A Guide To Understanding Workers’ Compensation
- What Is Covered by Workers’ Compensation?
- Workers’ Compensation: How It Works
- If the Employee Does Not Lose Work Time
- If the Employee Loses Work Time
- Wage Benefit Restrictions
A work-related injury or illness must arise from and occur during the course of employment. Medical expenses related to the treatment of a work-related injury or illness may be covered under workers’ compensation. This includes healthcare provider’s visits, hospital visits, physical therapy, prescription medication, medical equipment, and any out-of pocket medical expenses. Alternative treatments such as chiropractic care must be pre-approved. Workers’ compensation also pays for a percentage of wages lost as a result of an injury or illness. The absence must be related to a work injury, and it must be authorized by a medical provider.
Employees injured while on the job may be eligible to receive workers’ compensation benefits. The first step in filing a claim is to immediately notify the supervisor of the injury or illness. The supervisor is responsible for promptly completing a Supervisor’s Report of Injury or Occupational Illness Form on that documents the details of the injury. Upon completion, the supervisor sends the report to the Office of Risk Management. When Risk Management receives a report, it serves as a formal notice to the University that an employee sustained an accidental injury or illness while on the job. Risk Management refers the claim to the University’s third-party administrator, Travelers Indemnity Company. Travelers Indemnity Company will assign the claim to a claims adjuster who will review the facts provided to determine if the claim is approved under the District of Columbia Workers’ Compensation Act. Once the claim is accepted, the claims adjustment service is responsible for processing disability payments for lost work time. If it is determined that an employee is unable to return to the pre-injury job after recovering from a work-related injury or illness, the employee may be eligible for vocational rehabilitation services.
The claim is set up to make payments for any medical expenses related to the injury or illness. The employee should tell the healthcare provider to contact the workers’ compensation claims administrator at the Office of Risk Management for billing information.
Any absence from work must be authorized by the employee’s healthcare provider. The employee must be out of work for three days (excluding the day of injury) before workers’ compensation pays for lost work time. It is University policy to pay an injured employee for the balance of their work shift on the date of injury, no matter what time the injury occurs or whether the employee returns to work on the same day. The three-day wait includes weekends and holidays. If the employee loses one to three days of work (District of Columbia waiting period), no temporary disability payments will be made. If the employee loses 4 to 14 days , temporary disability will begin with day four. If the employee is out 14 consecutive days or more , workers’ compensation disability payments will begin with day one of the absence. The temporary disability payments are based on the wages the employee earned in the 26 weeks prior to the date of injury. The rate of pay for workers’ compensation is 66 2/3% of the average weekly wage up to a maximum amount that is calculated each year. The payments are tax-free and subject to limits set by the District of Columbia.
An employee may not receive workers’ compensation pay and regular University pay (including holiday pay) for the same period. Employees who receive both will be required to reimburse the University for the regular pay.
An employee may not use sick leave or paid leave in lieu of workers’ compensation pay. There are no exceptions.