Steps to Follow in the Event of a Work-related Injury or Illness
Supervisor's
Report of Injury Form (pdf)
To protect your right to Worker's Compensation Coverage
you must:
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Complete
the Supervisor's Report of Injury, sign it & get
your supervisor to sign it
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Go
to campus Health Services
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Return
the Supervisor's Report of Injury to Campus Safety
within 24 hours or by the next work day
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If an employee is injured or becomes ill as a result of his/her
normal work duties, the following steps should be taken:
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The employee must report any injury/illness, no matter
how minor, to the supervisor as soon as possible. Any delay may
jeopardize the employee's right to worker's compensation.
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The supervisor should send the employee to Health Services
for the injury/illness as soon as possible (extension 8111).
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The nurse will document the visit in the employee’s
file and prepare a state report (TWCC-1). The TWCC-1 is forwarded to
the Office of Human Resources and on to
our workers’ compensation insurance carrier. If the employee is
referred for off-campus medical treatment and does not agree to go, but
decides to at a later date, it should be reported immediately to
the Office of Human Resources at x7507.
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Within 24 hours or first working day after the injury/illness,
the employee and his/her supervisor must complete a Supervisor’s First
Report of Employee Injury form. Each supervisor should have this blank
form. The forms are also available through the Campus Safety office
or it may be printed
off of this website. It should be returned
to Harold Lovejoy in Campus Safety for record keeping and investigation.
The victim must make a statement, if at all possible, and attach to this
report. The victim's statement needs to state how the injury/illness occurred,
where, time, and what they were doing when the incident happened. Please be
sure that no medical records are attached to this Supervisor’s First Report
of Employee Injury Report. All medical documents go to the Office of Human Resources.
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When seeking off-campus medical service, the employee should
not pay or use his/her medical insurance. Instead,
provide the contact information for the workers' compensation insurance: Traveler's, P.O. Box 42927, Houston, TX 77242,
1-800-235-3610. The provider may also call
the Office of Human Resources for the
name, address and telephone number of our workers’ compensation insurance
carrier. It is the employee's
responsibility to verify that the provider is on the Approved List
for Worker's Compensation. The employee may access this list at
https://txcomp.tdi.state.tx.us/twccprovidersolution/homehtml or by
calling the Office of Human Resources at extension 7507 for assistance.
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If the employee misses work for 24 hours or longer
as a result of the injury/illness, it should be documented and reported
to Human Resources immediately. The first seven days of time missed
may be charged against the employee’s sick leave balance. If not enough
sick leave exists, vacation leave may be used, or leave without pay. The
employee will automatically be placed on Family Medical Leave Act (FMLA).
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After seven actual days of time missed, the
workers’ compensation insurance carrier will begin mailing checks to the
employee’s home to cover approximately 70% of his/her regular salary. If the employee
has a leave (VL or SL) balance, payroll will draw just enough from it each
day to make up the other approximate 30% of the employee’s regular salary.
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If an employee is unable to return to work after all vacation
and sick leave is exhausted, he/she will be placed in a Leave Without Pay status
and will be responsible for paying the university to continue any medical,
dental, life, vision, disability insurance, etc. that has been in effect.
The employee, however, will still be drawing the 70% of regular salary
directly from the insurance carrier.
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It is important to remember that through every phase of
a workers’ compensation case, the employee and his/her supervisor should
stay in contact with the Office of Human Resources. The Office of
Human Resources should be provided with the employee's work status reports
and any other information that the employee or supervisor has regarding
the employee's injury, ability to return to work, etc. The Office of
Human Resources will be
informed immediately when an employee returns to work after an injury
(employee must have doctor's release to return to work), is unable to continue working because of a reported injury or dies as
the result of an injury.
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