. Surrendering Firearms While on Sick Leave

A. Officers commencing sick leave for mental or emotional stress shall immediately surrender all Department-issued firearms in their possession to their immediate supervisor. The firearm(s) shall be turned over to the officer's immediate supervisor for safekeeping until the employee is released back to duty. The Employment Services Lieutenant will be responsible for taking possession of the firearm from the immediate supervisor.

B. Throughout the duration of a sick leave for mental or emotional stress, an officer is relieved from the obligation to take the proper police action that would ordinarily fall to a police officer in an off-duty status. Nothing in this statement is meant to relieve an officer from proper actions short of direct involvement or intervention, such as reporting emergencies to 911 and recording their observations of criminal conduct.

XIII. Restrictions on Employment Activities While on Sick Leave

A. No Department employee shall engage in any profession, trade, or occupation, for pay or as a volunteer, including any type of military service or duty, while on sick leave, extended disability leave, or on release time (See Seattle Police Manual Section 5.120 - Secondary Employment).

NOTE: Upon written request, permission to engage in secondary employment while on extended sick leave may be granted upon a health care provider’s medical recommendation to the Director of Human Resources and upon approval from the Chief of Police. Permission must be granted in writing prior to engaging in each such employment activity.

XIV. Reporting of Injuries to Reserve Officers

A. All reserve officers are required to report any occupational injuries or exposures that occurred while representing the City of Seattle as an on duty reserve officer. These injuries shall be reported to the Precinct Reserve Squad Supervisor, or to an available patrol supervisor.

B. Reporting of injuries to reserve officers is covered under RCW 51.12.035 and have significant procedural differences when compared to the reporting of injuries to full time officers. The injury documentation is processed through the City of Seattle Risk Managers Office, utilizing insurance forms that are specific to Reserve Officers. These forms include the following, which are available through the Precinct Reserve Squad Supervisor, or the Reserve Unit Administrative Supervisor. Copies of all completed forms must be forwarded to the Reserve Unit Administrative Supervisor.

 

1. Proof Of Loss-Short Term Disability Benefits

2. Authorization to Release Information

3. Proof of Loss-Medical Benefits

4. Proof of Loss-Accidental Death Insurance

5. Proof of Loss-Accidental Dismemberment Insurance

C. Regardless of severity, all injuries or exposures incurred by the Reserve Officers must at a minimum be documented on an Investigating Supervisor's Report of Industrial Injury (form 2.22). Copies of this form shall be forwarded as follows:

 

1. The original to the Employment Services Lieutenant.

2. Photocopy to the Safety Officer.

3. Photocopy to the Precinct Reserve Squad Supervisor.

4. Photocopy to the Reserve Unit Administrative Supervisor.

D. Limited Duty Assignments

 

1. Reserve Officers who are experiencing a short-term disability or injury may, with the approval of their Precinct/Section Captain, be assigned to the limited duty position within their precinct or unit of assignment.

2. Reserve Officers will be required to submit documentation of their medical condition requiring a limited duty assignment to their Precinct Reserve Squad Supervisor. This documentation will include any limitation or restriction, and all medications that are listed as schedule narcotics. A photocopy of this documentation shall be forwarded to the Reserve Unit Administrative Supervisor.

3. Limited Duty assignment will normally be limited to no more than 16 weeks, but can be extended at the discretion of the reserve officers Precinct/Section Captain.

4. Reserve Officers may not work any form of police related secondary employment while assigned to a limited duty position.