WORKERS COMPENSATION. Office of Human Resources

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1 WORKERS COMPENSATION Office of Human Resources

2 WHAT IS WORKERS COMPENSATION? Workers Compensation is a University paid benefit for employees and students that are working payroll or work study. Workers Compensation is a form of insurance that provides compensation medical care for employees who are injured in the course of employment. Workers' Compensation is designed to ensure that employees who are injured or disabled on the job are provided with fixed monetary awards, eliminating the need for litigation. CompSource Oklahoma has proved quality, low-cost workers compensation coverage to Oklahoma employers consistently since PAGE 2

3 EMPLOYER S RESPONSIBILTY Along with providing workers compensation coverage, the employer must perform some, if not all, of the following duties: Post a notice of compliance with workers compensation laws in a prominent place at each job site Provide immediate emergency medical treatment for employees who sustain an on-the-job injury Provide immediate medical attention if an injured worker is unable to select a doctor or advises the employer in writing of a desire not to do so File a report of the injury and mail or fax it to the nearest workers compensation board office. A copy of the report should also be mailed to the employer s insurance company. Create a written report of every accident resulting in personal injury that causes a loss of time from regular duties beyond the working day or shift on which the accident occurred or that requires medical treatment beyond first aid or more than two treatments by doctor or persons rendering first aid. Accede to all requests for further information regarding injured workers by the workers compensation board or the insurance company, such as statements of the employee s earnings before and after the accident, reports of the date the employee s return to work, or other reports that may be required to determine the employee s work status following the injury. PAGE 3

4 EMPLOYEES RESPONSIBILITY If an employee should be injured on the job, the following steps must be performed immediately: 1. If an injury occurs that requires immediate attention, seek medical attention immediately. 2. Within 24 hours after the injury make contact with the Department Head. 3. Within 24 hours of the injury contact the following: Benefits Manager/Risk Manager: Cecilia Taft Safety Officer: Darryl Hughes Written documentation from the employee through his/her immediate supervisor must be submitted as soon as possible on or after date of injury. 5. Should the employee expect to be off the job for three (3) days or more, both a Family Leave form and a Request for Leave from must be attached. 6. The forms indicated in #5 above, can be mailed to the employee s home by Human Resources if notified they are going to be absent and cannot come into the office to pick them up. 7. The employee must choose which compensation method they want to use and report it in writing to the Human Resources Office. See attached information. 8. An employee cannot return to work until a release from the physician is in the Human Resources Office. 9. The attached form must have all signature approvals before submitting to the Benefits Manager. PAGE 4

5 SUPERVISOR S RESPONSIBILITY If an employee is injured on the job, the following steps must be performed immediately: 1. If an injury of an employee occurs that requires immediate attention, seek medical attention immediately. 2. Within 24 hours of the injury of the employee contact the following: Benefits Manager/Risk Manager: Cecilia Taft Safety Officer: Darryl Hughes Written documentation must be submitted as soon as possible on or after date of injury. 4. If the employee is expected to be off the job for three (3) days or more, a FMLA request for Family Leave form, doctor s statement, and a Request for Leave from must be attached. 5. The forms listed in item #4 above can be mailed to the employee s home once Human Resources is notified that the employee is going to be absent for (3) days or more. 6. The attached forms must have all signature approvals before submitting to the Benefits Manager. PAGE 5

6 WORKERS COMPENSATION INFORMATION Should an employee need to seek medical attention at a hospital/doctor s office or need the carrier information for a prescription it is as follows: CompSource Oklahoma P.O. Box Oklahoma City, OK Their phone number is and as always, you can contact the Human Resource Office at (405) COMPENSATION OPTIONS FOR EMPLOYEES Employees have two (2) options when it comes to payroll compensation. 1. Employee can be paid at 100% using accumulated sick leave (or other leave programs available at the University if eligible) 2. Employee can be paid at 70% through CompSource Oklahoma. Should an employee choose not to use accumulated leave, then a letter stating such should accompany this packet. Also, with the completion/approval of the FMLA form, the employee s health benefits will continue for up to twelve (12) weeks. It will be the responsibility of the employee to continue the premium payments as long as they are compensated through CompSource Oklahoma after the twelfth (12) week. Should there be a lapse in coverage during this time the employee will not be allowed to re-enroll with the health insurance carrier for twelve (12) months. Please sign this form stating that the Benefits Manager discussed the options available to employees. Employee Signature Date PAGE 6

7 WORKERS COMPENSATION INFORMATION FULL NAME (LAST, FIRST, MIDDLE) SOCIAL SECURITY # COMPLETE ADDRESS CITY STATE ZIP TELEPHONE # DATE OF BIRTH GENDER LENGTH OF EMPLOYMENT OCCUPATION AM / PM DATE OF ACCIDENT/TIME AM / PM TIME WORKDAY BEGAN DATE EMPLOYER NOTIFIED PLACE OF ACCIDENT LATEST DATE EMPLOYEE WORKED DATE RETURNED NATURE OF ILLNESS: (DIAGNOSIS) CUMULATIVE INCIDENT: (CARPEL TUNNEL, HEART ATTACK) SINGLE INCIDENT: (SPRAIN, STRAIN, BURN, ETC) IDENTIFY PARTS OF THE BODY INVOLVED & DESCRIBE ACTIVITY AT TIME OF INJURY: IS THIS A CONTESTED CLAIM? YES NO PAGE 7

8 EMPLOYEE SIGNATURE DATE SUPERVISOR SIGNATURE DATE SAFETY OFFICER SIGNATURE DATE BENEFITS MANAGER/RISK MANAGER SIGNATURE DATE FOR OFFICE USE ONLY Was employment agreement made in Oklahoma? What is the average weekly wage for this employee? Policy # SIC# 8221 PAGE 8

9 Workers Compensation Supervisor Claim Reporting Information EMPLOYER Company Name: LU Worksite Location Supervisor Telephone Number Supervisor s Name Dept EMPLOYEE Name Home Address Home Telephone Number Social Security Number Date of Birth Male Female Date to Hire Title Prof. Code Last Date Worked Return to Work Date Accident Information Date & Time Place Where Accident Occurred Began Work Day at Work Date Description of Accident Description of Injury Was Injury Fatal YES NO Was Safety Equipment Provided and Used How Could This Accident Have Been Prevented? Witness(es) Name, address & daytime telephone Please forward for signatures: Department Head Manager/Safety/Quality Control Benefits Manager/Risk Management PAGE 9

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