Workers' Compensation

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					FIU Workers’ Compensation Program
      What You Need to Know…




 Florida Statute, Chapter 440.105:   "Any person who, knowingly and with intent to injure,
  defraud, or deceive any employer or employee, insurance company, or self-insured
  program, files a statement of claim containing any false or misleading information
           commits insurance fraud, punishable as provided in s. 817.234."


                                                                          February 7, 2010
              Content Overview
• Purpose of FIU Workers' Compensation Program…. 3
• Eligibility for Benefits……………………………… 4
• When an Injury Occurs…………………………….. 5
   – Medical Emergency……………………………………….. 6
   – Non-Medical Emergency………………………………….. 8
• Benefits:
   – Medical Treatment………………………………………… 9
   – Lost Time Wages………………………………………….. 10
   – Pharmacy/Prescriptions…………………………………… 12
• Assistance Directory……………………………….. 13
                FIU Workers’ Compensation
                         PC 224
                                                     2
     What Is the Purpose of The FIU
    Workers’ Compensation Program?
   To provide legally mandated benefits to workers
    who are injured at work, or who develop a job-
    related illness as a result of their employment.
   Benefits may include payment for medical bills,
    mileage, lost wages and vocational rehabilitation.
   The Florida Division of Risk Management
    determines eligibility for coverage based on the
    circumstances reported, not the FIU.




                                                         3
         Am I Eligible for Workers’
         Compensation Benefits?
   All FIU employees are covered under the State of Florida
    Workers' Compensation Program from their first day on the
    job.
   Coverage is available for full-time, part-time, and
    temporary employees, whether they are Faculty,
    Administrative & Professional (A & P), University Support
    Personnel System (USPS), Temporary Employees,
    Graduate Assistants, Student Assistants or College Work
    Study. (Conditions apply for temporary employees)
   Registered volunteer workers are also covered.
   Coverage is not available for independent contractors or
    vendors who provide services to state agencies.

                                                                4
What To Do When Injured on the
            Job?

 Actions Required of the Injured Worker
            and/or Supervisor:
1. MEDICAL EMERGENCY
  GO! REPORT! FILE!

2. NON-MEDICAL EMERGENCY
  REPORT! REQUEST! FILE!


                                          5
        MEDICAL EMERGENCY
                  GO! REPORT! FILE!
  GO to the nearest emergency medical facility
  ON-CAMPUS emergency transportation CALL Public Safety at 348-5911
                   Closest Emergency Medical Facility:
                        MODESTO MAIDIQUE CAMPUS
                         Kendall Regional Medical Center
                                 11750 Bird Road
                                  (305) 223-3000

                           BISCAYNE BAY CAMPUS
                      Mount Sinai Aventura Emergency Room,
                      Physician Offices, and Diagnosis Center
                             2845 Aventura Boulevard
                                  (305) 692-1000

  OFF-CAMPUS emergency transportation CALL 911

BE SURE TO INFORM THE EMERGENCY MEDICAL FACILITY AND RESPONDING
              PERSONNEL THAT THE INJURY IS WORK-RELATED

                                                                      6
      MEDICAL EMERGENCY (2)
                 GO! REPORT! FILE!
REPORT! (by injured employee or supervisor)
• To OptaComp at (877) 518-2583
  OptaComp Providers are available 24 hours a day 7 days a week
• To FIU Worker’s Compensation Program Coordinator at (305)
  348-7960


FILE      Workers Compensation claim report
• Online at HR Workers Comp
• By phone to FIU Worker’s Compensation Program Coordinator
  at (305) 348-7960
• Participate in Accident/Injury Investigation, as required


                                                                  7
     NON-MEDICAL EMERGENCY
                 REPORT! REQUEST! FILE!
REPORT! (by injured employee or supervisor)
•   To supervisor
•   To FIU Workers’ Compensation Program Coordinator at (305) 348-7960

FILE!
•   Workers Compensation claim report
     –   Online at HR Workers Comp
     –   By phone to FIU Workers’ Compensation Program Coordinator at (305) 348-7960


REQUEST!
•   Medical appointment, if required.
     Note: FIUWorkers’ Compensation Insurance Program Coordinator will coordinate the initial
         treatment with an approved Managed Care Network Provider. Medical treatment from an
         unauthorized Managed Care Network Provider may jeopardize your eligibility for Workers'
         Compensation benefits.




                                                                                                   8
     BENEFITS: MEDICAL TREATMENT
      Injured employees will be referred to an approved
       participating network healthcare provider. Failure to
     properly report or schedule non-emergency injuries will
         jeopardize your workers' compensation benefits.
 If you have questions regarding medical treatment, benefits
      or a Managed Care Network Provider, please contact
      the Workers' Compensation Program Coordinator for
         further information at 305-348-7960 or email at
                                           cruzma@fiu.edu.
The Procedure:
1)   Injured worker or injured worker’s supervisor completes the on-line Workers’ Compensation Injury
     Report. HR Workers Comp
2)   Workers’ Compensation gathers information and reports the claim to the Medical Provider – OptaComp.
3)   OptaComp Case Manager contacts injured worker and coordinates treatment between injured worker,
     Workers’ Compensation Coordinator and provider.
4)   State of Florida – Division of Workers’ Compensation sets up claim
5)   Workers’ Compensation Coordinator notify FIU Payroll Department, Benefits Department and
     Employee Relations of any lost time due to the work related injury.
6)   Office of Employee Assistance also available to provide assistant, if needed.                       9
BENEFITS: LOST TIME & WAGES

   Injured FIU employees may be eligible for workers’ compensation wage benefits
    while away from work (for more than 7 days) as a result of a work-related injury.

Eligibility begins on the eighth day (8) of partial or total disability:
    IF:

    a) Documentation from an approved Managed Care Network Physician or medical
    facility is submitted to the Workers’ Compensation Coordinator, WHICH
    substantiates the employee's inability to return to work as a result of the injury.
    OR

    b) The employee is certified to return to work on full or modified duty with
    restrictions, but the supervisor and/or department is unable to provide reasonable
    accommodation.

     SUPERVISORS ARE STRONGLY ENCOURAGED TO IDENTIFY APPROPRIATE
      MODIFIED DUTIES FOR EMPLOYEES WHO HAVE BEEN RELEASED TO WORK
                            WITH RESTRICTIONS.


                                                                                          10
  BENEFITS: LOST TIME & WAGES (2)

 The first 40 hours of missed work will be paid under Administrative Disability Leave.
  This includes intermittent visits to an authorized Managed Care Network Physician.
 After the first 40 hours, two-thirds of the injured employee’s wages are paid by the
  Workers' Compensation Program, while the remaining one-third may be paid by
  applying available accrued personal leave (sick, annual and compensatory). This
  allows the injured employee to receive their standard paycheck by making up the
  differences between Workers' Compensation wage benefit and his/her normal bi-
  weekly wage.
 Temporary employees DO NOT receive disability leave or payments, unless they have
  been medically disabled for a minimum of 21 consecutive days. After this time,
  Temporary employees will be eligible to receive retroactive pay for the first 7 days
  after the incident occurred.
 The injured worker is responsible for keeping the supervisor and the Worker's
  Compensation Coordinator informed regarding their work status, follow-up
  appointments, and physical therapy.
 Supervisors are responsible for maintaining communication with the injured worker
  while he/she is unable to work, and facilitating return to work.


                                                                                          11
             BENEFITS: PHARMACY

 The cost of medically necessary prescriptions for treatment and or recovery from
  work-related injuries is covered under the Workers' Compensation Program. A
  Cypress Card will be provided on your first doctor’s visit.
 Any pharmacy within the State of Florida may be used to fill a prescription.
 In most cases, pharmacies will charge OptaComp directly with no charge to the
  injured employee. However, some pharmacies may require the injured employee to
  pay for medications out-of-pocket. To obtain reimbursement for these charges you
  must make a copy for your records and submit the original receipt to:
    Florida Department of Financial Services
    Division of Risk Management
    Bureau of State Employees WC Claims
    P.O. Box 8020
    Tallahassee, FL 32399-0314




                                                                                     12
              Assistance Directory
WORKERS COMPENSATION PROGRAM COORDINATOR
           (Serves All Campus Locations)
Division of Human Resources
Modesto Maidique Campus, PC 224
Phone : (305) 348-7960
Fax: (305) 348-6476

DIVISION OF RISK MANAGEMENT
Bureau of State Employee's WC Claims
P.O. Box 8020
Tallahassee, FL 32399-0314
850-413-4847

OptaComp
P.O. Box 44291
Jacksonville, Florida 32231
877-518-2583
                                           13

				
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