Workers' Compensation Claims

Lewis and Clark College
Policy and Procedure

Subject: Workers’ Compensation Claims
Policy #:
Division: Business and Finance
Department: Physical Plant Services
Original Effective Date:
Date(s) Reviewed/Revised:
Approved By: Richard Bettega
Approval Date:

Purpose:

To ensure uniformity in the processing of claims for workers’ compensation benefits and to inform members of the College community of their responsibilities in notifying the College of their medical status when injured or ill as the result of a work related incident. To ensure that the College community is aware of the process for filing a workers’ compensation claims.

Policy Statement:

The College wishes to provide timely and effective workers’ compensation benefits to its employees. One of the prerequisites necessary to providing such benefits relates directly to the employees’ knowledge of the process and consequent fulfillment of employee, employer, and insurer obligations.

Procedures:

Lewis & Clark College will file an Oregon form 801 (Report of Occupational Injury or Illness) with the College’s workers’compensation insurer. The employee or employee’s supervisor shall contact the Occupational Health & Safety Officer who then completes the necessary forms and sends them to insurer. The insurer will evaluate whether the injury has arisen out of the course and scope of employment with the College. The claim will either be accepted or denied during the 90 day period following receipt of the 801. During this 90 day period, no benefits except for lost time benefits, will be paid.

IF THE WORKERS' COMPENSATION CLAIM IS ACCEPTED:

The insurer will pay all injury/illness related medical bills.
If a physician determines that the claimant is unable to work, the claimant will receive time loss benefits. However, the claimant will not be compensated for the first three days time loss unless he or she misses the first 14 calendar days of work after the date of injury, or is hospitalized overnight as an inpatient. These first three days may be charged to accrued sick leave.
If the claimant is allowed time loss benefits, he or she will receive a check about every 14 days while disabled from working.
Claimants may be required to treat with a Managed Care Organization (MCO) of the insurer's choosing. Any visits to health care providers outside the MCO prior to claim acceptance will be paid for by the insurer. See the Occupational Health & Safety Officer for details of the MCO’s for Lewis & Clark College.

IF THE WORKERS' COMPENSATION CLAIM IS DENIED:

The claimant will be responsible for medical costs related to the injury/illness. Therefore, claimants are encouraged to treat with their usual doctors or medical facilities during the 90 day deferral period so that medical expenses can be covered by their regular health insurance providers should the claims be denied.
Once a workers’ compensation benefits claim is denied, no time loss benefits are paid. Accrued sick leave may be used to cover the time lost from work, subject to reasonable verification by the College for the purpose of preventing sick leave abuse.

OTHER INSURANCE BENEFITS DURING TIME LOSS:

The College will continue to pay its portion of benefits premiums while its employees are medically unable to work due to a workers' compensation injury/illness, subject to insurance plan limitations. The Personnel Services Department can provide information regarding limitations applying to specific plans.
Employees are responsible for continuing to pay their portion of premiums while they are on time loss. Information regarding premiums is available from Personnel Services (x7837). If employees are not receiving paychecks from which to deduct benefit premiums, they must make arrangements to pay their share of the premiums with the Payroll Manager (x7820). If the Payroll Manager does not receive their portion of the premiums by the 20th of the month, the College may cancel coverage without further notice. Vacation and sick leave benefits are not accrued while on time loss.

EMPLOYEE RESPONSIBILITIES DURING TIME LOSS:

EMPLOYEES MUST NOTIFY THE LEWIS & CLARK OCCUPATIONAL HEALTH & SAFETY OFFICER WHENEVER THEY ARE UNABLE TO WORK AS THE RESULT OF AN OCCUPATIONAL INJURY OR ILLNESS.
Employees must follow up with their supervisors during absences. It is their responsibility to communicate with their supervisors on a regular basis to keep them up to date on their anticipated date of return to work. This allows their supervisors to adjust schedules during absences. In the event that employees are unable to reach their supervisors, they shall contact the Occupational Health & Safety Officer (x7872).
Physician Reports: Employees may be asked for periodic reports from their physicians to document progress. In cases of time loss, the ability to return to full, restricted, or modified work will be indicated by a written release from the treating physician. Any authorization for time loss, restricted or modified work, or work restrictions should be turned in to the Occupational Health & Safety Officer. The Occupational Health & Safety Officer will submit this information to EBI for determination of further Workers' Compensation claims benefits eligibility.
Medical Advice: If the treating physicians, or other providers of treatment, provides employees with instructions regarding the treatment of their conditions, they follow this medical advice. The College has a vested interest in prompt recovery and employees are obligated to follow their physician’s instructions.. Active participation in the doctor's treatment regime will help minimize the length of recuperation.

RETURN TO WORK:

Whenever an employee seeks medical treatment for a work related injury or illness, they must present a written authorization from the treated physician to the Occupational Health and Safety Officer on the first day they return to work. This authorization must clearly specify that the employee is medically able to return to work. If there are physical restrictions on the work they are able to perform, these must be explicitly stated.

RETURN TO WORK FOLLOWING WORKERS' COMPENSATION TIME

It is the College's hope that all injured or ill employees will heal quickly and will be able to return to work without modifications to their job duties. If, however, employees are not able to perform their regular job duties, modified work that is suitable to their medical restrictions will be identified. A written job description of this modified work will be submitted to the treating physician for approval. Once the College has received the physician's approval, the College will contact the subject employee and explain procedures for returning to work. Refusal to accept modified work may result in termination of employment and/or reduction or curtailment of workers’ compensation insurance benefits.