UNIVERSITY OF PITTSBURGH PROCEDURE 07-06-02

CATEGORY:            PERSONNEL
SECTION:                Employee Support
SUBJECT:               Workers' Compensation
EFFECTIVE DATE:   February 1, 2012 Revised
PAGE(S):                 4

I.    PURPOSE

      To outline the steps for reporting and filing a claim for Workers' Compensation,

      seeking appropriate medical treatment, and returning to work.

II.   SCOPE

      This procedure supports University Policy 07-06-02, Workers’ Compensation, and

      applies to all University of Pittsburgh faculty, staff, and certain student employees

      who believe they have sustained a work-related injury, illness, or disease.

III.  ADMINISTRATIVE RESPONSIBILITIES

      It is the responsibility of the Office of Risk Management, Insurance & Workers’

      Compensation (ORMI) to oversee the University’s administration and management

      of the Workers’ Compensation program in accordance with state regulations. 

      ORMI consults with the Office of General Counsel on claims as appropriate and

      delegates claims administration to a third-party claims administrator (TPA).  The

      University’s Workers’ Compensation program’s primary goals are the resolution

      of claims and the safe and timely return of employees to work.

      Employees or their supervisor must report any illness, injury, or disease that is

      believed to have arisen from the performance of one’s job duties to their supervisor

      and the TPA immediately.  Failure to report the injury immediately may jeopardize

      the Workers’ Compensation claim.

      Detailed directions for reporting a potential work injury or illness are located at

      http://www.cfo.pitt.edu/wc/index.html.

IV.  PROCEDURE

      Reporting a Work-Related Injury, Illness, or Disease

      Employee                                  1.   Immediately call the University’s TPA, UPMC

                                                            Work Partners, at 1-800-633-1197 (24 hours/

                                                            day, 7 days/week) to report the work-related

                                                            injury or illness.

                                                      2.   Notify your supervisor.

                                                      3.   Emergency assistance may be obtained from

                                                            campus Security or Public Safety Departments.

      Department/Supervisor              4.   Confirm with the injured worker that they have

                                                            taken the proper steps to report their injury. 

                                                            If he/she is unable to make this call, you

                                                            should do so on their behalf.

                                                      5.   Immediately investigate injury site and verify

                                                            that any potentially unsafe situations are

                                                            corrected.  Report any findings to the

                                                            University’s Office of Environmental Health &

                                                            Safety (EH&S) and to the TPA.

                                                      6.   Review the electronic injury report received

                                                            from the TPA and maintain in the appropriate

                                                            departmental file for the injured worker/

                                                            employee.

                                                      7.   Notify the TPA if the employee misses at least

                                                            one day of work because of the work injury/

                                                            illness, provide the date of the last shift

                                                            worked and paid, and provide a copy of

                                                            medical restrictions/excuse.

                                                      8.   Follow appropriate Human Resources

                                                            guidelines, policies or procedures if the

                                                            employee begins missing time from work.

      Medical Treatment

      Employee                                 1.   If you require medical treatment, non-

                                                           emergency treatment must be obtained

                                                           through the providerslisted on the Health

                                                           Care Provider Panel - Form C.

                                                           http://www.cfo.pitt.edu/wc/campmed.html.

                                                     2.   For a medical emergency, initial medical care

                                                           may be obtained at the nearest emergency

                                                           medical facility.

                                                     3.   Understand your rights and duties as set

                                                           forth by the PA Workers’ Compensation Act.

                                                           http://www.cfo.pitt.edu/wc/index.html.

                                                     4.   Forward any medical bills related to your

                                                           work injury to the University’s TPA.

      Department/Supervisor             5.   Advise and assist employee in seeking

                                                           appropriate medical attention if necessary. 

                                                           Non-emergency treatment must be obtained

                                                           through the providers listed on the Health

                                                           Care Provider Panel – Form C.

                                                           http://www.cfo.pitt.edu/wc/campmed.html.

                                                     6.   Ensure that your employee complies with

                                                           responsibilities as outlined above, #1-4.

      Lost Time Wage Payments

      Employee/Department/

      Supervisor                                1.   Pursuant to state law and TPA claim

                                                           acceptance, a waiting period is applicable

                                                           before lost time wage replacement is available.

                                                           You must be disabled more than seven (7)

                                                           calendar days (including weekends) before

                                                           WC payments for disability are payable.  Lost

                                                           time wage payments are payable on the

                                                           eighth (8th) day after injury.  Once you have

                                                           been off work fourteen (14) days, you receive

                                                           retroactive payment for the first seven (7)

                                                           days.  Please consult with the Office of Human

                                                           Resources for guidance on use of benefit

                                                           days, such as sick, vacation, FMLA, etc., to

                                                           cover any unpaid Workers’ Compensation

                                                           during this waiting period.

                                                           http://www.hr.pitt.edu/benefits/time.

                                                     2.   If an employee returns to work at wages less

                                                           than the time of injury average weekly wage,

                                                           partial wage replacement may be continued

                                                           as dictated by state law and administered

                                                           through the TPA.

      Return to Work

      Employee                                 1.   If you are released by the physician to return

                                                           to work with or without restrictions, advise

                                                           your supervisor and provide a copy of

                                                           restrictions.

                                                     2.   Communicate with your supervisor about any

                                                           changes in medical and work capability status

                                                           following each medical appointment related

                                                           to your work injury.

                                                     3.   Adhere to restrictions set forth by the panel

                                                           provider.

      Department/Supervisor              4.   If the employee is released to return to work

                                                            with restrictions based on his or her work

                                                            injury or illness, make every reasonable effort

                                                            to accommodate the restrictions.

                                                      5.   Ensure that the employee adheres to

                                                            restrictions as outlined by the Panel provider.

                                                      6.   Instruct the employee to communicate with

                                                            you about any change in medical status

                                                            following each medical appointment related

                                                            to his/her work injury or illness.

                                                      7.   When the employee returns to work, forward

                                                            a copy of the provider’s release and scheduled

                                                            return to work date to the TPA.

                                                      8.   Notify TPA of any issues or problems with

                                                            the employee’s return to work efforts.

V.   EXHIBITS

      Exhibit A - Remember: It’s Important to Tell Your Employer About Your Injury

      Exhibit B - Workers' Compensation Information

      Exhibit C – Health Care Provider Panel

      Exhibit D – Employee Acknowledgement of Rights & Duties

VI.  REFERENCES

      Policy 07-06-02, Workers' Compensation

      http://www.cfo.pitt.edu/wc