Workers' Compensation Injuries,
Illnesses and UPPS
No. 04.04.43
Claims Issue
No. 8
Effective Date: 11/6/2007
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. University employees will be informed 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 through the Career
Services office;
b. identify responsibilities and duties of the
Director, Environmental Health, Safety & Risk Management;
c. identify
responsibilities and duties of the Human Resources
representative 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. It is the
policy of
b. The Return
to Work program provides opportunities for an employee of the University who
sustains a compensable injury during the course and scope of employment, which
becomes a disability as defined by the Americans with Disabilities Act (ADA),
or a serious health condition as defined by the Family and Medical Leave Act
(FMLA), 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 in which the employee's regular position is modified to
accommodate the employee's physical capacities. Temporary assignment in a
restricted duty status under the Return to Work program will not exceed sixty
accumulative calendar days per claim. If the employee is unable to be released
to return to work without restrictions within the sixty accumulative calendar
day period, the employee will be placed in a leave status at the end of the
sixty day period. The employee will remain off work until he or she receives a
non-restrictive release.
c. The Return
to Work program shall not be construed as recognition that any employee who
participates in the program has a disability as defined by the
d. Specific
procedures shall be provided to guide all employees regarding the Return to
Work program by the Human Resources representative,
when necessary.
02. DEFINITIONS
02.01 Accident
Prevention Coordinator: The Director, Environmental Health, Safety & Risk
Management is responsible for implementing and
administering the Accident Prevention Program at
02.02 Workers'
Compensation Claims Coordinator: The Human Resources representative serves as
the Workers' Compensation Claims Coordinator responsible for coordinating
workers' compensation claims and the associated Return to Work program at
02.03 "Reportable"
Incident, Injury, or Illness: Any
incident, injury, or illness involving a university employee which occurred as
a result of, or in the course and scope of
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 and scope of employment that
results 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 accumulative
calendar days per claim, if approved by the employee’s department head and the
Human Resources representative.
02.06 Additional
Duty Safety Officers (ADSO): These persons are
appointed by department heads in accordance with UPPS No.
04.05.01, to assist in administering
the Risk Management and Safety Program in their departments. Their
responsibilities include:
a. Serving
as a point of contact with Human Resources and the Environmental Health, Safety
& 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 Workers'
compensation coverage for state employees is provided by the State of
03.02 For
university employees, the State Employees Workers' Compensation Program is
administered by the SORM. SORM is responsible for processing and paying
workers' compensation claims, providing risk management guidelines, legal and
administrative services for state agencies.
03.03 A
a. Must be an
employee of
b. The injury or occupational illness must have occurred on or after July 18, 1975.
04. RESPONSIBILITIES AND DUTIES
The
responsibilities listed in Section 04 are abbreviated in a claims procedure
checklist (Attachment
I).
04.01 As a
state employer of record,
a.
b.
1) Submit
Employers' First Report of Injury or Illness DWC-1S. This report is submitted
only if the employee incurs personal medical cost, or if there is more than one
day of lost time from work;
2) Submit
an Employee Election of Receiving Workers' Compensation Disability Payments --
Form SORM-80;
3) Submit
a Witness Statement Form No 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) When
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 is terminated.
5) Submit Employee's
Wage Statement DWC-3, when applicable;
6) Submit
other reports as required.
c.
04.02 Injured
Employee's Responsibilities:
a. Immediately
report or notify his or her supervisor or department
head of any on-the-job incident or injury or the first clear symptoms of illness
that might be related to their employment. The employee must report the injury
or illness regardless of whether loss of work-hours or medical services are
involved. The employee may lose their right to receive benefits if they fail to
report an injury or illness, in accordance with university policy.
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 is located on DWC’s Approved Doctor Listing (ADL) found at www.txcomp.twcc.state.tx.us as required by the Texas Labor Code.
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 Human
Resources web site;
d. If
an injury or illness results in the absence from work for more than one day or medical services are received, the employee must comply with the following legal
responsibilities to establish a claim for compensation:
1) A claim for
compensation with respect to such injury or illness
must be filed with the Division of Workers’ Compensation (DWC-41) within one year after
the occurrence of the injury or of 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. The employee must choose Election 1 or 2
below. Note: only accrued sick and
annual (vacation) leave are considered in making the following elections.
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.
Sick
leave must be exhausted before annual leave can be used.
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 an employee has exhausted their elected leave entitlements under Election 1 or
utilized them during the seven-day waiting period under Election 2, the
employee may be eligible to receive temporary income benefits for lost
wages from the SORM.
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
Human Resources representative.
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 Human Resources representative 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. Employees
who have filed a workers' compensation claim for a work-related injury or
illness must have a signed and dated medical release statement
(DWC-73) from his or her treating doctor before returning to work. The employee
must present the doctor's medical release to the Human Resources representative
before returning to work. The medical release must be evaluated and approved by
the Human Resources representative. 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): Responsibilities include the following:
a. Complete
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 Human Resources representative
within two workdays after submitting the Supervisor's Report.) Both forms are available on the Human
Resources web site.
b. When an
employee needs immediate medical treatment for their injury, call to notify the
Human Resources representative. Provide the Human Resources representative with
a preliminary copy of the Supervisor's Report providing the essential
information as soon as possible, but no later than the next working day after
being notified of the injury or illness.
c. The
supervisor forwards 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 Human Resources representative 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
04.04 Department
Head or Account Manager Responsibilities:
a. Insure that
department procedures are instituted to report all injuries or illnesses;
b. Notify the
Human Resources representative 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 Human Resources
representative in Human Resources.
d. Provide
the Human Resources representative with necessary information for the
preparation of the Employer’s First Report of Injury or Illness (DWC-1S). An Employer’s Report must be submitted to the SORM by
the Human Resources representative within five calendar days after the employer
is notified of the injury.
e. On the day
the incident occurs, submit to the Human Resources representative, 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
be referred to the Human Resources representative to be administratively
cleared 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 Human Resources. Requests from
account managers for employees to return to work with work restrictions will be
reviewed by the Human Resources representative for applicability. Approval to
return to work with restrictions will require the joint verbal approval of the Human
Resources representative and the employee's department head or account manager.
The Human Resources representative 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 accumulative calendar
days per claim.
04.05 Human
Resources Representative Responsibilities: The Human Resources representative 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 Human Resources representative serves as the liaison between the employee, SORM, medical providers, and the employee's department;
b. Ensure that
immediate notification is made to the 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.
3) A copy of
the DWC-1S will be mailed 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 will be allowed to return to work
only with, and after, joint approval of the department head or account manager
and the Human Resources representative;
g. Provide a
copy of monthly workers’ compensation leave summary to the Environmental Health, Safety & Risk
Management Office.
04.06 Accident
Prevention Coordinator (Director, Environmental Health, Safety & Risk Management)
Responsibilities:
a. Responsible
for implementing and administering the Accident Prevention Program at
b. Responsible
for 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) Provide
department heads and account managers with relative data on inspection reports
and follow-up activities (i. e., status reports). Information regarding
assessment and investigation status will also be provided to:
a) Vice
president responsible for the department and activity;
b) Human
Resources representative; and
c) University
Safety Committee.
5) Communicate
with the SORM via regular University channels for outside correspondence.
05. PROCEDURES FOR TERMINATION OF EMPLOYMENT
Termination
shall be in accordance with
05.01
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 absence from work is a factor, the decision on whether to terminate
an absent employee will not be made on the basis of the length of the absence
alone.
c. The
department will identify other legitimate business reasons that justify
terminating the employee under these circumstances.
05.03 Legitimate
business reasons 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. The
importance that the employee's duties be performed timely in order for the
employee’s department to accomplish its mission or work requirements.
d. The impact
of the employee’s absence on other employees, for example, an increased
workload on other employees.
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. The termination date must be the current date or a future date. The letter must clearly state that the termination was not based on the employee having filed a workers' compensation claim. 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 Human Resources representative, Human Resources Director and the divisional vice president.
b. The Human
Resources representative should be consulted for appropriate wording of the
termination letter. The Human Resources representative will contact the
University Attorney, should there be any questionable situations.
c. The Human
Resources representative will notify the Assistant Director of Human Resources
for Compensation and Employment of pending terminations.
05.05 Family
and Medical Leave Act (FMLA)
Employees
may not be terminated if they are protected under the Family and Medical Leave
Act (12 week period of time). FMLA is a separate personnel action unrelated to
the Workers' Compensation Act and associated workers' compensation claim. The
FMLA is administered by Human Resources under UPPS No.
04.04.30, "University Leave Policy".
06. REVIEWERS OF THIS UPPS
06.01 Reviewers of this UPPS include the following:
Position Date
Director, Human Resources May 1 E3Y
Director, Environmental Health, May 1 E3Y
Safety & Risk Management
University Attorney 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
Director
of Human Resources; senior reviewer of this UPPS
Vice
President for Finance and Support Services
President