Example of Workers Compensation Policy


Work-related injuries or illnesses may be covered under the University's Worker's Compensation Program. To be considered work-related, the injury or illness must arise from and occur in the course of employment. When authorized by a physician, medical expenses related to the treatment of a work-related injury or illness (including doctor, hospital, surgical, physical therapy, prescription medication, medical equipment, and any out-of-pocket medical expenses), are covered. Vocational benefits may also be provided.

Worker's Compensation also pays for wages lost as a result of an employee injury or illness, provided that the absence from work is related to a work injury or illness and is authorized by a doctor. Worker's compensation disability payments are approximately 66 2/3% of an employee's average weekly wages and are non-taxable income. If an employee is out on workers compensation for more than 30 days, than the employee has an obligation to continue paying his/her voluntary benefits. Employees in this situation should contact Human Resource Services for further information regarding payment of benefits.

The [Office of Risk Management] [Substitute in the relevant office at your university, if your institution uses a differently-named office for this task.] administers the University's Worker's Compensation Program for the University. Lost-time worker's compensation cases are handled by a third party claims adjustment service provider.


Following an accident, employees should notify their supervisor as soon as possible to complete an Accident Reporting Form, as well as the required _______________ [Provide name of state, as well as the names of the specific forms that your jurisdiction uses] forms. Upon completion, these forms should be returned to the Office of Risk Management. If possible, employees should have their supervisor sign an Authorization for Medical Treatment Form and take it to their medical appointment.

Employees involved in serious injuries requiring immediate medical attention should be treated at ________________________________ [Instruction: Provide the name and location of the place authorized to treat these types of medical cases.] or you may seek treatment with your primary care physician.

Non-serious injuries should be treated at ____________________________ [Instruction: Provide the name and location of the place authorized to treat these types of medical cases.]. For all other injuries, refer to the Common Questions about Worker's Compensation. Please try and limit receipts for out-of- pocket expenses, such as prescription medication and medical equipment and contact the Office of Risk Management as soon as possible so that we may direct you on how to obtain these products through our medical provider which will limit your out-of-pocket expenses. If you should need reimbursement, you may still contact the Office of Risk Management for reimbursement under the Worker's Compensation Program. Any absence from work must be authorized by the employee's treating physician. The employee must be out of work for three days (excluding the day of injury) before workers' compensation pays for work time that has been lost.

Modified duty may be provided by certain departments within the University for employees that can come to work but must temporarily alter their tasks. Modified duty is handled on a case-by- case basis depending on the recommendations of the treating physician. Employees on modified or restricted duty are not eligible for paid overtime work.

Employees on worker's compensation are responsible for keeping their supervisor and Risk Management informed of their work status. All disability documentation from the Physician noting the employees dates absent from work and the diagnosis of the injury or illness must be provided to the supervisor and Risk Management immediately.

If this documentation is not provided to Risk Management, the employee's continued absence from work will be considered unauthorized and the worker's compensation benefits will be suspended. When an employee is able to fully return to work, written clearance from the treating Physician documenting that the employee is fully capable of performing regular job duties must be provided to Risk Management and the Supervisor.

Worker's compensation claims are subject to investigation by the University's claims adjuster. Cooperating with the claims adjuster is essential for the effective and timely management of employee claims.

Accident Reporting Kit

Authorization for Medical Treatment Form

Employee's Notice of Accidental Injury or Occupational Disease


Subject's Name _________________


Contact Person Contact's Phone # E-mail address


Contact Person Contact's Phone # E-mail address


Contact Person Contact's Phone # E-mail address

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