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.
DEFINITIONS
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:
Position Date
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
President