Workers' Compensation Injuries, UPPS No. 04.04.43
Illnesses and Claims Issue No. 9
Review: May 1 E3Y
01. POLICY STATEMENTS
01.01 Under the provisions of the State Office of Risk Management (SORM) Workers' Compensation Program, each state agency is required to establish policies and procedures for the prevention of accidents, the enhancement of safety programs, and the processing of compensation claims. Specific objectives of this UPPS are to:
a. establish and disseminate university policy relating to the SORM Workers' Compensation Program. The university will inform employees of their rights under the Workers' Compensation Act through campus-wide postings, the new employee benefit packet, and orientation programs. Student employees will receive the benefit information as part of their new hire packet;
b. identify duties of the director, Environmental Health, Safety, and Risk Management;
c. identify duties of the workers’ compensation specialist (workers’ comp specialist) charged with workers' compensation;
d. establish procedures for processing workers' compensation claims; and
e. provide for periodic update of information to conform with state regulatory requirements.
01.02 Return to Work Program
a. The Return to Work Program provides a university employee sustaining a compensable workplace injury an opportunity to return to work at full duty. If the employee is not physically capable of returning to full duty, the Return to Work Program provides opportunities when available, for the employee to perform a temporary assignment that modifies the employee’s regular position to accommodate the employee’s physical capabilities. Temporary assignment in a restricted duty status under the Return to Work Program will not exceed sixty cumulative calendar days per claim. If the employee is unable to return to work without restrictions within the sixty cumulative calendar day period, the university will place the employee on leave status at the end of that period. The employee will remain off work until he or she receives a non-restrictive release.
b. The Return to Work program does not imply that an employee participating in the program has a disability as defined by the Americans with Disabilities Act 2008 (ADA). If an employee sustains an injury or illness that results in a disability, it is the employee’s responsibility to inform his or her supervisor or a person in a responsible management position and follow the procedure in UPPS No. 04.04.60, Workplace Accommodation.
c. The workers’ comp specialist will provide employees with specific procedures regarding the Return to Work Program, when necessary.
02.01 Accident Prevention Coordinator: The director, Environmental Health, Safety, and Risk Management is responsible for implementing and administering the Accident Prevention Program at Texas State.
02.02 Workers’ Comp Specialist: The workers’ comp specialist serves as the workers' compensation claims coordinator responsible for coordinating workers' compensation claims and the associated Return to Work Program at Texas State.
02.03 Reportable Incident Injury, or Illness: Any incident, injury, or illness involving a university employee that occurred as a result of university employment. An incident occurs when there is no physical or visible injury at the time, but may become an injury at a later date.
02.04 Workers’ Compensation Claim: A claim for compensation filed by a university employee for an injury or illness occurring in the course of employment that result in either:
a. more than one day of lost time; or
b. medical services from a job-related injury or illness.
02.05 Return to Work Program: On a case-by-case basis, employees absent from work due to a work-related injury or illness may return to work with medical work restriction for a period not to exceed sixty cumulative calendar days per claim, if approved by the employee’s department head and the workers’ comp specialist.
02.06 Additional Duty Safety Officers (ADSO): Department heads appoint these persons in accordance with UPPS No. 04.05.01, Risk Management and Employee Safety and Health Program to assist in administering this program. Their responsibilities include:
a. serving as a point of contact with the Environmental Health, Safety, and Risk Management Office;
b. reviewing incidents and helping supervisors complete incident reports;
c. facilitating investigation of the incident; and
d. making recommendations for preventing similar incidents.
03. STATE EMPLOYEES WORKERS' COMPENSATION PROGRAM
03.01 The State of Texas provides workers’ compensation coverage for the state employees as a self-insurance program, providing compensation and medical benefits for injuries and occupational illness arising from state employment.
03.02 SORM administers the State Employees Workers’ Compensation Program for university employees. SORM is responsible for processing and paying workers' compensation claims, providing risk management guidelines, legal and administrative services for state agencies.
03.03 A Texas State staff, faculty, or student worker, who sustains an injury or illness on or after July 18, 1975, is eligible for workers’ compensation benefits under the Texas Workers’ Compensation Act.
04. RESPONSIBILITIES AND DUTIES
The claims procedure checklist (Attachment I) contains an abbreviated list of the responsibilities outlined in this section.
04.01 As a state employer of record, Texas State has responsibilities to the injured employee, SORM, and the Texas Department of Insurance Division of Workers’ Compensation (DWC).
a. Texas State’s responsibility to the injured employee: Texas State must notify employees of workers’ compensation coverage and the requirements to obtain benefits by including notification in the New Employee Benefit Package, presenting the information in the New Employee Orientation, and posting notices throughout the campus.
b. Texas State's responsibilities to SORM:
1) Submit Employers' First Report of Injury or Illness DWC-1S. The university submits this report if the employee incurs personal medical cost or loses more than one day from work;
2) Submit an Employee Election of Receiving Workers' Compensation Disability Payments – Form SORM-80;
3) Submit a Witness Statement Form SORM-74, if applicable;
4) Submit Supplemental Report of Injury – DWC-6. Supplemental reports are submitted when:
a) An employee begins lost time from work;
b) An employee returns to work following absence from work for one or more days;
c) An employee, after returning to work, has additional days of disability because of the injury;
d) If the employee has an increase or decrease in earnings during the time they are receiving benefits; and
e) When an employee with a workers’ compensation claim, resigns or the university terminates the employment.
5) Submit Employee's Wage Statement DWC-3, when applicable; and
6) Submit other reports as required.
c. Texas State's responsibility to the Texas Department of Insurance Division of Workers’ Compensation (DWC): Texas State must prepare and submit to the DWC reports or information the commission requests.
04.02 Injured Employee's Responsibilities:
a. Immediately notify his or her supervisor or department head of any on-the-job incident or injury or the first clear symptoms of illness possibly related to employment.
b. When medical services are needed for a job-related injury or illness, an employee has the right to the initial choice of a treating doctor that accepts workers’ compensation. Employees may contact the workers’ comp specialist for assistance in locating a workers’ compensation doctor.
c. Request completion of a Supervisor's Report of Incident, Injury, or Illness Form, and Witness Report, if applicable. Both forms are available on the Environmental Health, Safety, and Risk Management Web site.
d. File a claim for compensation from the injury or illness with the Division of Workers’ Compensation (DWC -41) within one year of the injury or of the first distinct manifestation of the occupational illness:
1) File a compensation claim regarding the injury or illness with the Division of Workers’ Compensation (DWC-41) within one year of the injury or the first distinct manifestation of the occupational illness;
2) If lost time from work occurs, the injured employee must sign an Employee's Election Regarding Utilization of Sick and Annual Leave, SORM-80 Form. When choosing between Election 1 and 2 below, the employee must only consider accrued sick and annual vacation leaves.
a) Election 1 – employee elects to use all accrued sick leave, and
(1) all of accrued annual leave (vacation); or
(2) a portion of accrued annual leave (specifies number of hours); or
(3) none of accrued annual leave.
Employees must exhaust sick leave before using annual leave.
b) Election 2 – employee elects not to use accrued sick leave or annual leave. Employee will not receive workers' compensation payments until after a seven-day waiting period. The waiting period begins the first calendar date after the last active workday. Note: employees who select Election 2 will change their work status to leave without pay (LWOP).
3) After exhausting elected leave entitlements under Election 1 or utilizing them during the seven-day waiting period under Election 2, the employee may receive temporary income benefits for the lost wages from the SORM, if eligible.
4) It is the employee's responsibility to report health progress, provide a current Work Status Report (DWC-73), and the expected date for return to work to the workers’ comp specialist.
e. A classified employee with earned FLSA or state compensatory time may use it at the end of Election 1 after using their selected amount of sick and annual leave, or immediately with Election 2. The employee must present a written request to the workers’ comp specialist in order to use compensatory time during the lost time period the employee is away from work due to a work-related injury or illness (Ref: Office of the Attorney General, Opinion No. JC-0188, March 1, 2000).
f. Notify the workers’ comp specialist when an employee needs immediate medical treatment and provide a preliminary copy of the Supervisor’s Report as soon as possible, but no later than the next working day after receiving the injury or illness notification. The workers’ comp specialist must evaluate and approve the medical release. If the doctor's release has limitations, refer to Section 01.02, Return to Work Program.
04.03 Immediate Supervisory Personnel Responsibilities (Of Injured Employee):
a. Complete and return Supervisor's Report of Incident, Injury, or Illness and Witness Statement, if applicable, for any incident, injury, or illness reported or known to have occurred (Send the completed original witness statement to the EHS workers’ compensation specialist within two workdays after submitting the Supervisor's Report.). Both forms are available on the Environmental Health, Safety and Risk Management Web site.
b. Notify the workers’ comp specialist when an employee needs immediate medical treatment and provide a preliminary copy of the Supervisor’s Report within 24 hours or no later than the next working shift after receiving the injury or illness notification.
c. Forward the completed Supervisor’s Report of Incident, Injury, or illness to the department head or account manager through the assigned ADSO for review and signature. The signed original report must reach the workers’ comp specialist within seven calendar days of notification that an incident, injury, or illness has occurred.
d. Additional responsibilities of the supervisor:
1) Disseminate information relating to accident prevention;
2) Promote a safe and accident-free environment;
3) Give prompt attention to the elimination of unsafe conditions, unsafe behaviors or hazards; and
4) Adhere to safety policies of the university and the State of Texas.
04.04 Department Head or Account Manager Responsibilities:
a. Insure the department institutes procedures to report all injuries or illnesses.
b. Notify the workers’ comp specialist immediately, to report any of the following:
1) any serious injury;
2) any work-related illness or injury resulting in death; or
3) accidents involving more than one employee.
c. Review and sign the Supervisor's Report of Incident, Injury, or Illness and take appropriate action. Distribute the report as follows:
1) Retain a copy of the report in the department;
2) Forward the original report to the workers’ comp specialist in the Environmental Health, Safety, and Risk Management Office.
d. Provide the workers’ comp specialist with necessary information for the preparation of the Employer’s First Report of Injury or Illness (DWC-1S). The SORM must receive an Employer’s First Report of Injury or Illness (DWC-1S) from the workers’ comp specialist within five calendar days after receiving notification of the injury.
e. On the day the incident occurs, submit to the workers’ comp specialist, copies of the employee's time sheets for the current month and three months prior.
f. Employees who request to return to work after filing a workers’ compensation claim must receive administrative clearance from the workers’ comp specialist before returning to work. Employees with a doctor's release that has defined limitations may return to work, if possible, under the Return to Work Program, see Section 01.02.
g. Return to work with restrictions:
1) Department heads and account managers cannot allow an employee to return to work with medical restrictions without coordinating with the workers’ comp specialist. The workers’ comp specialist will review requests from department heads for employees to return to work with restrictions for applicability. Approval to return to work with restrictions will require the joint verbal approval of the workers’ comp specialist and the employee's department head or account manager. The workers’ comp specialist will follow up with an e-mail confirmation of the approval.
2) Temporary assignment in a restricted-duty status under the Return to Work Program will not exceed sixty cumulative calendar days per claim.
04.05 Workers’ Comp Specialist Responsibilities: The workers’ comp specialist must have a thorough understanding of the benefits and administrative procedures necessary to coordinate workers' compensation claims for university personnel. Specific duties include:
a. Provide personal briefings, if possible, to each employee who incurs a qualifying workers' compensation injury or illness. The briefing will apprise the worker of their rights and explain the procedures that will occur. The personal briefing will point out that the workers’ comp specialist serves as the liaison between the employee, SORM, medical providers, and the employee's department;
b. Ensure that immediate notification is made to SORM of any serious injury or work-related illness or injury resulting in death, or injury involving more than one employee;
c. Complete and process all workers' compensation injury or illness reports:
1) Verify that the employee has lost one or more work days, or has incurred medical expenses as a result of an injury or illness occurring in the course and scope of his or her duties;
2) Forward reports to the SORM; and
3) Mail a copy of the DWC-1S to the employee.
d. Administratively clear employees to return to work following a period of lost work time due to a work-related injury. Clearance to return to work will require a doctor's signed and dated statement (DWC-73) releasing the employee to return to work;
e. Serve as the Return to Work coordinator; see Section 01.02 for the Return to Work Program;
f. Assure that employees who have a restrictive release return to work only after joint approval of the department head or account manager and the workers’ comp specialist; and
g. Notify Human Resources of absences to coordinate FMLA and other benefits.
04.06 Accident Prevention Coordinator (Director, Environmental Health, Safety, and Risk Management) Responsibilities:
a. Implementing and administering the Accident Prevention Program at Texas State; and
b. Activities related to workers' compensation inspections and follow-up actions:
1) Schedules inspections, coordinates state agency assistance visits with administrators, and workshops;
2) Conducts accident prevention assessments of university facilities and operations to identify potentially hazardous conditions and unsafe behaviors and activities;
3) Coordinates implementation of recommendations for elimination of hazards and unsafe behaviors and activities identified on assessments, investigations, or surveys;
4) Provides department heads and account managers with relative data on inspection reports and follow-up activities (i. e., status reports) and provides assessment and investigation information to:
a) Vice president responsible for the department and activity;
b) Workers’ comp specialist; and
c) University Safety Committee.
5) Communicates with the SORM via regular university channels for outside correspondence.
05. PROCEDURES FOR TERMINATION OF EMPLOYMENT
Texas State UPPS No. 04.04.40, Disciplining and Terminating Staff Employees sets out termination procedures.
05.01 Texas State will not discharge or in any other manner discriminate against an employee because the employee has:
a. filed a workers' compensation claim in good faith;
b. hired a lawyer to represent the employee in a workers' compensation claim;
c. instituted a workers' compensation proceeding; or
d. testified or is about to testify in a workers' compensation proceeding.
05.02 The university is not required to hold a job open for an absent employee for an indefinite period of time. The university may terminate the employment of an absent employee for legitimate business reasons.
a. The department will determine each situation on a case-by-case basis, according to individual merits.
b. While length of work absence is a factor, that alone is not the basis for the decision to terminate an absent employee.
c. The department will identify other legitimate business reasons that justify terminating the employee under these circumstances.
05.03 Legitimate business reasons for termination include:
a. Whether the nature of the injury or illness prevents the employee from performing the essential functions of his or her position with or without reasonable accommodation. The employee is responsible for providing a medical prognosis showing when he or she can return to work;
b. Whether other persons are available to perform the duties of the employee’s position during the employee's absence;
c. Whether the employee can perform job duties in a timely manner enabling the employee’s department to accomplish its mission;
d. The impact of the employee’s absence on other employees, for example, an increased workload on other employees; and
e. Regardless of the existence of these or other legitimate business reasons, it is the university’s policy to discharge an employee who misses more than 180 consecutive days of work.
05.04 Termination Letter
a. The termination letter must include a specific termination date, either the current date or a future date. The employee should sign a receipt for the termination letter, either by signed personal acknowledgment of having received the notice or via certified return receipt mail. The department will retain the receipt and provide a copy to the workers’ comp specialist, Human Resources director, and the divisional vice president.
b. The workers’ comp specialist should consult on the appropriate wording of the termination letter and contact The Texas State University System (TSUS) Office of the General Counsel or Human Resources, should any questions arise.
c. The workers’ comp specialist will notify the associate director of Human Resources for Compensation and Employment of pending terminations.
05.05 Family and Medical Leave Act (FMLA)
The university will not terminate an employee protected under FMLA (12-week period of time). FMLA is a separate personnel action unrelated to the Workers' Compensation Act and associated workers' compensation claim. Human Resources administers FMLA under UPPS No. 04.04.30, University Leave Policy.
06. REVIEWERS OF THIS UPPS
06.01 Reviewers of this UPPS include the following:
Director, Environmental Health, May 1 E3Y
Safety, and Risk Management
Director, Human Resources May 1 E3Y
Chair, Faculty Senate May 1 E3Y
Chair, Staff Council May 1 E3Y
07. CERTIFICATION STATEMENT
This UPPS has been approved by the following individuals in their official capacities and represents Texas State policy and procedure from the date of this document until superseded.
Director of Environmental Health, Safety, and Risk Management; senior reviewer of this UPPS
Vice President for Finance and Support Services