Transcript Workers’ Compensation - Florida International University

FIU Workers’ Compensation Program
What You Need to Know…
Florida Statute, Chapter 440.105:
"Any person who, knowingly and with intent to injure,
defraud, or deceive any employer or employee, insurance company, or self-insured
program, files a statement of claim containing any false or misleading information
commits insurance fraud, punishable as provided in s. 817.234."
February 7, 2010
Content Overview
• Purpose of FIU Workers' Compensation Program…. 3
• Eligibility for Benefits……………………………… 4
• When an Injury Occurs…………………………….. 5
– Medical Emergency……………………………………….. 6
– Non-Medical Emergency………………………………….. 8
• Benefits:
– Medical Treatment………………………………………… 9
– Lost Time Wages………………………………………….. 10
– Pharmacy/Prescriptions…………………………………… 12
• Assistance Directory……………………………….. 13
FIU Workers’ Compensation
PC 224
2
What Is the Purpose of The FIU
Workers’ Compensation Program?

To provide legally mandated benefits to workers
who are injured at work, or who develop a jobrelated illness as a result of their employment.

Benefits may include payment for medical bills,
mileage, lost wages and vocational rehabilitation.

The Florida Division of Risk Management
determines eligibility for coverage based on the
circumstances reported, not the FIU.
3
Am I Eligible for Workers’
Compensation Benefits?

All FIU employees are covered under the State of Florida
Workers' Compensation Program from their first day on the
job.

Coverage is available for full-time, part-time, and
temporary employees, whether they are Faculty,
Administrative & Professional (A & P), University Support
Personnel System (USPS), Temporary Employees,
Graduate Assistants, Student Assistants or College Work
Study. (Conditions apply for temporary employees)

Registered volunteer workers are also covered.

Coverage is not available for independent contractors or
vendors who provide services to state agencies.
4
What To Do When Injured on the
Job?
Actions Required of the Injured Worker
and/or Supervisor:
1. MEDICAL EMERGENCY
GO! REPORT! FILE!
2. NON-MEDICAL EMERGENCY
REPORT! REQUEST! FILE!
5
MEDICAL EMERGENCY
GO! REPORT! FILE!
GO to the nearest emergency medical facility
ON-CAMPUS emergency transportation CALL Public Safety at 348-5911
Closest Emergency Medical Facility:
MODESTO MAIDIQUE CAMPUS
Kendall Regional Medical Center
11750 Bird Road
(305) 223-3000
BISCAYNE BAY CAMPUS
Mount Sinai Aventura Emergency Room,
Physician Offices, and Diagnosis Center
2845 Aventura Boulevard
(305) 692-1000
OFF-CAMPUS emergency transportation CALL 911
BE SURE TO INFORM THE EMERGENCY MEDICAL FACILITY AND RESPONDING
PERSONNEL THAT THE INJURY IS WORK-RELATED
6
MEDICAL EMERGENCY (2)
GO! REPORT! FILE!
REPORT! (by injured employee or supervisor)
• To OptaComp at (877) 518-2583
OptaComp Providers are available 24 hours a day 7 days a week
• To FIU Worker’s Compensation Program Coordinator at (305)
348-7960
FILE
Workers Compensation claim report
• Online at HR Workers Comp
• By phone to FIU Worker’s Compensation Program Coordinator
at (305) 348-7960
• Participate in Accident/Injury Investigation, as required
7
NON-MEDICAL EMERGENCY
REPORT! REQUEST! FILE!
REPORT! (by injured employee or supervisor)
•
•
To supervisor
To FIU Workers’ Compensation Program Coordinator at (305) 348-7960
FILE!
•
Workers Compensation claim report
–
–
Online at HR Workers Comp
By phone to FIU Workers’ Compensation Program Coordinator at (305) 348-7960
REQUEST!
•
Medical appointment, if required.
Note: FIU
Workers’ Compensation Insurance Program Coordinator will coordinate the initial
treatment with an approved Managed Care Network Provider. Medical treatment from an
unauthorized Managed Care Network Provider may jeopardize your eligibility for Workers'
Compensation benefits.
8
BENEFITS: MEDICAL TREATMENT
Injured employees will be referred to an approved
participating network healthcare provider. Failure to
properly report or schedule non-emergency injuries will
jeopardize your workers' compensation benefits.
If you have questions regarding medical treatment, benefits
or a Managed Care Network Provider, please contact
the Workers' Compensation Program Coordinator for
further information at 305-348-7960 or email at
[email protected].
The Procedure:
1)
2)
3)
4)
5)
6)
Injured worker or injured worker’s supervisor completes the on-line Workers’ Compensation Injury
Report. HR Workers Comp
Workers’ Compensation gathers information and reports the claim to the Medical Provider – OptaComp.
OptaComp Case Manager contacts injured worker and coordinates treatment between injured worker,
Workers’ Compensation Coordinator and provider.
State of Florida – Division of Workers’ Compensation sets up claim
Workers’ Compensation Coordinator notify FIU Payroll Department, Benefits Department and
Employee Relations of any lost time due to the work related injury.
Office of Employee Assistance also available to provide assistant, if needed.
9
BENEFITS: LOST TIME & WAGES
Injured FIU employees may be eligible for workers’ compensation wage benefits
while away from work (for more than 7 days) as a result of a work-related injury.
Eligibility begins on the eighth day (8) of partial or total disability:
IF:
a) Documentation from an approved Managed Care Network Physician or medical
facility is submitted to the Workers’ Compensation Coordinator, WHICH
substantiates the employee's inability to return to work as a result of the injury.
OR
b) The employee is certified to return to work on full or modified duty with
restrictions, but the supervisor and/or department is unable to provide reasonable
accommodation.
SUPERVISORS ARE STRONGLY ENCOURAGED TO IDENTIFY APPROPRIATE
MODIFIED DUTIES FOR EMPLOYEES WHO HAVE BEEN RELEASED TO WORK
WITH RESTRICTIONS.
10
BENEFITS: LOST TIME & WAGES (2)
 The first 40 hours of missed work will be paid under Administrative Disability Leave.
This includes intermittent visits to an authorized Managed Care Network Physician.
 After the first 40 hours, two-thirds of the injured employee’s wages are paid by the
Workers' Compensation Program, while the remaining one-third may be paid by
applying available accrued personal leave (sick, annual and compensatory). This
allows the injured employee to receive their standard paycheck by making up the
differences between Workers' Compensation wage benefit and his/her normal biweekly wage.
 Temporary employees DO NOT receive disability leave or payments, unless they have
been medically disabled for a minimum of 21 consecutive days. After this time,
Temporary employees will be eligible to receive retroactive pay for the first 7 days
after the incident occurred.
 The injured worker is responsible for keeping the supervisor and the Worker's
Compensation Coordinator informed regarding their work status, follow-up
appointments, and physical therapy.
 Supervisors are responsible for maintaining communication with the injured worker
while he/she is unable to work, and facilitating return to work.
11
BENEFITS: PHARMACY
 The cost of medically necessary prescriptions for treatment and or recovery from
work-related injuries is covered under the Workers' Compensation Program. A
Cypress Card will be provided on your first doctor’s visit.
 Any pharmacy within the State of Florida may be used to fill a prescription.
 In most cases, pharmacies will charge OptaComp directly with no charge to the
injured employee. However, some pharmacies may require the injured employee to
pay for medications out-of-pocket. To obtain reimbursement for these charges you
must make a copy for your records and submit the original receipt to:
Florida Department of Financial Services
Division of Risk Management
Bureau of State Employees WC Claims
P.O. Box 8020
Tallahassee, FL 32399-0314
12
Assistance Directory
WORKERS COMPENSATION PROGRAM COORDINATOR
(Serves All Campus Locations)
Division of Human Resources
Modesto Maidique Campus, PC 224
Phone : (305) 348-7960
Fax: (305) 348-6476
DIVISION OF RISK MANAGEMENT
Bureau of State Employee's WC Claims
P.O. Box 8020
Tallahassee, FL 32399-0314
850-413-4847
OptaComp
P.O. Box 44291
Jacksonville, Florida 32231
877-518-2583
13