Policy Number: 100
Workers' Compensation Insurance
I. POLICY AND GENERAL STATEMENT
The University of Texas Health Science Center at Houston ("university") participates in a program of self-insurance that provides worker compensation benefits for employees who suffer Compensable Injury or Occupational Disease while performing duties within the course and scope of their employment. Any questions concerning Workers' Compensation Insurance Coverage should be directed to Risk Management and Insurance ("RMI").
Compensable Injury: An injury arising out of, and in the course and scope of employment for which compensation is payable according to law.
Occupational Disease: A disease arising out of the performance of, and in the course of, employment that causes damage or harm to the physical structure of the body including other disease or infections naturally resulting from the work-related disease. An ordinary disease of life to which the general public is exposed is not considered an Occupational Disease unless it is the result of an incident related to a Compensable Injury or Occupational Disease.
A. Reporting Accidents, Injuries and Occupational Diseases
All on-the-job injuries, accidents and Occupational Diseases, regardless of how minor, must be reported by the employee immediately to the employee's supervisor. If an employee fails to report an injury and is unable to work the following day, that person will be required to see a health care provider or be considered absent without permission. The supervisor will complete the Supervisor's First Report of Injury as soon as the injury is reported and will send it immediately to RMI.
Employees must report an injury to the university within 30 days of the date on which the injury occurs or, if the injury is an Occupational Disease, within 30 days of when the employee knows or should have known that the Occupational Disease may have been related to employment. Failure to do so may result in a denial of the employee’s claim.
B. Seeking Medical Attention
Supervisors must offer to contact an appropriate health care facility for an injured employee. The employee has the right to refuse medical treatment. The employee’s refusal should be noted on the First Report of Injury Form. If the health care provider does not accept workers’ compensation insurance, the employee may be responsible for the medical costs associated with the claim. Emergency treatment is an exception. Contacts with health care facilities for individuals who require medical attention and who are employed in the Houston area are to be made as follows:
- refer all minor injuries to The University of Texas Health Services;
- refer major eye injuries to Cizik Eye Clinic; and
- refer all other major injuries to the Memorial Hermann Hospital - Texas Medical Center Emergency Department.
The supervisor may accompany any employee who requires medical attention to the appropriate medical facility.
An employee who is unable to return to work on the date of injury will be paid in full for the normally scheduled hours for that day.
C. Record-keeping and Leaves
When the injured individual is disabled from work for time other than that required for initial medical treatment, a Workers' Compensation Insurance Request for Paid Leave form must be completed and signed by the injured individual and the supervisor. This form must be submitted even if the person is an employee who elects not to use paid leave to remain on the payroll during the period of disability. Such election should be noted on the form.
Loss time due to work-related injuries or Occupational Disease may qualify for coverage under the Family and Medical Leave Act provided the employee meets the eligibility requirements. See HOOP Policy 106 Family and Medical Leave.
If the employee elects to use paid leave, the employee must first exhaust sick leave. Once sick leave has been exhausted, he or she may then choose to use other paid leave in lieu of receiving temporary income benefits (TIBs). Prior to making an election concerning the use of other paid leave, the employee will be advised that although there is a seven-day waiting period where TIBs are not payable, should disability extend to the fourteenth day after the first day of disability, the carrier will then issue a TIBs payment for the waiting period. TIBs are not payable as long as paid leave is being used. When the designated portion of sick and other paid leave is exhausted, the employee will be placed on a leave of absence without pay until the earlier of:
- released by a health care provider able to return to full or modified duty, or
- six months from date of injury.
Any weekly benefits paid are in accordance with the Texas Workers' Compensation Insurance Act.
D. Return to Work
An employee placed on leave of absence for a Compensable Injury will be returned to work when a work status report (DWC 73) which releases an employee to return to full-time or modified duty employment (see HOOP Policy 19 Temporary Modified Duty Assignments) is submitted to RMI or the supervisor.
An employee who is unable to return to work at the specified time must return to the health care provider for approval to remain off work; otherwise the person's absence will be considered unauthorized. Continued unauthorized absence can result in termination.
An employee who requires time off for medical treatment related to the injury must provide his or her supervisor with a health care provider’s release to return to work for each incidence of time off taken.
E. Death Benefits
If the death of an employee results from an injury covered under RMI, death and survivor benefits are payable to the legal beneficiaries in accordance with the Texas Workers' Compensation Act.
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