HR0397 – Worker’s Compensation

HR0397 – Worker’s Compensation

Topics:

Objective:

Workers’ compensation benefits for university employees are provided by the State of Tennessee in accordance with state law. The State of Tennessee and its Third-Party Administrator (TPA) are responsible for determining benefits payable for work-related injuries and illnesses and for medical treatment decisions.

This policy explains the responsibilities of employees who sustain work-related injuries and their supervisors and provides other information for injured employees. Campus and unit procedures may include additional responsibilities for injured employees and their supervisors.

Policy:

Workplace Injury Reporting Responsibilities

1. Employee Responsibilities
   
   Employees who sustain a work-related injury or illness must:
   1. Call 911 for all emergencies that result in serious bodily injury and seek treatment at the nearest emergency room.  Follow-up doctor and/or specialist appointments must be arranged by the TPA and not by the injured employee or supervisor.  The TPA may refuse to pay bills that are not from State-approved healthcare providers.
   2. For injuries that are NOT serious or life threatening, the injured worker must call the TPA prior to seeking medical treatment. Workers’ compensation reporting procedures may be found on the System Risk Management website here: https://riskmanagement.tennessee.edu/workers-compensation/
   3. Report it to an appropriate supervisor immediately unless unable to do so.  Employees will need to tell their supervisors exactly what happened, how it happened, explain any injuries that resulted from the incident, and identify any witnesses to the injury.
   4. If a supervisor is unavailable, contact the System Office of Risk Management.
   5. Complete all paperwork required by the University or State of Tennessee and assist with notifications to the State of Tennessee and/or its TPA.
   6. Obtain any needed medical treatment consistent with instructions from the TPA.
   7. Cooperate and communicate with the TPA, claims examiner, and University as requested.
   8. Notify their supervisor and human resources, as necessary, regarding their work status while out of work due to a workplace injury.
2. Supervisor Responsibilities Supervisors who receive a report of a work-related injury or illness must complete the following:
   1. Complete the required paperwork and forward to the System Office of Risk Management:
      • Workers’ Compensation Injury Report
      • Workers’ Compensation Procedures
      • Lost Time / Return to Work Calendar

   2. Ensure that the employee contacts the TPA’s Workplace Injury & First Notice of Loss Call Center.  A triage nurse will evaluate the injury and determine the employee’s immediate care or treatment options.  Contact information is in the Workers’ Compensation Procedures form on the Risk Management Office website.  If the employee is receiving emergency medical treatment and unable to contact the TPA’s Workplace Injury & First Notice of Loss Call Center, the supervisor should do so or contact the University’s Risk Management Office to assist.

   3. As soon as possible after the employee speaks with the triage nurse, contact the TPA’s Workplace Injury & First Notice of Loss Call Center and complete the First Notice of Loss.

   4. Address any questions regarding this process to the System Office of Risk Management.

3. In order to encourage prompt reporting of work-related injuries, the State of Tennessee will fine agencies that fail to complete the TPA’s First Notice of Loss within seven calendar days from the time the incident is first reported to the TPA.  Unless extenuating circumstances exist, any such fines will be the responsibility of the department.
4. Additional information about reporting work-related injuries is available on the Division of Claims Administration-Worker’s Compensation Program’s website at https://www.tn.gov/workforce/injuries-at-work/employers/employers/reporting-a-claim.html.

   Absence from Work.

5. An employee who is unable to work as a result of a work-related injury may choose to use accrued sick leave or annual leave for some or all of the lost work days.  An employee who does not have accrued leave available will be placed on leave-without-pay status.
6. An employee whose work-related injury constitutes a “serious health condition” as defined by the Family and Medical Leave Act will receive FMLA leave in accordance with Human Resources Policy HR0338 – Family and Medical Leave.

   Continuation of Benefits

7. Employees who have approved worker’s compensation claims and miss more than seven days’ work pursuant to the treating physician’s determination will be eligible for Temporary Total Disability (TTD) benefits beginning the eighth day of disability.
8. Because TTD benefits are designed to replace a portion of lost income, employees may elect to use sick leave or annual leave instead of receiving TTD benefits for all or part of the time they qualify for TTD benefits.  An employee may not retroactively alter a previous decision to use leave.  An employee may not receive both TTD benefits and also sick leave or annual leave.
9. The amount and duration of TTD benefits will be determined by the TPA in accordance with state law
10. The university will assume 100 percent of the cost of the premium for basic group medical coverage while employees are on an unpaid leave of absence for a work-related injury (subject to any restrictions imposed by the State).

    Return to Work

11. The University seeks to return injured employees to work as quickly as possible.  Human Resources Policy, HR0398 – Transitional Duty/Return to Work Program, contains information about the university’s temporary transitional duty and return to work programs. Supervisor must complete the Transitional Duty Plan Document and forward to the System Office of Risk Management.

    Recordkeeping

12. The System Office of Risk Management will maintain records of worker’s compensation claims and OSHA logs as required by university fiscal policy and applicable law.

Related Policies: HR0338 – Family and Medical Leave, HR0398 – Transitional Duty/Return to Work Program