HUMAN RESOURCE POLICY MANUAL
Topic: On the Job Injury and Illness Policy
Policy # 704.00 Version: 1.1 Effective Date: 07/01/08

A. GENERAL POLICY

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 to cover an employee's approved medical expenses and lost wages incurred as a result of an on-the-job injury or illness.

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, research or medical services 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 produced or proximately caused by some physical injury to the body.

 

Related medical expenses and wages are compensable under the On-the-Job Injury/Illness Program only if the injury or illness 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 and during the hours of service as workers.An employee will be considered “in the course of employment” while on break, at lunch or while walking to or from work if the accident occurs on property owned by and/or maintained by The University of Alabama. On-the-job injuries/illnesses that occur in the course of employment, but away from an employee’s normal work site, may also be covered under the University’s on-the job injury/illness policy.

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 from the described route for personal reasons (e.g. a sightseeing trip or visit to relatives or friends) the accident will not be considered to have occurred in the course of employment.

No benefits shall apply for an injury resulting from intentional injury/illness (including death) or injury incurred while intentionally harming another. The University also may limit, restrict or deny benefits if an employee is injured while engaged in an illegal activity or activity that is in clear violation of University policy.

An On-the-Job Injury/Illness 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 On-the-Job Injury/Illness claims at the request of the claimant or Risk Management. The Committee may also recommend On-the-Job Injury/Illness Program policy changes to be submitted for Administrative approval.

 

B. PROCEDURES

1. Reporting of Injuries

All on-the-job injuries or work-related illnesses (hereafter referred to as OJI’s), regardless of their severity, should be reported immediately to the employee’s supervisor. Supervisors are to determine the validity of the OJI and prepare and submit the Departmental Report of Injury (OJI form) to the Office of Risk Management within two (2) working days of the OJI. An employee has two (2) working days from the date of the OJI to report the injury to their supervisor and see a doctor at University Medical Center or the employee will forfeit their right to file an OJI. Failure to report the injury/illness to the employee’s supervisor and seek medical treatment may result in denial of On-the-Job injury/illness benefits.

In the case of injuries resulting from an assault, including sexual assault, 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. Emergency Medical Treatment

As a means of providing prompt medical attention for employees who incur OJI’s, the facilities of the University Medical Center are available for limited outpatient emergency care at no cost to the employee. Identification of the injured individual as a University employee is required by the University Medical Center.

University employees suffering an OJI should immediately report to or be taken to the University Medical Center. When the nature of the OJI permits, employees should notify their supervisors prior to reporting for treatment; otherwise, they should notify their supervisors as soon as possible.

The attending University Medical Center nurse practitioner or physician will determine if the employee should be referred to an outside specialist. A patient who is referred outside University Medical Center should continue treatment with that specialist until (s) he is released, since University staff cannot resume treatment begun by outside physicians.

Injured employees are required to use the services of University Medical Center except for extensive or major injuries or illnesses which require a greater degree of care than the medical center can provide. Such cases should be referred directly to DCH Regional Medical Center Emergency Department. If University Medical Center is closed at the time of the injury the employee should go directly to DCH Regional Medical Center Emergency Department.

If the employee’s supervisor has not completed an OJI form prior to arrival at UMC, it should be completed by the University Medical Center when the employee presents for treatment or as soon thereafter as possible, with one copy forwarded to the Office of Risk Management within the two (2) working day requirement.

All OJI forms received by Risk Management which have not been signed by the supervisor will be sent to the supervisor for signature.

3. Selection of Physicians

After administering initial care, the University Medical Center may decide to refer an employee to an outside specialist. Only those physicians who are authorized by the Office of Risk Management for follow-up care will be paid under this policy.

4. Referrals to Other Medical Facilities

If the OJI of an employee requires special or extensive medical treatment after being seen by the University Medical Center, the employee should be referred to or carried directly to the DCH Regional Medical Center Emergency Department. In any case of referral to the emergency department or to a private medical facility, supervisors should ascertain that the required OJI form is submitted to the Office of Risk Management within two (2) working days after the OJI.

5. Off Campus Injuries/Illnesses

An employee who is injured in the course of employment while away from the UA campus should seek emergency medical treatment from the nearest healthcare provider. The employee should advise the healthcare provider that he or she has been injured "on the job." The healthcare provider should contact the Office of Risk Management regarding payment for services rendered. Supervisors should complete the OJI form within two (2) working days of the employee’s OJI, and all follow-up treatment must be coordinated through the Office of Risk Management.

C. UNIVERSITY PAYMENT FOR OJI EXPENSES

  1. The cost of hospital care and professional services required as a result of an OJI must be filed under the University’s work-related injury coverage which is administered by Blue Cross. If an employee receives bills from a physician or medical facility related to their injury, the employee should forward the bills to the Office of Risk Management.
  1. 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 the prescription co-payments. If the employee has prescriptions filled at any other pharmacy, they will be required to pay the applicable co-pay(s). Employees should forward their receipts for all out-of-pocket co-pays and other OJI-related charges to the Office of Risk Management for reimbursement.
  1. Once the employee is released from the care of the designated attending physician, all University payments for the OJI-related charges will cease unless the Office of Risk Management grants approval for additional follow-up care.
  1. Willful failure of an employee to abide by physician-directed physical activity restrictions arising from a covered injury, or willful misrepresentation by an employee of his or her physical activities while under physical activity restriction, will result in termination of OJI benefits

.

  1. Willful failure to comply with physician-directed rehabilitation prescriptions will result in termination of OJI benefits.
  1. Abuse of the 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 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 an employee experiences a recurrence of an OJI and requires medical attention after being released from the designated attending physician, prior approval from the Office of Risk Management is necessary for the resumption of OJI benefits

.

  1. Upon requesting such approval, the employee should provide the following information to the Office of Risk Management:
    1. certification from the physician that the current medical problems are a result of the previous OJI; and
    2. the nature of the treatment or services to be performed.
  1. If treatment by the initial designated attending physician is not possible, the Office of Risk Management will designate another attending physician.
  1. Designated attending physicians must certify the need for any absence due to an OJI. The benefits described herein are awarded to each separate approved OJI. A recurrence of a previous OJI, with or without a separate incident, is not considered a separate OJI. Such a recurrence will be determined by the designated attending physician and approved by the Office of Risk Management.

NOTE: The University retains the right to access all relevant medical and other records of employees injured on the job and may require additional examinations and tests as it deems necessary.

E. LOST TIME/WAGES

  1. The On-the-Job Injury/Illness Program will compensate an employee for time lost as a result of on-the-job injury or illness in excess of four working days. Time lost on day one (i.e. day of the injury or the day the work-related illness is discovered) will be paid through the employee's department and should be charged to leave with pay. The next three working days are considered a waiting period during which no On-the-Job Injury/Illness Program wage benefits will be paid. The employee may elect to use his or her other accrued benefit time (sick leave, annual leave, or compensatory time) or to take without pay the three days after the day of the injury or onset of the occupational illness. The employee may use accrued benefit time for the time off during the waiting period only for the days the employee had been originally scheduled to work. However, if the employee remains out of work (or on reduced time or lower wages) due to the on-the-job injury/illness for a period of 21 calendar days from the date of the injury, one of the following will occur: (1) benefit time used for the first three days after the day of the incident will be replaced at the same rate and maximum as outlined in 2 below or (2) if benefit time was not used, the On-the-Job Injury/Illness 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 item 2 below).
  1. Beginning with the fourth work day following the day of the incident/accident or onset of illness/disease and through the 90th calendar day, the OJI Program will pay wages at the rate of 66 2/3% of the employee's regular rate of pay. This 66 2/3% wage benefit is charged to the employee’s department and is subject to a weekly maximum that is adjusted annually. All normal payroll deductions (including applicable taxes, insurances, parking fees, credit union withholdings, etc.) will continue.

The following is an example of how the process works:

a. Employee reports to work at 7:00 a.m. on Thursday and is injured at 9:00 a.m.

b. Employee goes to assigned physician and is advised that he or she may not return to work for two weeks.

c. Department should pay employee for a full day on Thursday (regular time for time worked and administrative leave for remainder of day).

d. Employee is eligible for OJI wage benefits beginning on the following Wednesday.

  1. Sick leave and annual leave will continue to accrue while OJI benefits are being paid.
  1. Employees may use accrued sick leave, annual leave or comp time in addition to the On-the-Job Injury/Illness benefit of 66 2/3% of regular pay (subject to the weekly maximum wage benefit) to result in earnings equal to the employee's regular rate of pay. The sick leave, annual leave or comp time used as a supplement to equal regular pay may exceed 33 1/3% of the employee's regular rate of pay if the employee's 66 2/3% OJI wage benefit is capped by the weekly maximum described in item 2 above. No combination of the OJI wage benefit plus supplemental time may exceed 100% of the employee's regular rate of pay.
  1. The employee must notify his or her department of the request for OJI benefits and request to use eligible accrued time as a supplement. The employee is responsible for keeping the immediate supervisor or department/unit head and the Office of Risk Management apprised of his or her status and projected date for return to work. The department/unit is responsible for submitting time records to Payroll for processing.

If there is lost time resulting from an on-the-job injury or illness, the employee will also be placed on Family and Medical Leave (if eligible) retroactive to the date of the injury or the reporting of the work-related illness. Family and Medical Leave and On-the-Job Injury/Illness Leave will run concurrently. Employees injured on the job who are eligible for Family and Medical Leave should also complete an (FML) Medical Leave Request Form. Forms are available in the Human Resources Service Center and on the HR website.

  1. On-the-Job Injury/Illness lost wages benefits are payable for a maximum of 24 calendar weeks from the date of the initial injury or the first written report of the work-related illness/disease. Lost wage benefits will cease at the end of the 24 calendar weeks or when an employee has been released to return to full duty by the assigned physician, whichever is earlier. The 24 week maximum benefit period is initiated from the date of the injury or the date the work-related illness/disease is first reported in writing, regardless of the date medical treatment is sought.
  1. An employee who terminates employment (voluntarily or otherwise) is not eligible for lost wage benefits following his or her UA employment termination date.
  2. Employees with serious work-related injuries or illnesses are also expected to apply for benefits under the University’s Long-term Disability Insurance Program. It is the sole responsibility of the employee to determine the estimated length of disability and to make application for benefits in a timely manner. Failure to apply for long-term disability benefits at least 45 days prior to the anticipated need for payment may delay payment of benefits. Employees should contact the HR Service Center for information on applying for LTD benefits.
  1. The Office of Risk Management will monitor the status of employees who are unable to work as a result of an OJI. Employees who are unable to return to full duty, or to modified duty if it can be accommodated by his or her department, within 24 calendar weeks from the date of the work-related injury or illness may be discharged from employment.
  1. Employees must follow the directions of the University-approved health care providers and the referral physicians with regard to treatment and any physical limitations or restrictions. Failure to comply with the guidelines of this policy may result in denial of medical expense/lost wage benefits and/or disciplinary action.

In coordination with the Office of Risk Management, the supervisor’s department/unit head will determine if the department/unit will be able to accommodate any modifications imposed by the treating physician.

Permanent Disability

 

The On-the-Job Injury/Illness Program provides for payment for permanent partial or permanent total disability resulting directly from an on-the-job injury or work-related illness. The designated healthcare provider will determine the existence, and degree, of disability. Payment for partial disability will be based on a schedule of benefits based on the employee’s average wage at the time of the injury or illness and the type of injury or illness involved.

 

All payments for permanent partial or total disability will be determined by the State of Alabama Board of Adjustments. Employees should contact the Office of Risk Management for information regarding State of Alabama Board of Adjustments claim forms. Any claim should be filed within the one year statute of limitations.

F. EXTENDED OJI BENEFITS (AFTER 90 DAYS)

If an OJI results in an employee being out for longer than 90 calendar days, the employee has the following options:

  1. Use any accrued sick, annual, and/or comp time to cover the remainder of the leave up to a maximum of 24 calendar weeks.
  2. Remain on leave in an unpaid status.
  3. Apply for Long-Term Disability (LTD), which will begin payment of 66 2/3% of regular salary when all sick leave time has been exhausted. Employees whose leave will be longer than 90 days are encouraged to file an application for LTD with the University’s Benefits Office as soon as that need is anticipated.

The length of leave due to an OJI will not exceed 24 weeks from the date of the injury/illness. After that time, the employee may be terminated, even though LTD benefits may continue. After termination, any further monetary claims by the employee must be filed with the State of Alabama Board of Adjustments within the Statute of Limitation of one year from the date of the injury.

If, on the 91st day of disability, the employee is not on approved LTD, they may be required to provide documentation from an approved physician that indicates the employee is not able to return to work due to the OJI. The employee will remain on leave, either paid or unpaid, for the remainder of the 24 week period. After this time, the employee may be terminated and any further monetary claims by the employee must be filed with the State of Alabama Board of Adjustments within the Statute of Limitation of one year from the date of the injury.

If an employee fails to apply for LTD benefits, the University will relinquish its monetary obligations under this policy after 24 weeks following the injury/illness. Any further monetary claims by the employee must be filed with the State of Alabama Board of Adjustments within the Statute of Limitation of one year from the date of the injury.

If an employee does qualify for LTD benefits and is terminated from employment at UA after 24 weeks from the date of their OJI, then the University’s sponsored single health insurance coverage for the former employee will be available to them at the current single premium rate paid by active employees as long as the former employee receives approved LTD benefits due to their OJI and until the former employee reaches age 65 and/or becomes eligible for Medicare.

If the former employee on LTD due to an OJI also wishes to retain family health insurance from the University of Alabama, they may do so by paying the current family premium rate paid by active employees each month until they reach age 65 or become Medicare eligible.

After the former employee has received LTD benefits for at least 24 months after being terminated from employment, then the former employee may be eligible for Medicare coverage under Social Security due to their disability. The former employee should contact the Social Security Administration at that time to apply for Medicare coverage.

The former employee should also notify the University and apply for Medicare coverage within 30 calendar days of reaching age 65 or when becoming eligible for Medicare (whichever comes first). At age 65 or when Medicare eligible, the former employee would be required to pay 100% of the monthly cost for the University’s sponsored health insurance in order to retain their single or family coverage to supplement their Medicare coverage.

G. SUBROGATION RIGHTS

If the injured employee, or in case of death, his or her dependents, recovers damages against another party for an on-the-job injury or work-related illness, 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.

Link to On-the-Job Injury or Accident Reporting form.

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