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Medical Only Claims – Remain at Work (Less than 7 calendar days off work). Injury Occurs. Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room Supervisor gives employee claim filing packet.

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Presentation Transcript
slide1

Medical Only Claims – Remain at Work

(Less than 7 calendar days off work)

Injury Occurs

Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room

Supervisor gives employee claim filing packet.

FROI* submitted to MCO by provider or employee

Employee completes/signs Part A (Incident Report)

Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist.

BWC assigns a claim number & allows or disallows the claim

MCO* contacts employee and sends FROI to BWC*

Follow up by BWC certified POR*

POR releases employee with or without restrictions and identifies treatment plan, including duration of restrictions.

Workers’ compensation specialist provides POR with employee’s job description.

POR identifies specific work duties within restrictions

POR releases worker to full duty without restrictions

END

If modified work is not possible employee remains off work and continues treatment.

Supervisor offers employee modified work whenever possible

Employee reports for duty and supplies supervisor with copy of restrictions.

Supervisor contacts workers’ compensation specialist for work modification assistance

Supervisor forwards copy of work restrictions to workers’ compensation specialist

LEGEND:

FROI = First Report of Injury

HSC = Health Science Campus

MCO = Managed Care Organization

POR = Physician of Record

RTW = Return to Work

Blue Text = Employee Action

Red Text = Supervisor Action

Green Text = Workers’ Compensation

Specialist Action

Employee is rechecked by POR

No restrictions

Full Duty

slide2

Lost Time Claims – Return to Work

(Over 7 Calendar Days Off Work)

Injury Occurs

Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist.

Employee completes incident report

Employee completes/signs Part A (Incident Report)

Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room

Supervisor gives employee claim filing packet.

FROI submitted to MCO by medical provider or employee

FROI submitted to MCO by medical provider or employee

Workers’ compensation specialist certifies/rejects the claim

Supervisor forwards all Absence Reports to workers’ compensation specialist

Follow up with BWC certified POR. Physician may prescribe therapy services and diagnostic testing; worker is unable to return to work.

BWC assigns a claim number & allows or disallows the claim

Workers’ compensation specialist faxes CWA Wage Advancement Agreement to BWC.

Employee’s time card reflects sick/vacation for first 7 calendar days off work.

Employee notifies supervisor of lost time work status.Supervisor notifies workers’ compensation specialist.

BWC begins paying compensation unless UT approves salary continuation

Test for diagnosis (health care services geared to early, safe return to work/transitional work)

BWC payments are sent directly to employee

Wage Advancement obligates the employee to endorse to the University payments of Worker’s Compensation to the extent of the advancement.

Diagnosis determined and medical care rendered

After missing work for 7 consecutive calendar days, BWC pays 72% of gross wage for the first 12 weeks of injury and 662/3% thereafter.

Workers’ compensation specialist gives physician a copy of employee’s job description.

Physician releases employee with restrictions, prescribes transitional work, including therapy intervention, on C-9 Form

Employee is offered modified or transitional work

Employee accepts modified or transitional work

slide3

Transitional

Restrictions

BWC stops payments if employee refuses modified or transitional work

Transitional plan approved by BWC

If modified work is not possible employee remains off work and continues treatment.

Supervisor offers employee modified work whenever possible

Therapist may do a functional capacity evaluation for abilities

Supervisor contacts workers’ compensation specialist for work modification assistance

Therapist develops transitional work plan & establishes a rehab schedule

Monitoring of on-site therapy by workers’ compensation specialist & supervisor

Employee reports for duty and supplies supervisor with copy of restrictions.

Transitional work ends when physician has released employee without restrictions or employee has participated in the program for 90 days.

Supervisor forwards copy of work restrictions to workers’ compensation specialist

Employee is rechecked by POR

No restrictions

Full Duty

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