A. GENERAL POLICY
1. The Workers' Compensation Act of the State of Alabama does not apply to The University of Alabama. The University provides and pays for The University of Alabama On-the-Job Injury/Illness Program (hereafter “OJI Program”) to cover an employee's approved medical expenses and lost wages incurred as a result of an on-the-job injury or on-the-job illness (hereafter referred to as an “OJI”).
2. For the purposes of this policy the following definitions will apply:
Accident shall mean an unexpected and unforeseen event, happening suddenly and violently, with or without human fault.
On-the-Job Injury is defined as an injury resulting from an accident arising out of and in the course of the employment, and shall not include an on-the job illness, except as provided for in this Policy.
On-the-Job Illness is defined as an illness resulting from the continuous and repeated exposure to hazardous materials documented to be dangerous to humans when the exposure is determined to be excessive or above permissible limits established by the manufacturer of the material or other credible sources such as the Occupational Safety and Health Administration, National Institute of Occupational Safety and Health or American Conference of Governmental Industrial Hygienists. An on-the-job illness shall have the same meaning as an occupational disease. An on-the-job illness does not include communicable diseases or infections typically transmitted by human contact. However, an exposure to a biologic hazard in an academic or research setting is considered an on-the-job illness as long as the exposure arose out of and in the course of employment. Alleged work-related stress, anxiety, depression or other mental illnesses are not covered under this program unless proximately caused by an on-the-job physical injury to the body.
3. Medical expenses related to an OJI and wages are compensable under the OJI Program only if the OJI is sustained in the course of, and arises out of, employment at the University. This policy does not cover employees except while engaged in or about the University’s premises where their services are being performed or where their service requires their presence as a part of service at the time of the accident. OJIs that occur in the course of employment, but away from an employee’s normal work site, may also be covered under the University’s OJI Program as long as the employee was acting within the scope of employment and was engaged in an activity related to his or her assigned duties and the general scope of the position. OJI benefits are generally not payable for injuries sustained while traveling to/from the work location or while engaged in an activity that is personal in nature and not incidental to employment such as, but not in limitation, meal breaks, running personal errands, participating in fitness activities unrelated to the position, etc.
4. Accidents that occur while an employee is traveling on UA business (defined as travel for which expenses are reimbursable by UA) will be considered to have occurred in the course of employment at UA. If the accident occurs during a deviation for personal reasons (e.g. a sightseeing trip or visit to relatives or friends, etc.) from the described route the accident will not be considered to have occurred in the course of employment.
5. No OJI Program benefits shall be provided for an OJI resulting from an intentional injury/illness (including death) or injury incurred while intentionally harming another other than in cases of self-defense while in the course and scope of employment or in the execution of duties by commissioned law enforcement personnel. The University also may limit, restrict or deny OJI Program benefits if an employee is injured while engaged in an illegal activity or in an activity that is a violation of University policy.
6. An OJI Benefits Review Committee consists of one representative from each of the following departments/units: Financial Affairs, Human Resources, and the Office of Counsel. The Committee will review OJI claims at the request of the claimant. The committee may also recommend and submit for Administrative approval OJI Program policy changes.
1. Reporting of Injuries
(a) All OJIs, regardless of their severity, should be reported by the employee to the employee’s supervisor within two (2) working days from the date of the OJI. An employee’s failure to report the OJI to employee’s supervisor within two (2) working days of its occurrence may result in a denial of benefits under the OJI Program. If circumstances permit, an OJI form should be completed by the supervisor before the employee seeks treatment at the University Medical Center (“UMC”).
(b) Supervisors are to prepare and submit the Departmental Report of Injury (“OJI form”) to the Office of Risk Management within two (2) working days after receiving the report of the OJI. If there is any question regarding the validity of the OJI or if there are circumstances that could affect the acceptance or denial of OJI benefits, Risk Management should be contacted immediately.
(c) In the case of OJIs resulting from an assault, including sexual assault or other suspected criminal act the incident also must be reported immediately to the UA Police who will report the incident to the employee's supervisor and to the Office of Risk Management.
2. Medical Treatment
(a) Except as provided for in paragraph 4 below, employees suffering an OJI must use the services of UMC which provides for limited outpatient emergency care at the Faculty/Staff Clinic at no cost to the employee. The UMC requires that the injured employee identify himself or herself as a University employee. On the day of the OJI and depending upon the seriousness of the OJI, employees should notify their supervisors prior to reporting for treatment; otherwise, they should notify their supervisors within two working days from the date of OJI or as soon thereafter as circumstances permit.
(b) In non-emergency situations, employees are encouraged to seek medical care either on the day the OJI occurred or as soon thereafter as is feasible. For OJIs that appear minor, superficial, or otherwise not serious, the employee in his or her discretion may either delay seeking medical treatment or forego medical care if the OJI resolves or heals itself without medical attention. The decision to delay or forego medical treatment does not change the requirement that an employee should report the OJI to employee’s supervisor within the 2 working days from the date of the OJI.
(e) Unless the situation is outside of the employee’s control, the employee must keep all scheduled appointments. Failure to keep scheduled appointments may result in the termination of OJI benefits. If an employee is unable to keep a scheduled appointment, the employee must make a reasonable effort to cancel and reschedule the appointment. The employee may be responsible for paying appointment cancellation fees, unless there is reasonable justification for not cancelling the appointment prior to cancellation deadline to avoid the cancellation charge.
(f) If treatment by the initial or current approved attending physician is not possible or is outside of the field of expertise of the treating physician, the Office of Risk Management will designate another attending physician.
(g) If an employee aggravates a pre-existing OJI, the approved attending physician must certify the need for treatment and/or absence from work. The OJI Program benefits described herein are awarded to each separately approved OJI. A recurrence or aggravation of a previous OJI, with or without a separate incident, is not considered a separate OJI.
3. Medical Records
4. Selection of Outside Physicians/Specialists
After the initial visit to UMC or other appropriate emergency medical facility, UMC may decide whether to refer an employee to an outside physician or specialist for further treatment. Only those physicians or specialists who are approved by the Office of Risk Management for follow-up care will be paid under the OJI Program. An employee’s use of the services of a physician, specialist or other medical provider without the prior approval of the Office of Risk Management may make the employee rather than the University liable for the payment of those unauthorized services under the OJI Program. An employee who is referred to an approved outside physician or specialist should continue treatment with that physician or specialist until he or she is released because UMC staff typically will not resume medical treatment begun by approved outside physicians or specialists.
5. Referrals to Other Medical Facilities
(a) If, upon being seen at UMC it’s determined that the employee’s OJI is of such severity that it will require a greater degree of emergency care than that which is available at the UMC, the employee shall go to the DCH Regional Medical Center Emergency Department (University Blvd. location) or to the physician, diagnostic clinic, or other facility as directed by the UMC staff. In cases where the employee’s OJI is very severe, the employee should go or be transported directly to the DCH Regional Medical Center Emergency Department. In any case of referral to the Emergency Department or to a private medical facility, the employee’s supervisor should ascertain that the required OJI form is submitted to the Office of Risk Management within two (2) working days after the OJI.
(b) If the employee’s OJI occurs on a weekend or such other times when the UMC is closed, the employee should go directly to the DCH Regional Medical Center Emergency Department (University Blvd. location).
6. Off-Campus Injuries/Illnesses
C. UNIVERSITY PAYMENT FOR OJI EXPENSES
1. The cost of approved hospital care and professional services required as a result of an OJI must be filed under the University’s OJI Program coverage which is administered by Blue Cross/Blue Shield of Alabama. If an employee receives bills from an approved physician or medical facility related to their OJI, the employee should forward the bills to the Office of Risk Management.
2. If an injured employee has their OJI-related prescriptions filled at the pharmacy designated by the University as the official OJI pharmacy, the employee will not be required to pay any prescription co- payments. If the employee has OJI-related prescriptions filled at any other pharmacy, they will be required to pay the applicable co-pay(s) and then seek full reimbursement from the University. Employees should forward their receipts for all out-of-pocket co-pays for OJI-related prescriptions and other authorized OJI-related charges to the Office of Risk Management for reimbursement.
3. Once the employee is released to return to full work duty by the University-approved attending physician, all University payments for the OJI-related charges will cease unless the Office of Risk Management grants approval for additional follow-up medical care.
4. Willful failure of an employee to abide by physician-directed physical activity restrictions arising from an OJI, or willful misrepresentation by an employee of his or her physical activities while under physical activity restrictions will result in termination of OJI benefits.
5. Failure to comply with approved physician-directed rehabilitation and approved follow-up care, which may include, but is not limited to, subsequent physician visits, referrals to specialty physicians, referrals for second-opinions, diagnostic testing, disability evaluation testing, physical or occupational therapy, work-hardening programs, or to follow the dosage and frequency of physician prescribed medications will result in termination of OJI Program benefits.
6. The OJI Program benefits for any employee testing positive for illegal drugs or alcohol will be denied and the employee will be subject to disciplinary action up to and including discharge from employment in accordance with University policy.
7. Abuse of the OJI Program or misrepresentation of facts in connection with a claim for benefits under the OJI Program will not only jeopardize an employee’s eligibility for OJI Program benefits, but will also subject the employee to disciplinary action up to, and including, discharge from employment.
D. UNIVERSITY PAYMENT FOR FOLLOW-UP CARE
1. If, after being released to full duty by the approved attending physician, an employee experiences a recurrence of an OJI and requires additional medical attention, prior approval from the Office of Risk Management is necessary for the resumption of OJI Program benefits.
2. When requesting approval for follow-up care, the employee should provide the following information to the Office of Risk Management:
(a) certification from the University approved physician that the current medical problems result from or are directly related to the previous OJI;
(b) the nature of the follow-up treatment or services to be performed; and
(c) such other information and records as the University reasonably requests.
E. LOST TIME/WAGES
The OJI Program generally will compensate an employee for time lost as a result of on-the-job injury or illness in excess of four calendar days. Time lost on day one (i.e. day of the on-the-job injury or the day the on-the-job illness is discovered) will be paid through the employee's department and should be charged to administrative leave with pay. The next three calendar days are considered a waiting period during which no OJI Program wage benefits will be paid. During that three calendar day waiting period, the employee may elect to use his or her accrued sick leave, annual leave, or compensatory time (hereafter “Accrued Benefit Time”) or to take leave without pay. However, if the employee remains out of work (or on reduced time or lower wages) due to the OJI for a period of 21 calendar days from the date of the OJI, one of the following will occur: (i) Accrued Benefit Time used for the first three days after the day of the OJI will be replaced at the same rate and maximum as outlined in paragraph E-2 below or (ii) if Accrued Benefit Time was not used, the OJI Program will pay the lost wages at 66 2/3% of the employee’s regular rate of pay but subject to the weekly maximum outlined in paragraph E-2 below. For University law enforcement officers, payment of lost wages for the period of OJI leave will be at the officer’s normal rate of compensation pursuant to Ala. Code §36-21-13; the provisions of that Code Section dealing with matters other than the amount of compensation shall apply only to the extent consistent with this policy.
(b) Two or more dependents. If the deceased employee leaves two or more dependents, the death benefit shall, subject to the setoff described below, equal the product of two figures: a compensation amount, calculated as 66 2/3 percent of the employee’s current rate of pay; multiplied by 500, reduced to present value using the current calculator provided by the Alabama Department of Industrial Relations. The compensation amount is subject to a maximum that is adjusted annually by the Alabama Department of Industrial Relations.
The University will recognize the Code of Alabama §36-21-12(2011) in determining the OJI benefits for a commissioned law enforcement officer. When necessary, the University will establish an injury benefit board as required by the Code of Alabama.
Law enforcement officers who at the time of injury are actively defending persons or property or are actively enforcing the law with respect to an actual or suspected offender, payment of lost wage benefits for periods of OJI leave will be at the officer’s normal rate of compensation.
J. SUBROGATION RIGHTS
If the injured employee, or in case of death, the employee’s spouse and/or dependents, recover damages against another party for an OJI , the amount of the damages recovered and collected shall be credited to UA to the extent the OJI Program has paid benefits. If the damages recovered and collected are in excess of the benefits payable under the OJI Program, there may be no further obligation on the part of UA to pay benefits on account of the injury or death. UA shall be entitled to subrogation for benefits expended by the employer on behalf of the employee.
Risk Management Bob Pugh, Director