HR0397 – Worker’s Compensation
|Eligibility And Coverage||Record-Keeping|
|Claims And Reporting Policies: Responsibilities And Timelines||Injuries To Non-Employees|
|Absence From Work||Procedures|
|Return To Work Or Termination||Related Policies|
|Injury Caused By Assault|
To provide medical care and compensation to eligible university employees who are injured or contract occupational illnesses in the course of employment with the university in accordance with federal workers' compensation (WC) law and state of Tennessee regulations.
- For purposes of this policy, an "eligible employee" shall be defined as any person who:
- performs work for the university, and
- is compensated for that work directly by the university, and
- is not covered under any other workers' compensation policy, and
- is not solely an independent contractor or consultant operating under a contract with the university.
- Claims for compensation and medical services in connection with work injuries or illnesses for university employees are submitted to the State of Tennessee Division of Claims Administration (DOC) in accordance with state regulations and procedures. In order to qualify for compensation, the following must occur:
- The employee must seek medical treatment within one year of the injury or illness.
- The claim must be approved by the Division of Claims (DOC) through a contracted claims management service serving as a third party administrator.
- Medical care and service providers must be pre-approved by the claims examiner assigned to the claim by the DOC's contracted claims management service.
All required forms, information, and assistance with procedures are available from the campus or institute workers' compensation representative.
- Employee Responsibilities. An employee who sustains any work-related injury or illness must:
- Report the incident to a supervisor on the day it occurs unless physically unable to do so.
- Complete a report of the injury or illness and submit it to the supervisor or to the campus workers' compensation office to file a claim for compensation with the state DOC.
- Complete and submit any other documentation that may be required by the university.
- Obtain medical treatment from a doctor selected from the list of state-approved primary care physicians and facilities. These can found on the Tennessee Workers' Compensation website, under the 'Primary Care Provider Directory' navigation link. In the event the injury requires emergency treatment, the employee should seek treatment from the nearest emergency room; however, follow-up care must be provided by an approved doctor.
- Complete and submit an accident report even if the injury does not require medical attention at the time of the accident. The report will be considered an "incident only" file, and will be held for one year from the date of injury. In the event the employee later decides to seek medical attention, the completed form will then be filed with the state DOC.
- Submit any bills or receipts for related medical services or prescriptions to the campus workers' compensation representative if the workers' compensation claim is approved.
- Comply with all treatment prescribed by the approved treating doctor (if receiving compensation either for medical expenses or for lost time) and provide all medical records required by the claims examiner. Non-compliance may result in loss of compensation.
- While on medically required sick leave or leave of absence, maintain contact with department by submitting all release/return-to-work information to supervisor after doctors' visits, and communicating with department on a regular schedule arranged by supervisor.
- Departmental Responsibilities. A university supervisor with knowledge of a work-related injury or illness shall:
- Immediately provide the employee with all required forms for reporting the incident and assist the employee in locating an approved medical provider (either by directing the employee to the list of approved doctors (see 3.d. above) or by assisting the employee in contacting the campus workers' compensation office).
- If an injured employee is unable to complete the necessary forms, report the incident in writing on the employee's behalf within one business day of knowledge of the incident.
- Complete any supplemental forms as required by the university and immediately route the completed forms to the campus workers' compensation office or representative. The supervisor may also choose to assist the employee in filing the claim directly by faxing the completed accident report to the state Workers' Compensation Call Center (toll-free 866-261-5795) or by helping the employee call the Call Center directly (toll-free 866-245-8588). If a claim is filed directly by the employee or the department, claim documents must still be forwarded to the campus workers' compensation office.
- Submit an "incident-only" report for a work-related injury or illness, which does not involve medical attention or time lost from work, or for which an employee refuses to file a claim.
- Provide lost time information to the campus workers' compensation office, which includes specific dates and types of leave taken (sick leave, annual leave, or leave without pay), and date of return to work. If an employee is placed on restrictive duty, the department shall provide information regarding specific days of restricted duty and date of return to full duty.
- Maintain positive communication with employee on extended sick leave or leave of absence by establishing a regular contact schedule with absent employee (every two weeks is recommended).
- Campus or Institute Workers' Compensation Responsibilities.Upon receiving a report of work-related injury or illness, the designated campus or institute workers' compensation representative shall:
- Submit the required information to the DOC's claims management service within one business day of receiving the claim.
- Submit a copy of each claim or "incident-only" report and all supporting documentation (including initial medical information) to the system workers' compensation office within one week of receiving the claim or report.
- Submit one copy of each reported claim or incident-only report to the appropriate campus or institute safety officer, exclusive of medical information (per HIPPA privacy regulations).
- Forward claims-related bills and medical reports to the employee's claims examiner appointed by the claims management service. All other claims-related documents received or generated at the local campus or institute (such as work releases, lost time calendars and leave information, restricted duty and return-to-work information, correspondence or e-mail with employee regarding claim) shall be forwarded to both the claims examiner and the system workers' compensation office.
- Provide the DOC with certification of the employee's actual earned income from the university for the entire 52 weeks preceding the day of injury if the injured worker becomes eligible for temporary total disability pay (i.e., "lost time pay"). Income includes all base salary, overtime, longevity pay, and any bonuses received. Certification of the income shall be copied to the system workers' compensation office.
- System Workers' Compensation Office Responsibilities. To assist the overall workers' compensation process, the system workers' compensation office shall:
- Establish procedures for implementing the university workers' compensation policies, and provide training and support to campus or institute representatives, employees, supervisors, and departments in workers' compensation policies, procedures, and activities.
- Determine the OSHA-reportability of all work-related injuries and illnesses throughout the university; and maintain and publish the required OSHA logs and annual reports.
- Serve as the custodian of record; maintain and preserve claims documentation as outlined in FISCAL POLICY FI0120, RECORDS MANAGEMENT.
- Absence on the Day of Injury/Illness. In the event an employee is unable to continue working due to a work-related injury or illness, the employee will receive his or her regular pay for the entire work shift for the day of the work-related injury or illness.
- Leave Election for Subsequent Days Away From Work. An employee who is unable to return to work after the day of the work-related injury may choose to use accrued sick leave or annual leave for the lost work days. An employee with no accrued annual leave will be placed on leave without pay.
- During medically-required absences of one day or longer, an employee with an approved workers' compensation claim may choose to use leave without pay instead of sick or annual leave, or may choose to combine sick, annual and leave without pay. However, the employee may not retroactively alter a previous use of leave after the time records have been submitted to the university time-keeping system.
- If the employee elects leave without pay, the department must make the necessary system changes to place the employee on inactive pay status. The department must report the days away due to the injury (either annual, sick, or leave without pay) as workers' compensation time, and must notify the campus or institute workers' compensation office of the exact days of the lost time and types of leave used.
- An employee who returns to work may be granted reasonable time off from work for physical therapy, examinations or other medical treatments required by the approving physician. This time off must be approved in advance, and the employee must choose to use sick, annual, or leave without pay. The employee should schedule time off so as to create minimal interruptions to departmental work.
- Temporary Total Disability Pay (TTD). An injured employee may qualify for replacement pay from the state Division of Claims for extended periods of TTD (also known as lost work time) under the following guidelines:
- The claim must be accepted or approved by the DOC or the claims management service.
- The injured employee becomes eligible for TTD pay after having been away from work for seven (7) calendar days due to the injury and the time off from work must be on doctor's orders. TTD pay begins with the eighth (8th) day of an approved absence.
- The employee may receive TTD pay for eligible days only if the days were designated as leave without pay. The employee will not receive TTD pay for eligible days if the days were covered by sick or annual leave.
- An employee who is on approved workers' compensation absence for more than fourteen (14) calendar days may be eligible for retroactive TTD pay for the first seven calendar days of lost work time if the time lost was leave without pay and was not covered by any other paid leave.
- TTD pay is based on the employee's average weekly gross salary for the year preceiding the accidental injury, and is equal to two-thirds of that weekly salary, up to the maximum allowable by state law. It is not taxable income.
- TTD is paid on a bi-weekly basis directly by the state DOC, and continues until such time as the consulting physician states that the employee has either recovered sufficiently to resume work or has reached maximum recovery.
- An employee who is enrolled in either the TCRS or JCRS retirement plan is entitled to claim up to one year of a TTD period as creditable service toward retirement, providing he or she returns to active service immediately following the end of the workers' compensation TTD benefits, or retires during or immediately following the TTD period.
- Continuation of Benefits. Eligible for various benefits during a workers' compensation leave is described in POLICY HR0355, LEAVE OF ABSENCE, except as noted below.
- The university will assume 100 percent of the cost of the premium for basic group medical coverage in force at the time of the work-related injury or illness for an employee who is placed on leave of absence without pay for one full workday or more, providing that the lost time claim is approved by the state DOC.
- The university will assum 100 percent of the cost of the premium for basic group medical insurance coverage regardless of whether or not the state has approved the claim if the injured employee is placed on leave of absence without pay for an entire calendar month. Such payment begins on the first day of the month subsequent to the date on which an employee is officially placed on leave without pay.
- University payment of 100 percent of these preimums will end on the first day of the month after any of the following occur:
- The employee returns to an active pay status on the university payroll; or receipt of medical certification that the employee is able to return to work.
- The employee ceases to draw workers' compensation benefits for lost work time, or the employee is denised workers' compensation benefits for lost work time, whichever comes first.
- The employee receives a permanent rating of disability from the employee's approved workers' compensation physician.
- The death of the employee.
- Modified Work Schedule and Duties. The university encourages the use of modified work schedules and/or modified duties if beneficial to both the employee and the department. Modified work schedules and/or duties are temporary, and are granted only with the expectation that the employee will be able to return to full performance of the original duties after a reasonable period of time.
- An employee who has not yet been released for full return to work may be returned to work on a modified work schedule and/or with the modified work duties with the approval of the treating physician and supervisor, and as appropriate for the employee's abilities.
- If a physician determines an employee can work on a part-time basis, state workers' compensation provides for payment of two-thirds of the salary difference between the average weekly wage at the time of the injury and the weekly wage earned in the part-time work, subject to statutory maximums. The department pays the employee only for actual hours worked.
- Any modified schedule and/or duties should be reviewed periodically (every 7-14 days is recommended) to determine if such schedule and duties are still warranted and can be continued by the university. As part of the review process, an updated physician's statement may be required.
- In instances where the work-related injury leads to a disability within the guidelines of the Americans with Disabilities Act, reasonsable accommodations will be considered.
- FMLA Protection. Under the provisions of the Family and Medical Leave Act, an injured employee may have some rights to a period of job protection during a workers' compensation absence. Under this Act, the protected period could be up to twelve weeks, depending on the employee's use of any Family Medical Leave during the preceding year. Regardless of the status of a workers' compensation claim, in the event an injured employee is unable to return to work upon expiration of any FMLA leave rights, the employee's appointment with the university may be terminated at the university's discretion.
- Disability Retirement. An injured employee who is unable to return to duty, and who is enrolled in the TCRS or JCRS retirement system, may have some rights to disability retirement, even if the employee has not been a state employee long enough for vesting in the state retirement system.
- In the case of a job-related injury caused by an assault, upon approval by the State Department of Finance and Administration, the university may provide a salary continuance benefit of 100 percent of the employee's salary for up to a maximum of 28 calendar days without requiring the employee to use any sick or annual leave.
- The Tennessee Department of Finance and Administration must receive the claim within ten (10) calendar days from the date of injury; the claim is forwarded to that department by the system workers' compensation office.
- If the employee is unable to work within the initial 28 days, the Division of Claims Administration must approve the claim for any additional salary continuance benefits. If approved, the employee will continue to receive 100 percent of his or her salary up to an additional 62 days. In no event shall the total period of salary continuance exceed 90 calendar days.
- The university will be reimbursed for two-thirds of the employee's base pay up to the maximum dollar amount specified in the state law for any salary continuance paid by the state for approved assault claims.
- The university system workers' compensation office shall maintain records of workers' compensation claims and OSHA logs as required by university fiscal policy and OSHA regulations.
An injury to a non-employee on university property must be reported by an employee having knowledge of the injury to the campus or institute safety office and the university system risk management office. Refer to FISCAL POLICY FI0135, INSURANCE WORKERS' COMPENSATION, GENERAL LIABILITY, AUTOMOBILE ACCIDENT CLAIMS, AND PROPERTY.
|Health Science Center:||uthsc.edu/policies/w932_document_list.php?app=HR|
|Institute of Agriculture:||ag.tennessee.edu/Pages/UTIApolicies.aspx|