Workers Compensation Insurance EMPLOYEE, SUPERVISOR AND EMPLOYER RESPONSIBILITIES. UT System, Office of Risk Management August 17, 2015

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1 EMPLOYEE, SUPERVISOR AND EMPLOYER RESPONSIBILITIES, Office of Risk Management August 17, 2015

2 What is Workers Compensation? A state-regulated insurance program that pays medical bills and some lost wages for employees with work-related injuries and/or illnesses. Workers compensation will is to provide medical benefits, replace a portion of the employee s lost wages if the injury or illness caused a loss of some or all income for more than seven days. 2

3 WCI does not apply to the following WCI does not apply to students or visitors. WCI only applies to student employees when they are injured in the course of their employment. 3

4 Responsibilities Employee Requirements Supervisor Requirements Employer Requirements 4

5 Employee Requirements 5

6 Attend all mandatory training Employees Comply with all rules and regulations and best management practices applicable to the workplace and the environment Report any unsafe conditions or if you are required to conduct an unsafe act. 6

7 Employee Sustains and Injury If an employees sustains an injury there are three scenarios Incident Only Medical Attention with Lost Time Sick leave Leave without Pay Medical Attention Participation in Return to Work program All require a First Report Of Injury. 7

8 Employee Notification Requirements Notify supervisor and file a First Report of Injury (DWC-1) immediately after if they sustain a compensable injury or occupational disease while carrying out their respective job duties. Incident Only Injury does not require medical attention (band aid etc. ). Medical Attention Injury requires medical attention and must be obtained from a network approved doctor 8

9 How can I get a network provider directory? A list of doctors and other medical providers is available online from the IMO website: (Click Find a Provider to perform a search.) 9

10 DWC-1 Employer s First Report of Injury or Illness 10

11 Non-Compensible Injuries Occurred while the employee was in a state of intoxication Employee's willful attempt to injure himself or to unlawfully injure another person Arose out of an act of a third person intended to injure the employee because of a personal reason and not directed at the employee as an employee or because of the employment 11

12 Non-Compensible Injuries (con.) Arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the employee's work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required of the employment Employee s horseplay Negligent non-compliance with applicable and established occupational health and safety rules and regulations (i.e) Failure to comply with those rules and regulations identified in routine training 12

13 Supervisor Requirements 13

14 Supervisor Responsibilities Ensure employee is working in compliance with rules, regulations and BMP s applicable to the workplace. A Supervisor cannot request an employee to perform an unsafe act or work in unsafe conditions. 14

15 Supervisor Responsibilities In the event of an injury The Supervisor has the ultimate responsibility to insure that the appropriate filing is conducted in the event of a work place injury. The Supervisor must ensure a First Report of Injury is filed within 24 hours of being notified or made aware of an injury (incident or medical attention) by an employee. A Supervisor is required to have his employee participate in Return to Work/Modified Duty Program in the event he is injured. A Supervisor is required to keep in contact with his injured worker in the event he needs medical attention and is released from work. 15

16 What If the Employee Never Reports an Injury But the Supervisor Is Aware Of It? As a Supervisor, if you are aware of an employee s injury, a report must be filed even if it is to inform of an incident only. 16

17 Return to Work Program HOP entitled Modified Duty/Return to Work Policy Injured employees AND supervisors are required by State law to participate in the program Modified duties decided in conjunction with doctor, supervisor, DEHS. Temporary assignment is not to exceed 90 days The DEHS administers the Return to Work Program 17

18 Employer Requirements 18

19 Notice of Injury and Timely Reporting The employer required to file an Employer s First Report of Injury or Illness with the insurance carrier and the injured employee after notification of an injury. 19

20 Notice of Injury and Timely Reporting _ lost time or Notice of Occupational disease The employer is required to file an Employer s First Report of Injury or Illness with the insurance carrier and the injured employee within eight (8) days after the employee s absence from work or receipt of notice of an occupational disease. [DWC Form-001] Good idea to keep in mind: * File right away or you could pay. * Failure to report a lost time or occupational disease claim may result in monetary penalties assessed by TDI/DWC to the employer. Per the Texas Labor Code Sec , a violation is subject to a maximum penalty of $25,000 per day per occurrence. 20

21 Employer Reporting Responsibilities The following forms are filed electronically by the UTRGV Claims Representative(s) via an online system (ice) and are sent to, WCI, as needed: (NOTE: Incident-only reports are not sent to. These are kept for institution review only.) Employer s First Report of Injury -- DWC-1 Network Acknowledgment (Must accompany DWC-1 injury report) Supplemental Report of Injury -- DWC-6 (only for lost time claims) Employee s Request for Paid Leave -- WCI Form-23 (if lost time) Wage Statement -- DWC-3 (if lost time) 21

22 DWC-6 Supplemental Report of Injury 22

23 DWC-6 Supplemental Report of Injury form has multiple purposes. It is used to report an employee s lost time from work, a return to work date, resignation, termination, or if a fatality occurred following the reported injury. 23

24 DWC-6 Filing Deadline Within 3 days of: The injured employee s return to work The injured employee s inability to work due to the injury Within 10 days of: The injured employee s earnings decrease because of the injury The injured employee s resignation, termination, or death 24

25 WCI Form-23 Request for Paid Leave 25

26 Texas Labor Code Sec (Use of Accrued Leave) An employee may elect to use sick leave before receiving income benefits. Benefits do not begin until ALL sick leave is exhausted. AFTER all sick leave is exhausted an employee may use all or a portion of their other leave to remain on the payroll. An Employee may elect to go on Leave Without Pay (LWOP) immediately. *** If off work with a doctor s excuse, an injured employee must wait 7 days before any income benefits are paid by WCI. 26

27 The WCI Form 23 is completed for ALL Lost Time Claims Complete this form as soon as you know the employee is losing time from work and their disability is related to the reported injury. The purpose is to report to WCI the employee s choice for use of their leave. The form must be signed by the injured employee and their supervisor to verify their election. Sick Leave (Must use all accrued sick leave hours) NO use of any sick leave Other paid leave (Could be partial use of accrued vacation leave hours) LWOP (If reporting sick or other leave, can complete LWOP information on the same form.) *** Form must be submitted for each/every disability period if lost time is intermittent. 27

28 DWC-3 Wage Statement

29 PURPOSE Used by WCI to calculate the employee s average weekly wage (AWW) Reports Pecuniary and Non-Pecuniary Wages Pecuniary: money the employee can put in their pocket * Includes overtime and longevity pay Non-pecuniary: relates to employer benefits such as health insurance premium sharing Complete the DWC-3 form as soon as possible, no later than 30 days from 8 th day of disability or immediately upon request from WCI. 29

30 Network Acknowledgment 30

31 What is a Certified Texas Workers Compensation Health Care Network? It is a program that has been certified by the State of Texas to provide health care services to employees who have been injured while doing their job. The injured employee is able to select a doctor within the network to treat them for their work-related injury. 31

32 PENALTIES Texas Labor Code and The Employer Institution could be responsible for payment of any/all fines if found to be negligent in timely reporting. The Texas Dept. of Insurance, Division of Workers Compensation, has the authority to assess from $500 up to $25,000 for any violations. It is extremely important to file all required forms within the statutory time period(s). 32

33 Other Consequences of Untimely Filing Hardship to injured employee or Over payment or under payment of income benefits could result in additional penalties. 33

34 Reminder: Additional information is available from multiple other sources including the and UTRGV websites. Questions? 34

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