To be eligible for workers’ compensation, an injury or an illness must arise from and occur in the workplace. Medical treatment for work-related injuries and illnesses will be covered under workers’ compensation, including visits to a health care provider, hospital treatment, physical therapy sessions, prescribed medicines and medical equipment, plus any out-of-pocket medical expenses-not covered or out of network. Medical treatments, including chiropractic care, are considered alternative treatments and should be pre-approved. Additionally, workers’ compensation provides partial wage loss coverage due to injury or illness because of work. The patient must be off work and under medical care for the injury or illness.
How Does Workers Compensation Work?
Workers injured on the job can generally file for these benefits. The injured employee should immediately notify you as the supervisor regarding the injury or illness. The supervisor is then responsible for completing a Supervisor’s Report of Injury or Occupational Illness Form, which should document the details of the injury. Upon completion, the report is sent to the Office of
Risk Management
With that report, the Office of Risk Management receives a formal notice from the University that an employee has incurred an accidental injury or illness while on the job. Risk Management assigns that claim to the University’s third-party administrator, Travelers Indemnity Company. A claims adjuster who will review the facts provided will be given the claim by Travelers Indemnity Company in order to determine whether or not it is going to be approved under the District of Columbia Workers’ Compensation Act. Once the claim is accepted, the claims adjustment service is responsible for processing disability payments for lost work time. If it is determined that an employe
Benefits When the Employee Does Not Lose Time from Work
The form is prepared to facilitate reimbursements for any medical expenses incurred due to an injury or illness. The employee should inform the health care provider to coordinate further with the Workers’ Compensation claims administer at the Office of Risk Management for billing information.
When the Employee Loses Work time
All absences from work must be backed by the healthcare provider of the employee. An employee should go out of work for three days (excluding the injury day) before any compensation for lost work time is available under workers’ compensation. It is the policy of the University to pay the injured employee the balance of his work shift on the day of injury, whatever time injury occurs or the employee is not able to return to work on that same day. The three-day wait includes Sundays and holidays. If the employee misses one to three days of work (waiting period for the District of Columbia), no temporary disability payments will be made. For absence of the employee between 4 and 14 days, the temporary disability will begin from day 4. An employee who is absent consecutively for 14 or more days is compensated from the very first absent day for a disability under workers’ compensation. The employee was earning wages for the 26 weeks prior to the date of injury to determine the temporary disability wages for the employee. Each year, the maximum that will be calculated will be 66 2/3% of the average weekly wage. The payments are free from tax and bound by the limits specified by the District of Columbia.
Wage Benefit Restrictions
An employee will not receive both worker’s compensation pay and regular University pay, including holiday pay, for the same time period. Employees found in violation of this will have to reimburse the regular pay of the University.
Sick leave or paid leave cannot be used by an employee in worker’s compensation.
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