Employee Information/Responsibilities - FAQ
- Where do I go for treatment?
- How do I file a claim?
- What will happen after I am injured?
- Who do I contact about the status of my claim?
- What are my responsibilities?
- What about missed time benefits?
- What about travel expenses?
- What is "supplementing?"
- What about medical treatment and bills for a work-related injury?
- What about tax considerations?
- When I have a doctor's appointment, do I have to use sick time if it is for an on-the-job injury?
- If I am feeling better, do I have to continue any additional scheduled medical or therapy appointments?
- The Patient Status Report (PSR) indicates that I have limitations/restrictions and my department has offered to accommodate those restrictions. However, I do not feel I can perform the work offered. Do I have to go back to work?
- What if I start having trouble with a previous work-related injury and my doctor thinks I need additional evaluation or treatment? Do I have to have it approved by workers' compensation before I have the treatment/evaluation?
- The authorized medical provider has indicated that I am at Maximum Medical Improvement (MMI). What does this mean?
- What about the Family and Medical Leave Act?
- Can I use the Catastrophic Leave Program when my work absences are due to a work-related injury?
- How does an employee transfer while on temporary work restrictions?
- What resources are available for additional assistance?
- What is the definition of that term?
- What are the procedures to obtain medical information in a workers’ comp situation?
- Are the content of meetings with WC staff confidential?
- Under Workers' Compensation, can the employer require the employee to perform restricted work?
Where do I go for treatment?
Visit our web site for a listing of treatment locations at http://www.uiowa.edu/hr/benefits/wc/locations.html
Report your injury to your supervisor or HR Unit Representative within 24 hours. This person will ask you several important questions to gather information to complete a First Report of Injury form on the Employee Self Service web site. The First Report of Injury form must be completed and sent to the Benefits Office within 24 hours of the injury/illness.
You can find your HR Unit Representative by clicking on "My HR Unit Rep" on the Employee Self Service web site.
This will require that you know your HawkID and password. If you do not know your HawkID or password, you can find assistance on the HawkID Guide web site at: http://hawkid.uiowa.edu.
If you need medical attention, obtain it at one of the approved treatment locations. Staff at these locations will give you a document called a Patient Status Report (see Glossary). You must submit this report to your supervisor within 24 hours (or 1 business day) of the appointment.
You/your supervisor will complete the First Report of Injury form based on the report of the injury. If there are witnesses, their names should be included. The form will be submitted electronically to UI Benefits to document your reported workers' compensation claim.
Sedgwick CMS handles the administration of the University’s workers’ compensation plan and the Benefits Office handles the day to day case management of workers' compensation claims. Sedgwick CMS will investigate your claim and determine if it meets criteria set out by Iowa Workers’ Compensation laws. Sedgwick CMS approves or denies the claim. If the claim is approved and you are missing time due to this approved claim, you will begin receiving missed time benefits according to the rules/guidelines established by the State of Iowa. You will be notified if your claim is denied.
You must keep your supervisor informed of your prognosis and your need for additional medical attention (if any), as well as any missed time from work. If the injury involves time away from work, a claims representative from Sedgwick CMS will contact you to gather claim information, and the Benefits Office will send you a benefits election packet.
PLEASE NOTE: Filing a false or inflated workers' compensation claim is subject to prosecution.
Report each work-related injury/condition to your supervisor or HR Unit representative as soon as possible within 24 hours.
Obtain medical care from an approved facility.
Provide your supervisor with the Patient Status Report (PSR), completed and signed by the authorized medical provider within 24 hours (or one business day) following a medical appointment. The PSR provides specific information regarding the medical diagnosis, treatment plan, recommended physical restrictions and their duration, and next medical appointment date/time.
Do not return to work until the PSR is reviewed with your UI supervisor. Failure to provide the PSR to your supervisor may result in disciplinary action.
Attend all scheduled appointments related to your workers' compensation claim. If you fail to attend a scheduled appointment, you will not be allowed to work until an updated PSR is provided and reviewed.
Follow recommended restrictions/capabilities at work and in all non-work activities. Restrictions will remain unchanged until the next scheduled appointment with an authorized provider. However, an authorized medical provider may alter the recommended limitations and provide updated restrictions as appropriate. Failure to comply with restrictions may jeopardize an employee's workers' compensation benefits.
Review information on the current PSR with your supervisor to confirm indicated restrictions/capabilities and discuss availability of appropriate temporary work.
Discuss appropriate work assignments and work schedule with your supervisor.
Complete only assigned work based on current PSR and the discussion you had with your supervisor.
Immediately contact your supervisor with questions or concerns related to temporary restricted-duty work assignments (i.e., increasing discomfort, etc.). Temporary restricted-duty work assignments should not exceed 6 months in duration.
By law, missed time benefits begin after a waiting period of three calendar-days of absence. If you miss work for more than 14 calendar days, missed time benefits will also be paid for the waiting period.
Workers’ compensation missed time benefits typically represent approximately 2/3 of a person’s regular weekly salary, depending on their income. Workers’ compensation missed time benefits have a maximum payment, so the income replacement percentage will be lower for higher income employees. You receive workers’ compensation missed time benefits during the healing period when you are unable to work, or when your department is unable to provide you with work within the identified restrictions.
Please note that you may elect to supplement workers’ compensation benefits with accrued leave. The combination of your workers’ compensation benefits and accrued leave should approximate your regular weekly salary.
If you are able to work “restricted duty” during the healing period, you will receive your full salary instead of workers’ compensation missed time benefits.
Receipt of your first missed time benefits check from workers' compensation is dependent on the completion time of the Sedgwick CMS investigation. Once a claim is approved, missed time is paid weekly. The checks are sent directly from Sedgwick CMS to your home address.
You should stay in contact with the Workers’ Compensation Specialist to determine what effect payment of missed time benefits may have on your financial situation. Notify the Workers’ Compensation Specialist in the Benefits Office at (319) 335–2676 when you receive your first workers’ compensation missed time benefit check.
Transportation to Treatment for Work-Related Injuries
Mileage reimbursement is provided for individuals using their personal vehicle to travel to and from treatment for a work-related injury. The Travel Reimbursement form can be requested from the UI Benefits Office at 335-2676. A receipt for parking is required if included in the reimbursement request.
Reimbursement of a taxi fee is provided for individuals traveling to and from their University work location to the UI HealthWorks Clinic in North Liberty, Iowa. The Travel Reimbursement form can be requested from the UI Benefits Office. A receipt for taxi fare is required.
The University of Iowa has established an account with Yellow Cab of Iowa City to provide taxi service to and from an individual’s University work location to the UI HealthWorks Clinic in North Liberty, Iowa. Individuals should call Yellow Cab of Iowa City at 319-338-9777 to request cab service. At the time of pick-up, individuals will be required to show their University ID to the Yellow Cab driver. The taxi will not wait during the clinic appointment. Rather at completion of the appointment, a return ride should be scheduled. Individuals using Yellow Cab of Iowa City and following the established process will not be required to pay a fee at the time of service.
Use of a University Vehicle for Transportation:
A University vehicle may be used for transportation to the UI HealthWorks clinic as approved by the employee’s department.
Use of Personal Vehicle to Transport a Colleague:
It is not recommended that individuals use their personal vehicle to transport a colleague to the UI HealthWorks Clinic for medical treatment. Mileage reimbursement will not be provided in this case.
Workers’ compensation missed time benefits do not replace your entire salary. Supplementing is using accrued leave to add to the workers’ compensation missed time benefits to bring your income during the healing period up to as close to your normal salary as possible.
If you choose not to supplement and elect to take workers’ compensation benefits only, you will save your accrued leave. However, if you choose not to supplement, your department will put you on a leave of absence, removing you from “in pay” status.
If you are not in pay status, you will lose all University benefits except health care coverage, which will continue for up to four months. These four months will run concurrently with your FMLA rights.
If you are missing time, once you satisfy the waiting period of 3 days you will receive a Benefit Election Form from the University of Iowa Benefits Office. You will make your Benefit Election decision and return the form to the Benefits office through regular or campus mail.
The first appointment for a work-related injury at one of the authorized locations is paid by workers’ compensation at 100%.
Continued authorized medical care is care received at these same locations. UI Healthworks, or Sedgwick CMS may direct you to additional providers. If your claim is approved by Sedgwick CMS, authorized medical treatment will be paid at 100% by The University of Iowa and Sedgwick CMS. There are no co-payments or deductibles. You may also be reimbursed for your mileage to, and from, your first medical treatment for the work-related injury, and all authorized medical care that follows (see the Mileage Reimbursement Form).
Payment for unauthorized care may be denied by both your private health insurance carrier and workers’ compensation. It is important that treatment for all workers’ compensation injuries is authorized by Sedgwick CMS. This is consistent with the laws of the State of Iowa.
With authorized care, you may receive a statement indicating the charges have been filed with your private health insurance provider as well as workers’ compensation. You may also receive a statement from your private health insurance provider stating that payment has been denied because this is a workers’ compensation claim. THIS IS THE NORMAL PROCEDURE of many insurance companies, and is not within the control of the University Benefits Office.
UIHC and other providers normally bill both the workers’ compensation provider and your private health insurance carrier.
If your health insurance Explanation of Benefits (EOB) indicates that these charges are pending, you should assume the payment issue between the two companies will be resolved. If the statement indicates you are to pay any amount for services related to your claim, contact the medical provider and inform them this is a workers’ compensation matter.
If you receive a “Past Due” notice or a collection letter, please contact the Benefits Office at (319) 335-2676.
If your claim is not approved, contact your personal insurance carrier. Notify them that your worker’s compensation claim was denied and provide them with any additional information they require. Your personal insurance should pay any bills according to the terms of your insurance policy.
If your authorized medical provider is not affiliated with The Worker’s Health Clinic, UI HealthWorks, or UIHC Emergency Room, you must obtain a blank PSR from the Workers Health Clinic and present this document to your authorized medical provider for appropriate completion at each appointment. Provide a copy of the completed PSR to your supervisor within 24 hours or 1 business day.
Workers’ compensation benefits are not taxed by the Federal or State governments.
At the end of year, you pay taxes based on reported income from The University of Iowa. THIS INCOME DOES NOT INCLUDE ANY WORKERS’ COMPENSATION PAYMENTS.
No. If your claim is approved by Sedgwick CMS, medical and therapy appointments are counted as time at work.
Yes. You must continue with any follow-up appointments as directed by the treating physician. Failure to attend related appointments may result in discontinuation of your workers' compensation benefits and your department should not allow you to work until an updated PSR or communication is provided.
The Patient Status Report (PSR) indicates that I have limitations/restrictions and my department has offered to accommodate those restrictions. However, I do not feel I can perform the work offered. Do I have to go back to work?
If you do not feel you can perform the work under those restrictions, you must contact the treating physician for an appointment to discuss the current limitations/restrictions. In the meantime, if you do not return to work you will jeopardize your workers' compensation benefits and may be disciplined according to attendance policies.
What if I start having trouble with a previous work-related injury and my doctor thinks I need additional evaluation or treatment? Do I have to have it approved by workers' compensation before I have the treatment/evaluation?
Yes, Sedgwick CMS must approve the treatment. Contact the Workers' Compensation Specialist in the UI Benefits Office at (319) 335-2676 to begin the process.
This means you are not expected to improve beyond your present status. When you attain MMI, your physician will determine the extent of any permanent injury and inform Sedgwick CMS. Your benefit status will change to Partial Permanent Impairment, or "Permanency" benefits. You will be entitled to a certain number of weeks of workers' compensation benefits based on the Impairment Rating, if any, as provided by your physician. There is a possibility of receiving zero weeks of workers' compensation benefits, based on the impairment rating.
The provisions of the Family and Medical Leave Act (FMLA) may apply in situations where a work-related injury does not permit work. Contact your HR Unit Representative with any questions.
Yes, after you have exhausted your sick leave and vacation.
You may need to complete:
Missed Time Weekly Report
Benefit Election Form
Mileage Reimbursement Form
An employee is eligible to transfer to another department or position while on temporary restricted work due to a work related injury if the following applies:
- the employee must be responsible for informing the other department of any temporary restrictions in place related to a work injury
- the hiring department must be able to accommodates the temporary work restriction in place at the time of the transfer
What resources are available for additional assistance?
Visit our Resource page at: http://www.uiowa.edu/hr/benefits/wc/contacts.html
The department uses the Patient Status Report in order to determine restrictions, authorization to return to work, etc. You should not request completion of a DOL medical certification form.
Yes. Information shared with WC staff is confidential. Only restrictions are shared with the employing department, unless the employee signs a Release of Information Form permitting the sharing of medical information.