Workers' Compensation is a special kind of medical insurance. If you suffer a work-related injury or illness, your employer (the Commonwealth of Virginia) must pay for both the medical expenses and, if appropriate, a percentage of lost wages in all compensable claims.
Responsibilities of the Employee:
- Select a treatment provider from the list of Panel Physicians
- Adhere to your physician's instructions and treatment plans
- Comply with the established policies & procedures
- Keep all parties informed of your status
Unlike normal illnesses/injuries that are treated on a client- physician basis, Workers' Compensation closely involves the University, the your supervisor, and the insurance carrier. The following paragraphs provide policies and procedures for your information.
Select a Panel Physician
Employees must select a Panel Physician(s) or medical facility provided by the Workers' Compensation Office for treatment unless there is an emergency situation or prior release has been obtained. Employees must comply with all treatment protocols and appointments as prescribed. In the event the individual is not satisfied with the care, notify the Workers' Compensation Specialist and request a change in the physician or facility.
Use of Sick Leave
In order to maintain consistency with the original leave accrual system and the Virginia Sickness and Disability Program (VSDP), all employees will be required to use sick leave for the first seven (7) calendar days to cover time off for a claim of work related injury or illness. In cases when an employee is out of work for more than 7 calendar days on a compensable claim, the use of WT (worker's compensation leave) will commence on day 8. All use of the WT code must be authorized by the Workers' Compensation Specialist. *All* time off for a work related injury must be established in writing by the treating health provider. The written release must denote a specific time period along with the physician's signature and must be presented to the Workers' Compensation Specialist. The treating physician must also verify the return to work status in writing to the Workers' Compensation Office prior to reinstatement. Any time missed from work that has not been prescribed by your physician will be charged to annual leave, sick leave, or Leave Without Pay (LWOP) as appropriate.
VSDP Participants Notify UNUM
VSDP participants must also notify UNUM at (800) 652-5602 if the injury results in a physician releasing them from work.
Continuation of Salary
If the claim is accepted as a workers' compensation claim, the employee will be paid 66 2/3% of his/her average weekly wage. This benefit is non-taxable. A VSDP participant may be eligible to receive more than the 66 2/3% depending on his/her length of service. Continuation of salary at 100%, while a compensability decision is being made, is contingent on the amount of available sick leave balance (accrual system) and the establishment of a Short-Term Disability Status (STDS) by UNUM.
Where should bills, doctor's notes, disability slips, etc be sent?
Any bills, doctor's notes, disability slips, and other documents received by the employee must be forwarded to the Workers' Compensation Specialist, Human Resources, 4400 University Drive, MSN 3C3, Fairfax, VA 22030-4444. During your appointment(s), please impress upon the physician's staff the importance of having accurate coding and written information on statements sent to MC Innovation (MCI) for payment. All medical provider's invoices must be complete with appropriate medical notes and insurance codes and should reference your claim number and date of injury. Invoices may be sent directly to MC Innovations, Inc., PO Box 1140, Richmond, VA 23218, phone (804) 649-2288. Any invoices received by Workers' Compensation will be forwarded to MCI on your behalf for payment.
Temporary Total Short-Term Disability
If entitled to Temporary Total Short-Term Disability (TTD) payments under Workers' Compensation, the funds will be paid to you through payroll during regular payroll runs once the University receives payment from MCI. Workers' Compensation payments for lost wages are not subject to federal income tax.
Wage employees are not paid through the University for time off due to injuries. Should the work related temporary total disability exceed seven days, the percentage of lost time wages will be forwarded directly to the employee from MCI. All employees (faculty, classified and wages) must provide written notification to the Workers' Compensation Office of a physician medically releasing them from work and prior to their reinstatement.
What if the injury/illness recurs?
If the injury/illness recurs after your physician has certified you as recovered, please notify the Workers' Compensation Office immediately. Do not simply return to the attending physician and assume that the treatment will automatically be covered by the worker's compensation insurance.
Some injuries and illnesses are not compensable
In some cases, the insurance carrier may determine that the injury/illness is not compensable. For personnel covered under one of the State's medical insurance plans the State Workers' Compensation Program may pay for the initial visit, provided the Assignment of Benefits form is returned within thirty days of receipt of the denial letter. This form allows MCI to reimburse carriers and medical providers at the allowable rate. It is the employee's responsibility to complete and file the Application for Benefits form with MCI.
Family Medical Leave Act
In accordance with GMU policy, leave is also covered under the Family Medical Leave Act (FMLA) and runs concurrent with all time out due to the injury and/or illness.
Americans With Disabilities Act
Compensability is not a determinate factor for an employee to be considered protected under the Americans With Disabilities Act (ADA). If you feel that your injury/illness qualifies you for accommodation, please call, Ruth Townsend, Associate Director/ADA Coordinator 703.993.8730 to discuss your concerns.
The Virginia Workers Compensation Commission
Please read carefully the information provided by the The Virginia Workers' Compensation Commission. The Application for Benefits is entirely employee driven and in a compensable claim continues the applicable benefits beyond the statute of limitations. In the event you feel that you have not been treated fairly regarding your claim for a work-related injury/illness or for the compensation for lost time and wages, you may appeal the matter to the Virginia Workers' Compensation Commission. The Commission will conduct a hearing and issue a binding decision. The appeal process is outlined in the booklet and on the reverse side of the blue Application for Benefits. If you have any questions regarding the Commission's form, contact the Workers' Compensation Specialist.