Workers Compensation Program Review and Approval Authority

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1 July 2003

2 Workers Compensation Program Review and Approval Authority Prepared and Edited by: Assistant Director Date UM Workers Compensation Manager Date Reviewed and Approved by: Chair - UM E, H & S Operations Committee Date Chair - UM E, H & S Policy Committee Date Approved as University of Maryland Policy: Vice President for Administrative Affairs Date

3 Table of Contents IMPORTANT TELEPHONE NUMBERS... ii UM WORKERS COMPENSATION POLICY... 1 GLOSSARY OF TERMS... 3 WORKERS COMPENSATION PROCEDURES... 6 MODIFIED DUTY FOR WORK-RELATED INJURIES OR ILLNESSES USM POLICY ON MODIFIED DUTY... Attachment1 USM POLICY ON ACCIDENT LEAVE FOR EXEMPT AND NONEXEMPT EMPLOYEES...Attachment 2 USM POLICY ON FAMILY AND MEDICAL LEAVE... Attachment 3 UM FITNESS FOR DUTY POLICY AND PROCEDURES... Attachment 4 Workers Compensation Program i

4 Important Telephone Numbers Dept. of Environmental Safety (301) UM Workers Compensation Manager Injured Workers Insurance Fund 1-(888) Call Center - for reporting accidents UM Policy Number Injured Workers Insurance Fund 1-(800) Billing University Health Center (301) Appointments Department of Personnel Services (301) Benefits Office (Stacey Sims) Department of Personnel Services (301) Employee Relations Office (Jennifer Smith) ii Workers Compensation Program

5 Policy Statement I. Purpose This policy is intended to authorize a Workers Compensation Program to inform employees and staff about the requirements and responsibilities relating to the reporting of work-related injuries and employee eligibility for workers compensation and related benefits. II. Policy The University is committed to making the workplace a safe and healthy environment, to preventing on-the-job accidents, and to the treatment, care and rehabilitation of employees injured on the job. In accordance with State workers compensation law, the University participates in a State self-insurance plan for work-related accidents which is administered by the Injured Workers Insurance Fund (IWIF). The University seeks to fulfill its commitments and responsibilities through a Workers Compensation Program, to be administered by the Department of Environmental Safety (DES) in liaison with the University Health Center. III. Management Responsibilities Both employees and other University departments bear a shared responsibility with DES for implementing the Workers Compensation Program. DES shall assist employees and departments in program administration by providing technical, regulatory and related management services, including training and problem specific review and analysis. A. University: Pursuant to Maryland Workers Compensation law, the University assumes costs of accidental work-related disabilities without regard to fault. The premium for Workers Compensation Insurance is paid for entirely by the University. An employee is protected by Workers Compensation from the first day of employment. B. Employee: It is the employee s responsibility to give a detailed, complete and accurate description of the circumstances surrounding the accident/injury to his supervisor immediately after it occurs, or as soon as practicable thereafter. In the event of disability, the employee shall provide continuous medical documentation. If requested by the University or insurer, the employee shall comply with a request for a medical evaluation. Workers Compensation Program 1

6 C. Departments: It is the responsibility of each department to designate an individual to be responsible for workers compensation recordkeeping and reporting. The designated individual shall be responsible for assuring that work-related employee accidents are reported promptly and accurately to the Injured Workers Insurance Fund (IWIF), collecting information and medical documentation pertaining to employees injured on the job on behalf of the DES Workers Compensation Manager, providing copies of the necessary paperwork to the DES Workers Compensation Manager, and assisting the Department in implementing the Workers Compensation Program and procedures regarding the administration of workers compensation benefits. The designated individual shall serve as an adjunct to DES within the scope of this policy. D. University Health Center: The University Health Center provides initial medical treatment following a work-related accident or injury, and, follow-up medical treatment, as required. The University Health Center supplies the employee with necessary forms and provides a medical diagnosis, recommends medically required work restrictions, when necessary, and authorizes the employee s return to work. E. Department of Environmental Safety: DES is responsible for the development and administration of the Workers Compensation Program at the University of Maryland. A Workers Compensation Manager is located in the Workers Compensation Office at DES to assist employees and supervisors with case management. DES shall maintain a master record of all work-related accidents resulting in injured employees; serve as the University liaison with IWIF for claims management; provide training and assistance to departmental designees on workers compensation procedures; and investigate serious workrelated accidents and occupational illnesses or exposures to hazardous substances. 2 Workers Compensation Program

7 Glossary of Terms Accident: The Occupational Safety and Health Act (OSHA) defines an accident as a one time instantaneous incident at the workplace which is caused by an external force and results in a wound or other condition of the body. The injury must be identifiable by time and place of occurrence and member of the body affected; it must be caused by a specific event or incident within a single day or work shift. Accident Leave: Accident leave is monetary compensation for time lost from work due to a work-related accident if (a) it is determined to be compensable under the Workers Compensation Act and (b) a physician examines the employee and certifies that the employee is disabled as a result of the injury. Whether an employee receives accident leave is determined by the UM Workers Compensation Manager. Employees are eligible for accident leave if they are appointed in a regular employment status. Contractual, contingent, temporary, and hourly employees are not eligible for accident leave. Accident leave is two thirds (2/3) of the employee s gross wages. It is nontaxable, non-cumulative, and is available for up to six (6) months from the first day of disability. Accident leave is paid by the injured employee s department. The employee must provide the department with continuous medical documentation of his/her disability. If, following an injury, an employee has been totally disabled for 6 months and a physician certifies that he/she is disabled, accident leave can be extended up to 12 months. Accident leave shall be terminated on the date that the employee is able to return to work at full duty or to modified duties designated by the University, as certified in writing by a physician. Accident leave is based on a maximum forty (40) hour work week. If an employee works more than forty hours, accident leave compensation will be based only on the employee s forty hour salary. See USM VII Policy on Accident Leave for Exempt and Nonexempt Employees. Compensability: Eligibility for benefits under Workers Compensation is based on the compensability of the injury. Not all injuries that occur in the course of employment are deemed compensable. An initial determination on compensability of a workplace injury is made by IWIF. The final determination is made by the Workers Compensation Commission. Fitness For Duty: Fitness for duty refers to the physical and/or mental readiness of an employee to perform the essential functions of his or her job. A fitness for duty examination may require psychological, medical and/or substance abuse assessment following an emergency situation in which an employee appears impaired or demonstrates violent, abusive or threatening behavior while at work or, following a non-emergency situation in which a supervisor has reason to believe an employee may be unfit to perform the duties and responsibilities of his position. An employee may be directed to provide verification of fitness for duty so that the University may ascertain whether the employee is able to regularly and routinely perform responsibilities of his/her position. The Department of Personnel Services, upon approving a request for a Workers Compensation Program 3

8 fitness for duty evaluation shall forward a request for a medical fitness for duty examination to be performed at the University Health Center. The examination will be paid for by the University. The employee may see his/her own physician at personal expense. The University Health Center shall examine the employee and consult with the employee s private care physician(s) as necessary. The head of the employee s unit, in consultation with the Department of Personnel Services, will then make an administrative determination about the employee s fitness to work, taking into consideration the medical evaluation, the essential duties of the employee s position and any requested accommodations, if applicable. Outcomes of an administrative evaluation may include the following: fit to work without limitations; fit to work with limitations; not fit to work. If an employee is unable to regularly and routinely perform his duties, the Director of Personnel may take action in accordance with policies on: voluntary separation, termination, reasonable accommodation, modified duty or disability retirement. There are other University policies which may bear on a fitness for duty procedure. See Attachment 4 UM Fitness For Duty Policy and Procedures. Injured Workers Insurance Fund (IWIF): The Injured Workers Insurance Fund (IWIF) is a self-supported statutorily-created insurance fund created for the purpose of providing workers compensation coverage to employees of public and private employers in the State of Maryland. Modified Duty: Modified duty is a temporary, non-permanent assignment of available job tasks depending on University departmental needs, which is compatible with an employee s medical restrictions, as certified by a physician, and which supports the employee s transition to a prompt return to full duty. The total number of days that an employee can be assigned modified duties should not exceed 180 calendar days in any 12 month period. Modified duty provides employees who are injured on the job, the opportunity to perform productive work within the physical and environmental limitations posed by the injury or illness. Employees are eligible for consideration for available temporary modified duty assignments, depending on departmental needs, if they are medically certified to work with temporary medical restrictions and are expected to return to full duty. The employee returns to his/her regular duty when released by the University Health Center or his/her private medical provider. See USM VII-7.41 Policy on Modified Duty and UM Fitness for Duty Policy and Procedures. Occupational Disease: OSHA defines an occupational disease as a condition produced in the work environment over a period longer than a single work day or work shift. Among other causes, it may result from systemic infection, repeated stress or strain, exposure to toxins, poisons, fumes or other continuing conditions of the work environment. Temporary Total Benefits (TTB): Temporary Total Benefits (TTB) is monetary compensation for time lost from work due to work-related accidents for employees (a) not eligible for accident leave or (b) when eligibility for accident leave has expired. TTB is paid by IWIF, not the University, and must be requested by the employee. In 4 Workers Compensation Program

9 accordance with University System of Maryland policy, all available accident leave must be used before qualifying for TTB. TTB is paid at the rate of twothirds (2/3) of the employee s gross wages and provides compensation to the temporarily disabled employee until the physician states the he/she may return to work. Employees must complete and submit an employee claim form to the Workers Compensation Commission in order to receive TTB. The State of Maryland does not consider the first three (3) days of time lost from work to be compensable time, unless the disability extends to two weeks or more. Important: Unlike accident leave, which is paid by the University, an employee receiving TTB will not continue to earn leave and seniority and have contributions made to health care premiums while receiving TTB. If an employee wants to continue their health insurance or any other subsidized benefits while receiving TTB, he/she must contact the Benefits Office in the Department of Personnel Services. TTB compensates the employee for salary only, not benefits. Pursuant to University System of Maryland policy, the combination of the use of accrued leave and leave without pay shall not exceed two (2) years. In the event the accident results in a serious medical condition, the employee may also be eligible for protection under the Family and Medical Leave Act (FMLA). FMLA provides eligible employees with a serious medical condition up to twelve (12) weeks of leave per calendar year and provides job protection during this time period. FMLA leave is unpaid leave. However, based on the election of the employee or the University, accrued paid leave shall be substituted for all or any part of FMLA leave. See USM VII-7.40 Policy on Accident Leave for Exempt and Nonexempt Employees and USM VII-7.50 Policy on Family and Medical Leave. Workers Compensation: Workers Compensation is a system established by state law under which injured employees receive benefits in connection with work-related injuries or occupational illness. The Workers Compensation Commission is the State Arbitration Board that ensures employees are given fair treatment in the event of a work-related accident or illness. Workers Compensation Program 5

10 Workers Compensation Procedures I. Purpose These procedures are intended to provide information to faculty and staff about their rights and responsibilities relating to work-related injuries and to establish campus-wide practices to control and monitor costs borne by the campus relating to Workers Compensation benefits provided for such injuries pursuant to University leave policies and workers compensation laws. II. Management The Department of Environmental Safety (DES) is responsible for the administration of the Workers Compensation procedures. DES shall work in consultation with the University Health Center who is responsible for the medical administration of workrelated injuries. All other University departments bear a shared responsibility with DES for the costs borne by the campus relating to work-related injuries. DES shall assist these units in efficient and cost effective program administration by providing technical, regulatory and related management services, including training and problem specific review and analysis. III. Reporting Procedure Employee Instructions & Responsibilities: An employee is obligated to inform his/her Supervisor verbally of an accident immediately after it occurs or at the earliest opportunity thereafter. If the accident occurs while on campus, it is recommended that the employee seek medical treatment at the University Health Center. Written instructions and all necessary forms will be provided to the employee at the time of treatment. If the accident occurs while off campus and the employee goes to an emergency room or to their private physician, the employee may obtain the appropriate forms for reporting the accident from the University Health Center, the UM Workers Compensation Manager, or via the DES web site at Immediately following initial medical treatment, an employee should complete the Employee s Report of Work-Related Injury Form and forward it to his/her supervisor. IMPORTANT: All injuries - regardless of how insignificant they may seem - must be reported immediately. 6 Workers Compensation Program

11 IMPORTANT: Any medical treatment other than emergency visits, initial treatment, or routine office visits must be pre-authorized by IWIF. An employee s injury/illness must be deemed compensable before pre-authorization for additional medical treatment is granted. If an employee s injury/illness is deemed compensable under Maryland Workers Compensation law, the injured employee s medical expenses will be paid by the Injured Workers Insurance Fund (IWIF). Billing statements may be sent to: Injured Workers Insurance Fund P.O. Box 9899 Baltimore, MD IMPORTANT: Each accident resulting in an employee injury is assigned an IWIF case number and all medical bills must be identified with the employee s case number. Call to get the number. IMPORTANT: Neither the existence of an IWIF Case Number nor the filing of an Employee s Report of Injury Form initiate the filing of a Claim for Permanent Partial or Total Disability Benefits with IWIF. IWIF is the workers compensation insurance carrier for University employees. An IWIF insurance adjuster may call the injured employee to investigate the accident. The employee is expected to provide as many details as possible about the incident. The information provided will aid the adjuster in determining if the injury is compensable under Maryland Workers Compensation law. The injured employee may be asked by IWIF or the University, to go for a medical evaluation. Failure to comply with this request may jeopardize the employee s receipt of benefits. Supervisor Instructions & Responsibilities The Supervisor should obtain as many details as possible about the incident from the employee and witness(es), if applicable. The Supervisor should ensure that the employee completes the Employee s Report of Work-Related Injury Form and that witnesses, if any, complete the Accident Witness Statement. The Supervisor is responsible for collecting all forms. The Supervisor should complete the Supervisor s Report of Work- Related Injury Form. The Supervisor must return the Employee s Report of Work-Related I Injury Form, the Accident Witness Statements, and the Supervisor s Report of Work-Related Injury Form to the UM Workers Compensation Manager within 24 hours of the accident. All completed forms should contain a detailed description of the circumstances. The Supervisor should report the number of days lost from work and the Workers Compensation Program 7

12 type of leave used by the employee on the Supervisor s Report of Work- Related Injury Form. The Occupational Safety and Health Act requires that all time lost from work due to a job injury must be recorded and reported. This information must be provided on the Supervisor s Report of Work- Related Injury Form. If the employee has not returned to work when the report is submitted, the Supervisor must inform the UM Workers Compensation Manager of the return-to-work date. The reporting procedure applies to all employees, regardless of employment status. IMPORTANT: All injuries - regardless of how insignificant they may seem - must be reported immediately. IMPORTANT: Supervisors may not penalize employees for work-related injuries and injuries will not be included as part of performance evaluations unless the injuries were a result of a deliberate unsafe act. IV. Medical Treatment In accordance with the Maryland Workers Compensation Law, the University shall provide medical treatment whenever necessary following an on-the-job accident. If possible, initial treatment shall be provided by the University Health Center. The University Health Center shall assess and recommend additional medical treatment with an outside consultant, when necessary. The employee may select a physician of his/her own choice. However, the University reserves the right to require periodic medical evaluations by a physician of its own choosing. IMPORTANT: Time-off from work as a result of an accident is not determined by the employee. It is determined by the employer s medical provider (University Health Center) or the treating physician if referred. Medical professionals determine whether the employee requires time off from work due to disability. If medical treatment outside the University Health Center is required before a decision on compensability has been made by IWIF, it is recommended that the employee obtain a medical provider that accepts his/her health insurance. If initial treatment is provided at an emergency room or by the employee s private medical doctor, the employee must contact the Workers Compensation Office to obtain the appropriate forms for reporting the accident to IWIF and must provide medical documentation related to that initial treatment to the Workers Compensation Office. V. Permanent Total or Partial Disability Benefits If the employee suffers an injury that results in a permanent total or partial disability, a Claim must be filed with the Workers Compensation Commission to receive a 8 Workers Compensation Program

13 disability award. It is recommended that employees should consider retaining legal counsel to be represented at Workers Compensation hearings. Awards of Permanent Total or Partial Disability Benefits are based on the part of the body injured and the extent of the disability. Time Limits The statute of limitations for filing a claim is two (2) years from the time the accident is reported and one year from the time symptoms occur or the employee is diagnosed with an occupational disease. Important: The Employee s Report of Work-Related Injury Form is used to report a work-related injury; filing this form initiates a determination by IWIF on the compensability of the employee s medical expenses relating to the injury. However, the filing of this form does not initiate a Claim for an award for permanent total or partial disability. A separate claim form must be filed in order to receive an award for permanent total or partial disability. Workers Compensation Program 9

14 Modified Duty for Work-Related Injuries or Illnesses In an effort to facilitate the early return to work for employees who are recovering from a workrelated accident and to ease the transition into a resumption of full duties, the University s Workers Compensation Program encourages departments to consider eligible employees for appropriate temporary modified duty assignments, depending on departmental needs. See USM VII-7.41 Policy on Modified Duty. Use of temporary modified duty assignments in the context of the Workers Compensation Program provides the employee who is medically able the opportunity to perform productive work consistent with medical restrictions imposed by his/her injury and assists in minimizing workers compensation costs. Regular employees who are recovering from a work-related injury but are medically certified by the University Health Center or their medical provider as able to work with temporary restrictions and who are expected to return to full duty in their previously held position are eligible to be considered by their department for an appropriate, temporary modified duty assignment, depending on departmental needs. Any such assignment should be made in accordance with the USM VII-7.41 Policy on Modified Duty. In identifying an available modified duty assignment, the Department shall consult with the Employee Relations unit of the Department of Personnel Services, the employee, the University Health Center, and the employee s private physician (if appropriate). Following consultation between the employee and the University, the employee shall be informed in writing of the available temporary, modified duty assignment. If the Department determines that no appropriate modified duty assignment is available, the employee on accident leave or TTB will continue receiving these benefits until such time as the institution identifies an appropriate modified duty assignment or the employee s condition improves sufficiently such that the University Health Center or a private medical provider certifies that the employee can return to his/her full duties. If an employee refuses to accept a modified duty assignment, accident or sick leave may be terminated. An employee who refuses modified duty, shall be reported to IWIF and a request shall be made for a suspension of benefits. 10 Workers Compensation Program

15 Roles and Responsibilities: The University Health Center: Evaluate the injured employee and complete the University Health Center Supervisor Form documenting the employee s injury and noting any applicable restrictions. A copy of the completed University Health Center Supervisor Form should be provided to the employee. Provide specific medical limitations for those employees for whom return-to-work in the Modified Duty Program for Work-Related Injuries or Illnesses is possible. The University Health Center should submit a copy of all medical documentation to the Employee Relations unit of the Department of Personnel Services, the employee s departmental supervisor, and the UM Workers Compensation Manager. The department head, in consultation with the Employee Relations unit of the Department of Personnel Services, will then make an administrative determination about the availability of a temporary modified duty assignment, taking into account the medical evaluations, any medical limitations and departmental needs. The University Health Center should periodically assess the ability of employees in the Modified Duty Program for Work-Related Injuries or Illnesses to return to full duty. The University Health Center should notify the Department, the UM Workers Compensation Manager, and the employee about the employee s prognosis for full recovery and the estimated date when he/she will be released for a return to full duty without restrictions. The Department/Supervisor: The Department should maintain appropriate documentation regarding program participants. The Department should monitor the employee s assignment to temporary modified duty and perform periodic evaluations regarding whether the assignment suits departmental and employee needs. The Department should provide the University Health Center, the UM Workers Compensation Manager, and the employee with periodic updates regarding employees assigned to modified duty. The Department is responsible for coordinating with the Employee Relations unit of the Department of Personnel Services to determine if the employee is eligible for an appropriate temporary modified duty assignment. Workers Compensation Program 11

16 After consulting with Employee Relations, the Department is responsible for informing the employee of the available temporary modified duty assignment. The Department should inform the employee that if the employee participates in the modified duty program, he/she will receive his/her regular rate of pay for the hours worked instead of the 2/3 rate of pay on accident leave or TTB. The Injured Employee: If an appropriate modified duty assignment is offered, the employee should sign the Modified Duty Program Acceptance Form acknowledging that he understands and accepts the temporary modified duty assignment. To continue in the program, the employee shall be required to submit an updated doctor s certificate as necessary upon the expiration of the medical provider s last assessment. The employee shall provide the University Health Center with copies of all medical documentation requested by the University. The Department of Environmental Safety: Compile modified duty data and prepare reports to update affected departments. Audit the Modified Duty Program for Work-Related Injuries or Illnesses. Establish an incentive program to reward departments with a successful Modified Duty Program for Work-Related Injuries or Illnesses. Provide guidance to the department s designated contact person. The Workers Compensation Manager: Coordinate with IWIF and Payroll Services to ensure that the employee is appropriately compensated when he/she enters the Modified Duty Program for Work- Related Injuries or Illnesses. Communicate to eligible employees that failure to accept a modified duty assignment opportunity may result in discontinuation of sick leave, accident leave or TTB. Notify IWIF of the employee s refusal to accept an early return-to-work assignment. 12 Workers Compensation Program

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