The supervisor completes the Supervisor’s Report of Injury or Occupational Injury Form whenever an employee has or reports a work-related injury or illness. Fax the form immediately to Risk Management at (202) 687-5680. Early notification assures prompt and effective treatment and case management. The report can then be sent to University’s third-party administrator, Travelers Indemnity Company, who handles all claims.
- Supervisor’s Report Form (DOC)
When completing the form the supervisor should question the employee in person (or via telephone if this is not possible) to get the specific facts of the reported accident and injury and to fill out the Supervisor’s Report of Injury or Occupational Illness Form.
The form must be completed in its entirety. All information requested is necessary to assure that the personal information in Georgetown’s Genesys system is accurate and Risk Management will have the ability to contact the employee and to meet OSHA requirements. Care must be taken in reporting non-witnessed accidents to report in the third person using words such as employee states, claims or alleges.
If the supervisor has further information that he/she thinks is pertinent, that information should be communicated to Risk Management by phone.
The information contained in the Supervisor’s Report of Injury or Occupational Injury Form is used to complete the mandated Workers’ Compensation Act of the District of Columbia Employer’s First Report of Occupational Injury or Disease.
- Employee Medical Treatment
- Work Absence and Medical Authorization
- Workers’ Compensation Leave
- The Workers’ Compensation Leave Form
- Return to Work Clearance
- Employee’s Payroll Deductions
- Family and Medical Leave
- Short-Term and Long-Term Disability
- If a Claim is Denied
- Severe: Call GERMS at (202) 687-4357 or call 911.
- Urgent: The employee should get treatment at the nearest emergency room or urgent care facility in the area. If appropriate, have someone escort the employee.
- Non-Urgent: The employee should get medical treatment from a healthcare provider of choice as soon as possible but no less than one week after the incident occurs.
NOTE: If necessary, secure the area where the injury occured to prevent another injury (e.g. oil spill on floor, ice on pavement, faulty equipment, etc.).
If, at the time of initial medical evaluation (or any subsequent evaluation), an employee is taken out of work the employee must provide written documentation from a healthcare provider explaining the reason for the absence, the period the absence is to cover, and if possible, a projected date for return to work. Failure to do so may result in the denial of a claim.
It remains the employee’s responsibility to obtain a note from the medical provider after each visit documenting the current work status. This note is then given to the supervisor who will forward it to Risk Management for appropriate follow up.
For return to work or release to full duty a note from the medical provider must also be presented to the supervisor.
Workers’ compensation leave is used for employees who have an authorized absence and are receiving workers’ compensation pay for the period of time he/she receives such payments. When an employee has an authorized absence, the supervisor must mail the Employee’s Work Absence Letter to an employee upon receipt of a healthcare provider’s authorization.
- If an employee’s absence exceeds 14 days or more, complete Part A of the Workers’ Compensation Leave Form to de-activate the employee in Genesys and stop paychecks. Contact Risk Management at (202) 687-6622 for guidance.
- Submit the form to the department personnel responsible for keying Genesys transactions.
- When the employee returns to work complete Part B of the Workers’ Compensation Leave Form to re-activate the employee in Genesys and resume paychecks.
An employee must provide the supervisor with a healthcare provider’s written clearance before resuming work. If the clearance specifies restrictions, contact Risk Management to discuss possible accommodations. The University cannot allow employees to return to work without a medical clearance.
Workers’ compensation payment checks are issued by a third-party administrator and are not subject to University payroll deductions. While employees are receiving workers’ compensation pay they continue to be responsible for their health and life insurance premiums and any other benefit programs they are enrolled in, as well as payments for University services such as parking, fitness memberships, etc. If their paychecks are garnished for any reason it is their responsibility to immediately report this information to Risk Management. Employees are held responsible for all payments in arrears for all of the above.
Employees who are absent from work and receiving workers’ compensation wage benefits may be eliglble for Family and Medical Leave benefits. To apply an employee must complete the Georgetown University Leave Request Form and submit it to Human Resources for processing. For information and assistance contact your human resources generalist at (202) 687-2500.
Employees may not receive workers’ compensation wage replacement benefits and Short-Term or Long-Term disability benefits for the same period. For information or assistance contact the Faculty and Staff Benefits Office at (202) 687-2500.
If an employee’s workers’ compensation claim is denied he/she may be eligible for Short-Term or Long-Term disability benefits. Contact the Office of Benefits to process an application.
An employee may also contact the Office of Risk Management or their human resources generalist to discuss their claim status and options.
Contact the Office of Risk Management at (202) 687-6622.