The University of Alabama in Huntsville Employee Occupational Injury Policy (Rev.)

The University of Alabama in HuntsvilleEmployee Occupational Injury Policy (Rev.)

Robert W. RiederUniversity Counsel

UAH Office of CounselManagers and Supervisors Workshop

Office of Counsel/Human ResourcesSeptember 21, 2012

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UAH Occupational Injury Policy

Alabama Workers’ Compensation law – not applicable to employees of state agencies/ institutions

UAS employees Board of Trustees policy - UAS institution employees

to be provided benefits for on-the-job (OJI) injuries UAH Occupational Injury Policy

For administration of OJI program Most recent revision – February 2, 2012 eff. date

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Key “players” Employee – must carry out certain duties Supervisor OJI Coordinator (OJI/C) in Office of Counsel

Who is an “employee”? All UAH faculty and staff, full-time and part-time Student workers + graduate assistants

Policy encompasses Injuries Illnesses/diseases caused or aggravated by

unusual hazards associated with employee’s job

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Triggering event: an employee is injured: While performing job duties - the injury must

been caused by an accident “arising out of and in the course of employment” (“job-related”)

On or off campus and at any time, as long as job-related

Three “steps” to an OJI claim Reporting Securing medical attention Filing a claim

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Step 1: Employee reports the injury Injury immediately apparent

To supervisor – immediately, if possible, but no later than 2 days afterward

To Office of Counsel Within 1 calendar week Complete Employee Occupational Accident/-

Injury Report Supervisor follow-up with Office of Counsel to

verify employee contact Injury apparent outside “work day period” – same

as above Delay in reporting – possible effect

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Step 2 – Employee obtains medical treatment, as needed “Emergency” injury

Only “first aid” treatment needed: UAH Police may be able to administer UAH Faculty/Staff Clinic – possible resource

For more serious injuries, employee should ordinarily go to hospital emergency room

Transportation – supervisor or campus police may help arrange

Ambulance – may be called, but charges are employee’s responsibility

In appropriate case, family member may transport employee

Ultimate responsibility - employee, not University Employee must comply with supervisor’s instructions

regarding emergency treatment6


Step 2 – Employee medical treatment (cont’d) “Non-emergency” injury

Employee/supervisor contact OJI/C OJI/C arranges appointment at UAB Health Center

Family Practice Clinic (“Clinic”) Or, OJI/C arranges appointment with another physician

(“Approved Physician), where Clinic not within employee’s health insurance

Employee insurance: University BCBS insurance: OJI/C supplies to health care

provider BCBS work-related injury (WRI) billing number Other insurance: employee informs health care

provider that UAH not subject to Alabama Workers’ Compensation law and does not carry W/C insurance

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UAH Occupational Injury Policy Step 2 – Employee medical treatment (cont’d)

Use of other than foregoing “approved health care providers” – cost may not be paid by University

Employee must comply with supervisor’s instructions to seek non-emergency medical assistance

Physician’s directives - employee must comply to be eligible for OJI benefits

Treatment by non-physicians - employee should contact OJI/C before treatment to insure cost will be paid

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Step 2 – Employee medical treatment (cont’d)

Injury that is job-related but away from campus Secure medical help, as needed Contact OJI/C for further information

Follow-up treatment By Clinic or Approved Physician, or by physician to

whom employee is referred by foregoing provider(s)

Use of other than foregoing medical providers – cost may not be paid by University

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Step 3: Employee files OJI claim Claim form

Employee must file to obtain OJI benefits Obtain online at http://www.uah.edu/legal/injuries.php or

from OJI/C. Complete and return, with other documents (e.g., medical records release form) to OJI/C

Must be signed in presence of OJI/C or other notary Misconception: completing of Employee Occupational

Accident/Injury Report = filing OJI claim Delay in filing

May result in claim denial (automatic for delay of 1 year or more)

Employee need not wait until all treatment completed

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Step 3: Employee files OJI claim (cont’d) University attorney

Reviews claim, supporting documents, and all facts Makes approval/non-approval recommendation to Assoc.

Vice President for Human Resources Final authority – Vice President for Finance and Admin. As additional medical expenses are incurred,

supplemental claim may be filed with OJI/C Misrepresentation/fraud in regard to claim –

consequences: Disqualification of employee for any OJI benefits Disciplinary action, including possible dismissal

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OJI Benefits – two types: Medical expense benefits (MEB) – payment or

reimbursement of medical treatment costs Lost wage benefits (LWB)– wage payments for

absence from work due to injury

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Medical expense benefits UAS OJI policy covers only medical expenses not

paid by employee’s health insurance Employee with UAH BCBS insurance:

All expenses, including deductibles and co-pays, are paid up to policy limits (assuming WRI billing no. given to health provider)

Claim may be made for non-insured benefits Employee with other health insurance

Submit all medical expenses to health insurance carrier Provide OJI/C with proof of payment/nonpayment from

carrier, plus invoices/statements from health care providers, medication receipts, etc.

University will pay non-insured portion of expenses

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Medical benefits (cont’d)

Limitations Paid only until employee reaches “maximum

medical improvement,” as determined by medical evaluation

Limited to “reasonable costs” Treatment by chiropractor, podiatrist, pain clinic,

psychologist, or counselor Necessity of referral by “approved health care

provider” Necessity of prior notice to OJI/C

University may require additional medical exam/tests

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Lost wage benefits Physician certification – absences:

All OJI work absences must be supported by physician certification – includes initial period of absence, subsequent periods, and period extensions

Must be signed by physician Must include description of injury/condition and period of

anticipated absence Must be provided to both supervisor and OJI/C!

Physician certification – return to work: “Release to work” certification must be provided before

employee returns after absence Must indicate employee able to work and any limitations Must be presented 1st to OJI/C and then to supervisor

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Lost Wage Benefits (cont’d) Employee “status report”

Includes condition and progress toward recovery Provided to supervisor

Required by OJI Policy each week on Friday morning Required generally by Staff Handbook:

Throughout the period of absence, employees must keep the supervisor or department head informed of their physical condition and their estimated date of return. Employees who do not comply with these provisions may have their absence charged to leave without pay or have other disciplinary action taken against them. “Sick Leave,” p. 49

Mandatory

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Lost wage benefits (cont’d) Leave charged - “waiting period”

Day of injury + next working day Charged to administrative leave (full pay)

Leave charged – post-waiting period Sick/vacation leave

Absence charged to such leave unless employee opts for OJI leave

Employee receives full pay TRS credit - continues to accrue Normal withholding (taxes, insurance premium

payments, TRS contributions, etc.) made Vacation and sick leave - continue to accrue Holidays – full pay received

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UAH Occupational Injury Policy Lost wage benefits (cont’d)

Leave charged – post-waiting period (cont’d) OJI leave

Employee may elect to take OJI leave When to elect – within 10 days after injury or after 1st day

of absence, whichever is later How to elect – written request to OJI/C, who will notify

Payroll Pay

Amount - 66 2/3% of employee’s current rate of pay Special rule for law enforcement officers Withholding – taxes, insurance premiums, etc. Vacation and sick leave accrual – no Holidays – paid at 66 2/3 % rate May supplement pay from available sick/vacation leave to

receive amount equal to current rate of pay18

UAH Occupational Injury Policy Lost wage benefits (cont’d)

OJI Leave (cont’d) How long received?

General – from 1st day of absence after waiting period until physician releases employee to return to work

Maximum period – 180 consecutive calendar days Ceases if and when employee begins to receive long-

term disability (LTD) salary benefits Ceases upon employee termination, voluntary or not

LTD salary continuation benefits UAH provides LTD coverage for all employees Eligibility

90 days of continuous disability Permanent or extended disabled condition

Mandatory application – employee with OJI If return to work within 90 days of injury not likely –

must apply for LTD Contact Benefits/Employee Services Office for help 19


Lost wage benefits (cont’d) Unpaid medical leave

Employee may request, under UAH policy, when Not released for work by physician 180 day lost wage benefits period has run LTD carrier has determined – not eligible for LTD

May be granted for up to 6 months Employee retains right to position

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Lost wage benefits (cont’d) Leave under Family and Medical Leave (FMLA) Act

Benefit 120 days (per annual period) of unpaid leave Job protected

Qualifying events (see UAH FMLA Policy for details) Employee remains in medical facility overnight Employee receives continuing treatment from health care

provider for more than 3 consecutive days Employee undergoes restorative surgery

Supervisor notification to Benefits/Employee Services If supervisor becomes aware of qualifying event – UAH, as

employer, may designate absence as FMLA leave If employee communicates desire to designate absence as FMLA

leave – may be designated if employee qualifies

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Termination of employment An employee may not be terminated

Simply due to injury or OJI claim During the 180 day maximum lost wage period During approved unpaid medical leave period During FMLA leave period

An employee not able to work due to injury is subject to termination at other times

After absence of 1 year due to OJI, an employee ordinarily will not be continued in job

Contact OOC and Office of Human Resources for assistance regarding any termination issue

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Continuation of insurance benefits UAH provides several insurance programs:

Some are provided on cost-sharing basis: group health and dental

Some are provided at no cost to employee: group term life, AD&D, LTD

Contact Benefits/Employee Services for more information when questions arise, during periods of absence due to an employee’s OJI, about:

An employee’s eligibility for continuation of insurance benefits

An employee’s responsibility for premium payments

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Permanent disability benefits UAH provides permanent partial and total disability

benefits similar to those set forth in the Alabama W/C statute

All such benefits are subject to off-set for benefits received from other sources (LTD insurance, Social Security, Alabama Teachers’ Retirement System, etc.)

Death benefit Paid pursuant to formula set out in OJI Policy Paid to dependents designated in Policy in single lump

sum payment Subject to offsets Burial expense benefit

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Policy available on Office of Counsel website at http://www.uah.edu/legal/policies

This Presentation will be available on this website at http://www.uah.edu/legal/presentations

For assistance, contact Robert Rieder Kerry Mitchell

University Counsel On-the-Job Injury Coordinator824-6633/W 824-6633/W698-2025/C [email protected]@uah.edu

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Documents

The University of Alabama in Huntsville Employee Occupational Injury Policy (Rev.)