Workers' Compensation Insurance: Frequently Asked Questions
Workers' Compensation Insurance (WCI) is insurance specifically designed to provide medical benefits and, in some cases, financial payments to employees on the payroll of The University of Texas System who suffer an injury or occupational disease while in the course and scope of employment.
Anyone who receives a paycheck from the University is covered by WCI. This includes faculty, staff, direct wage employees, lecturers, and student workers.
If the injury requires immediate medical attention, the priority is to receive medical attention.
It is the responsibility of the injured employee to complete a First Report of Injury (FRI) form and submit it to the Department of Environmental Health and Safety. A Supervisor or someone designated to act on behalf of the employee is required to complete the second part of the form prior to submission.
The form provides you with the option of checking off an incident only box or receiving medical treatment box. Be clear on the form whether you are asking for medical treatment or reporting this as only an incident.
Complete a FRI, in conjunction with your supervisor within 24 hours of injury. Do not provide your group health insurance card. If it is not possible to get the employee’s signature, the next best alternative is to get the employee's spouse or relative to sign the form on behalf of the employee. If neither the employee nor one of the employee's relatives can sign the form, we recommend that you call the employee on the telephone and document the employee's decision on the form. After the employee's decision is recorded on the form, please sign the form as follows:
APPROVED BY PHONE (DATE)
_______________________________
Signed: (Department Rep Signature)
UT System acquired the services of the IMO Med Select Health Care Network. Treatment must be obtained under these guidelines with a Network Provider.
An employee should not use group health insurance to obtain medical treatment for a compensable on-the-job injury. You can access the WCI insurance information on our website www.utrgv.edu/ehsrm/programs/risk-mana/workers-comp Notification of an on the job injury.
Prescription medication for the first seven days of medication can also be accessed via First Fill.
Most Urgent Care facilities are open late but if this is an emergency, after regular business hours go to the nearest hospital for treatment. Do not provide the group health insurance card.
Call EHRSM 665-3690 the next day to ensure the processing is done correctly and bills will not be sent to you personally.
Workers’ Compensation applies to all employees having sustained an injury while in the course and scope of their job, regardless of the injury occurring in your office or your home. The primary qualification in this specific case is proper documentation through the Department of Human Resources that demonstrates the person was authorized to work at home.
Regardless of medical treatment, the Supervisor has an obligation to notify EHSRM – WC Representative. Failure to do so may result in fines to the University. A person has the choice to elect the status as an Incident Only or Medical Treatment. EHSRM will proceed accordingly including investigating if needed, based on the option chosen, the report will then be transmitted to the Texas Division of Insurance - Workers’ Compensation.
Medical benefits are available immediately to a worker who is injured in the course and scope of employment and treats with a Network Provider.
An injured employee that cannot return to work has the option of using his accrued personal leave (sick/ vacation) or obtaining workers’ compensation temporary income benefits. This will be based on the doctor’s recommendation and availability of work accommodation. If the injured worker chooses to go on workers’ compensation benefits, the length of the lost time must be longer than seven days and begin on the eighth day of disability to be eligible but will revert to the initial date of injury. Compensation is 70% of the employee’s average weekly wage.
Yes. FMLA is intended to run concurrently with any illness or injury.
Once an employee chooses the type of leave to use, that leave must continue for the duration until the return to work or the leave is exhausted.
Yes. If an employee loses time from work on the date of injury that lost time should be counted in determining whether the employee has missed more than one day of work. For instance, if an employee misses half a day on the date of injury and then misses the next full day, he or she has missed more than one day of work. [Note: Lost time from work need not be consecutive]. The date of injury does not count against the injured worker as far time off.
No. Lost time is that period during which the injured employee is physically unable to work due to a compensable injury. Sick leave, or another form of leave that is available, must be used for this activity.
Also known as Light Duty, an injured worker may not be able to return to work in their regular capacity but is still physically able to work, the University can accommodate with restrictions set by their doctor. We strive to have our employees active and back at work once medically able.
90 days.
Yes. Receipt of Workers' Compensation Temporary Income Benefits (TIBs) does not automatically make a person ineligible for the benefits listed above. However, the amount of benefits due under other programs may be affected by receipt of workers' compensation temporary income benefits. The institutional Human Resources Office should be contacted for specific information regarding eligibility for Long Term Disability.
Workers' Compensation benefits are currently not subject to federal income taxation. If an employee has specific questions about this matter, we recommend the employee be directed to the Internal Revenue Service or to his or her legal advisor.
An employee who attempts to obtain Workers' Compensation benefits to which he or she is not entitled should be warned that there are serious penalties for making false or misleading statements, misrepresenting, or concealing material facts, and/or fabricating, altering or concealing documents in order to obtain workers' compensation benefits. Monetary penalties of up to $5,000 may be assessed against an employee by the Division of Workers' Compensation Commission for any of these deceptive actions. Additionally, it is a criminal offense (up to a second-degree felony, depending on the dollar amount involved) to knowingly commit any of the above listed acts in an attempt to wrongfully obtain workers' compensation benefits.