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The University of Alabama in Huntsville Employee Occupational Injury Policy (Rev.). Robert W. Rieder University Counsel UAH Office of Counsel Managers and Supervisors Workshop Office of Counsel/Human Resources September 21, 2012. UAH Occupational Injury Policy.

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the university of alabama in huntsville employee occupational injury policy rev

The University of Alabama in HuntsvilleEmployee Occupational Injury Policy (Rev.)

Robert W. Rieder

University Counsel

UAH Office of Counsel

Managers and Supervisors Workshop

Office of Counsel/Human Resources

September 21, 2012

uah occupational injury policy
UAH Occupational Injury Policy
  • Alabama Workers’ Compensation law – not applicable to employees of state agencies/ institutions
  • UAS employees
    • Board of Trustees policy - UAS institution employees to be provided benefits for on-the-job (OJI) injuries
    • UAH Occupational Injury Policy
      • For administration of OJI program
      • Most recent revision – February 2, 2012 eff. date
uah occupational injury policy1
UAH Occupational Injury Policy
  • Key “players”
    • Employee – must carry out certain duties
    • Supervisor
    • OJI Coordinator (OJI/C) in Office of Counsel
  • Who is an “employee”?
    • All UAH faculty and staff, full-time and part-time
    • Student workers + graduate assistants
  • Policy encompasses
    • Injuries
    • Illnesses/diseases caused or aggravated by unusual hazards associated with employee’s job
uah occupational injury policy2
UAH Occupational Injury Policy
  • Triggering event: an employee is injured:
    • While performing job duties - the injury must been caused by an accident “arising out of and in the course of employment” (“job-related”)
    • On or off campus and at any time, as long as job-related
  • Three “steps” to an OJI claim
    • Reporting
    • Securing medical attention
    • Filing a claim
uah occupational injury policy3
UAH Occupational Injury Policy
  • Step 1: Employee reports the injury
    • Injury immediately apparent
      • To supervisor – immediately, if possible, but no later than 2 days afterward
      • To Office of Counsel
        • Within 1 calendar week
        • Complete Employee Occupational Accident/-Injury Report
        • Supervisor follow-up with Office of Counsel to verify employee contact
    • Injury apparent outside “work day period” – same as above
    • Delay in reporting – possible effect
uah occupational injury policy4
UAH Occupational Injury Policy
  • Step 2 – Employee obtains medical treatment, as needed
    • “Emergency” injury
      • Only “first aid” treatment needed:
        • UAH Police may be able to administer
        • UAH Faculty/Staff Clinic – possible resource
      • For more serious injuries, employee should ordinarily go to hospital emergency room
      • Transportation – supervisor or campus police may help arrange
        • Ambulance – may be called, but charges are employee’s responsibility
        • In appropriate case, family member may transport employee
        • Ultimate responsibility - employee, not University
      • Employee must comply with supervisor’s instructions regarding emergency treatment
uah occupational injury policy5
UAH Occupational Injury Policy
  • Step 2 – Employee medical treatment (cont’d)
    • “Non-emergency” injury
      • Employee/supervisor contact OJI/C
        • OJI/C arranges appointment at UAB Health Center Family Practice Clinic (“Clinic”)
        • Or, OJI/C arranges appointment with another physician (“Approved Physician), where Clinic not within employee’s health insurance
      • Employee insurance:
        • University BCBS insurance: OJI/C supplies to health care provider BCBS work-related injury (WRI) billing number
        • Other insurance: employee informs health care provider that UAH not subject to Alabama Workers’ Compensation law and does not carry W/C insurance
uah occupational injury policy6
UAH Occupational Injury Policy
  • Step 2 – Employee medical treatment (cont’d)
    • Use of other than foregoing “approved health care providers” – cost may not be paid by University
    • Employee must comply with supervisor’s instructions to seek non-emergency medical assistance
    • Physician’s directives - employee must comply to be eligible for OJI benefits
    • Treatment by non-physicians - employee should contact OJI/C before treatment to insure cost will be paid
uah occupational injury policy7
UAH Occupational Injury Policy
  • Step 2 – Employee medical treatment (cont’d)
    • Injury that is job-related but away from campus
      • Secure medical help, as needed
      • Contact OJI/C for further information
    • Follow-up treatment
      • By Clinic or Approved Physician, or by physician to whom employee is referred by foregoing provider(s)
      • Use of other than foregoing medical providers – cost may not be paid by University
uah occupational injury policy8
UAH Occupational Injury Policy
  • Step 3: Employee files OJI claim
    • Claim form
      • Employee must file to obtain OJI benefits
      • Obtain online at http://www.uah.edu/legal/injuries.php or from OJI/C. Complete and return, with other documents (e.g., medical records release form) to OJI/C
      • Must be signed in presence of OJI/C or other notary
      • Misconception: completing of Employee Occupational Accident/Injury Report = filing OJI claim
    • Delay in filing
      • May result in claim denial (automatic for delay of 1 year or more)
      • Employee need not wait until all treatment completed
uah occupational injury policy9
UAH Occupational Injury Policy
  • Step 3: Employee files OJI claim (cont’d)
    • University attorney
      • Reviews claim, supporting documents, and all facts
      • Makes approval/non-approval recommendation to Assoc. Vice President for Human Resources
    • Final authority – Vice President for Finance and Admin.
    • As additional medical expenses are incurred, supplemental claim may be filed with OJI/C
  • Misrepresentation/fraud in regard to claim – consequences:
    • Disqualification of employee for any OJI benefits
    • Disciplinary action, including possible dismissal
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UAH Occupational Injury Policy
  • OJI Benefits – two types:
    • Medical expense benefits (MEB) – payment or reimbursement of medical treatment costs
    • Lost wage benefits (LWB)– wage payments for absence from work due to injury
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UAH Occupational Injury Policy
  • Medical expense benefits
    • UAS OJI policy covers only medical expenses not paid by employee’s health insurance
    • Employee with UAH BCBS insurance:
      • All expenses, including deductibles and co-pays, are paid up to policy limits (assuming WRI billing no. given to health provider)
      • Claim may be made for non-insured benefits
    • Employee with other health insurance
      • Submit all medical expenses to health insurance carrier
      • Provide OJI/C with proof of payment/nonpayment from carrier, plus invoices/statements from health care providers, medication receipts, etc.
      • University will pay non-insured portion of expenses
uah occupational injury policy12
UAH Occupational Injury Policy
  • Medical benefits (cont’d)
    • Limitations
      • Paid only until employee reaches “maximum medical improvement,” as determined by medical evaluation
      • Limited to “reasonable costs”
      • Treatment by chiropractor, podiatrist, pain clinic, psychologist, or counselor
        • Necessity of referral by “approved health care provider”
        • Necessity of prior notice to OJI/C
    • University may require additional medical exam/tests
uah occupational injury policy13
UAH Occupational Injury Policy
  • Lost wage benefits
    • Physician certification – absences:
      • All OJI work absences must be supported by physician certification – includes initial period of absence, subsequent periods, and period extensions
      • Must be signed by physician
      • Must include description of injury/condition and period of anticipated absence
      • Must be provided to both supervisor and OJI/C!
    • Physician certification – return to work:
      • “Release to work” certification must be provided before employee returns after absence
      • Must indicate employee able to work and any limitations
      • Must be presented 1st to OJI/C and then to supervisor
uah occupational injury policy14
UAH Occupational Injury Policy
  • Lost Wage Benefits (cont’d)
    • Employee “status report”
      • Includes condition and progress toward recovery
      • Provided to supervisor
        • Required by OJI Policy each week on Friday morning
        • Required generally by Staff Handbook:

Throughout the period of absence, employees must keep the supervisor or department head informed of their physical condition and their estimated date of return. Employees who do not comply with these provisions may have their absence charged to leave without pay or have other disciplinary action taken against them. “Sick Leave,” p. 49

      • Mandatory
uah occupational injury policy15
UAH Occupational Injury Policy
  • Lost wage benefits (cont’d)
    • Leave charged - “waiting period”
      • Day of injury + next working day
      • Charged to administrative leave (full pay)
    • Leave charged – post-waiting period
      • Sick/vacation leave
        • Absence charged to such leave unless employee opts for OJI leave
        • Employee receives full pay
        • TRS credit - continues to accrue
        • Normal withholding (taxes, insurance premium payments, TRS contributions, etc.) made
        • Vacation and sick leave - continue to accrue
        • Holidays – full pay received
uah occupational injury policy16
UAH Occupational Injury Policy
  • Lost wage benefits (cont’d)
    • Leave charged – post-waiting period (cont’d)
      • OJI leave
        • Employee may elect to take OJI leave
          • When to elect – within 10 days after injury or after 1st day of absence, whichever is later
          • How to elect – written request to OJI/C, who will notify Payroll
        • Pay
          • Amount - 66 2/3% of employee’s current rate of pay
          • Special rule for law enforcement officers
          • Withholding – taxes, insurance premiums, etc.
          • Vacation and sick leave accrual – no
          • Holidays – paid at 66 2/3 % rate
          • May supplement pay from available sick/vacation leave to receive amount equal to current rate of pay
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UAH Occupational Injury Policy
  • Lost wage benefits (cont’d)
    • OJI Leave (cont’d)
      • How long received?
        • General – from 1st day of absence after waiting period until physician releases employee to return to work
        • Maximum period – 180 consecutive calendar days
        • Ceases if and when employee begins to receive long-term disability (LTD) salary benefits
        • Ceases upon employee termination, voluntary or not
    • LTD salary continuation benefits
      • UAH provides LTD coverage for all employees
      • Eligibility
        • 90 days of continuous disability
        • Permanent or extended disabled condition
      • Mandatory application – employee with OJI
        • If return to work within 90 days of injury not likely – must apply for LTD
        • Contact Benefits/Employee Services Office for help
uah occupational injury policy18
UAH Occupational Injury Policy
  • Lost wage benefits (cont’d)
    • Unpaid medical leave
      • Employee may request, under UAH policy, when
        • Not released for work by physician
        • 180 day lost wage benefits period has run
        • LTD carrier has determined – not eligible for LTD
      • May be granted for up to 6 months
      • Employee retains right to position
uah occupational injury policy19
UAH Occupational Injury Policy
  • Lost wage benefits (cont’d)
    • Leave under Family and Medical Leave (FMLA) Act
      • Benefit
        • 120 days (per annual period) of unpaid leave
        • Job protected
      • Qualifying events (see UAH FMLA Policy for details)
        • Employee remains in medical facility overnight
        • Employee receives continuing treatment from health care provider for more than 3 consecutive days
        • Employee undergoes restorative surgery
      • Supervisor notification to Benefits/Employee Services
        • If supervisor becomes aware of qualifying event – UAH, as employer, may designate absence as FMLA leave
        • If employee communicates desire to designate absence as FMLA leave – may be designated if employee qualifies
uah occupational injury policy20
UAH Occupational Injury Policy
  • Termination of employment
    • An employee may not be terminated
      • Simply due to injury or OJI claim
      • During the 180 day maximum lost wage period
      • During approved unpaid medical leave period
      • During FMLA leave period
    • An employee not able to work due to injury is subject to termination at other times
    • After absence of 1 year due to OJI, an employee ordinarily will not be continued in job
    • Contact OOC and Office of Human Resources for assistance regarding any termination issue
uah occupational injury policy21
UAH Occupational Injury Policy
  • Continuation of insurance benefits
    • UAH provides several insurance programs:
      • Some are provided on cost-sharing basis: group health and dental
      • Some are provided at no cost to employee: group term life, AD&D, LTD
    • Contact Benefits/Employee Services for more information when questions arise, during periods of absence due to an employee’s OJI, about:
      • An employee’s eligibility for continuation of insurance benefits
      • An employee’s responsibility for premium payments
uah occupational injury policy22
UAH Occupational Injury Policy
  • Permanent disability benefits
    • UAH provides permanent partial and total disability benefits similar to those set forth in the Alabama W/C statute
    • All such benefits are subject to off-set for benefits received from other sources (LTD insurance, Social Security, Alabama Teachers’ Retirement System, etc.)
  • Death benefit
    • Paid pursuant to formula set out in OJI Policy
    • Paid to dependents designated in Policy in single lump sum payment
    • Subject to offsets
    • Burial expense benefit
uah occupational injury policy23
UAH Occupational Injury Policy
  • Policy available on Office of Counsel website at http://www.uah.edu/legal/policies
  • This Presentation will be available on this web- site at http://www.uah.edu/legal/presentations
  • For assistance, contact

Robert Rieder Kerry Mitchell

University Counsel On-the-Job Injury Coordinator

824-6633/W 824-6633/W

698-2025/C kerry.mitchell@uah.edu

riederr@uah.edu