Process
Sedgwick CMS is the Workers’ Compensation Administrator for The University of Iowa. Sedgwick is responsible for investigating, determining compensability, and performing various functions related to handling of the claim. This includes authorization of medical care providers and issuing benefits to employees based on lost work time and permanent impairment related to the covered injury/claim as required by Iowa Workers’ Compensation Law. The HR Specialists in the Benefits Office work closely with Sedgwick in the day to day case management of the workers’ compensation claims.
- Injury Occurs -- Notify supervisor/complete FROI on Self Service website and submit to the Benefits Office within 24 hours. Department will also conduct a safety investigation, if appropriate
- Complete FROI -- Complete First Report of Injury form on Self Service website and submit to the Benefits Office within 24 hours.
- Department Safety Investigation -- Department will conduct a safety investigation, if appropriate.
- No Medical or Lost
Time –
Injury/Illness was minor, no care or follow-up care is required, employee returns to work. - Medical Only/Care
Directed to Provider –
Injury/Illness resulted in the need for medical attention. Employee should be directed to Workers Health Clinic or UI Health Works. If true emergency and/or injury/illness takes place outside of business hours, M-F, (8a-5p), employee should be directed to the Emergency Treatment Center. - Back
to Work (may
or may not have
restrictions) –
Employee returns after medical appointment with a PSR. Supervisor and employee review the information on the PSR. If restrictions are given, discuss appropriate work assignments/schedules while considering indicated restrictions and capabilities. - Medical & Lost
Time/Care Directed to Provider --
Injury/Illness resulted in the need for medical attention. Employee should be directed to Workers Health Clinic or UI Health Works. If true emergency and injury/illness takes place outside of business hours, M-F, (8a-5p), employee should be directed to the Emergency Treatment Center. - Restricted
and/or Missing Time –
Employee returns with a PSR. PSR indicates restrictions or no return to work. Department cannot accommodate restrictions and employee is taken off work. - Missed
Time & Pay –
By law, missed time benefits begin after a waiting period of 3 calendar days of absence. If your employee misses work for more than 14 calendar days, missed time benefits will also be paid for the 3 day waiting period. - WC Benefits typically represent approximately 2/3 of the employee’s pay. This check will be mailed directly to the employee’s home address from Sedgwick. WC benefits are received only during the healing period or when the department is unable to accommodate restrictions and provide restricted work. If the employee is able to work a full shift of “restricted duty” during the healing period, he/she will receive their full salary instead of workers’ compensation missed time benefits.
- Employees may elect to supplement workers’ compensation benefits with accrued leave. The combination of workers’ compensation benefits and accrued leave should approximate the employee’s regular weekly salary. Receipt of the 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.
- Back
to Work (may or may not have restrictions) –
Employee returns after medical appointment with a PSR. Supervisor and employee review the information on the PSR. If restrictions are given, discuss appropriate work assignments/schedules while considering indicated restrictions and capabilities.
Download above information as flowchart (pdf)
Questions? benefits@uiowa.edu