Information for Employee

I was injured at work. What do I do? 

If the injury requires emergency medical care, call 911 to seek immediate treatment at the nearest Emergency Room. After you are stabilized, you will receive any necessary additional medical care within the established carrier health care network. You should complete the First Report of Accident/Incident form before the end of the shift of the day you had the injury. Failure to report a job related injury within 48 hours will result in a late reporting fine and/or potential denial of a claim.

If the injury does not require emergency care but still requires medical treatment, please contact the Office of Risk Management first to locate the nearest carrier approved facility. Please make sure that you and your supervisor complete the First Report of Accident/Incident form and submit it to the Office of Risk Management within the required 48 hour time frame.

If the injury does not require medical care, complete a Department Incident Log. Knowing where and how injuries occur enables us to investigate, track and take corrective action before someone else is injured.

For approved local hospitals, urgent care centers and medical providers, please click here. Or, call 1-800-327-3636 and select 4 at the prompt to speak to one of the carrier representatives (available Monday thru Friday, 7:00 a.m. - 6:00 p.m. CST).

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What do I record on my timecard?

On the day of your injury, the time spent waiting for and receiving medical care before the end of your shift should be recorded as worked time. If the doctor takes you off from work and you are sent home you will be paid as though you had worked a full shift. Your follow-up visits with your treating physician or physical therapist should be recorded as sick or vacation time. Please work with your supervisor/manager about making up time away from work.

Please visit "If you are unable to work" for more details on when sick/vacation time can be used if you are placed out of work beyond your current shift.

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Who pays for the cost of my medical care? 

The cost of your medical care is paid through workers' compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers' compensation claim. This means you would not be responsible for deductibles or co-pays for authorized treatment. If you receive a bill from a medical provider, please advise them to bill Southern Methodist University's Workers' Compensation Carrier instead of you (or your insurance).

If your injury requires medication, you will be provided with an Express Script pharmacy card to cover the cost of the prescription. The card is specific to medications for your workers' compensation injury and does not require any co-pays, just prior authorization. There are nearly 53,000 pharmacies in the Express Scripts network (ex. CVS, Walgreens, Wal-Mart).

If the injury is later determined not to be work related, Southern Methodist University generally pays the initial cost of medical care and medications provided. However, the cost of medical care and medicines provided by the Emergency Room, Urgent Care, or other providers will be your responsibility. Contact the Office of Risk Management at 214-768-3737 if you have questions regarding whether the services will be covered.

We understand the importance of getting medical care and knowing in advance if there is a potential for out-of-pocket costs to you. We will review your injury ("claim") as quickly as possible and let you know the outcome of that claim as soon as we can. Your timely completion of the incident report speeds the review process so that questions regarding whether the injury and the associated costs are covered can be answered as quickly as possible.

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How is it determined whether the injury is covered under workers' compensation?

Each incident report is forwarded to the Office of Risk Management. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are given to the Workers' Compensation Manager. The Workers' Compensation Manager will interview you regarding the incident, relevant medical history, and outside work activities to gather the necessary information to determine whether the injury can be covered under workers' compensation. If the circumstances are very complex, the WC Manager may also consult with legal and/or medical personnel, and/or request to review the relevant medical records, and/or request additional information from your supervisor. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.

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Who lets me know the outcome of the review?

The Workers' Compensation Manager will let you know the outcome of the review. The informal process is to let you know either in person or by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with your family physician).

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Who should I contact if I have questions about the review decision?

You are welcome to contact the Workers' Compensation Manager in the Office of Risk Management regarding the decision. You are also welcome to request that the decision be re-reviewed by the Assistant Director or Associate Vice President of Police & Risk Management. If you still have questions, you may also contact the Division of Workers' Compensation under Texas Department of Insurance.

In addition, the Division of Workers' Compensation Board is the state's administrative agency responsible for administering all workers' compensation claims in the state. An ombudsman at the Board is available to you at no charge who can help answer questions regarding claims and to help you through the process of appealing a decision if you do not agree with it.

To contact the Division of Workers' Compensation you can email them at WorkersCompCustomerServices
@tdi.state.tx.us or call 1-800-252-7031.  You can also access their website at TX Division of Workers' Compensation.

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My personal doctor is familiar with my medical history. Can I get treatment from him or her instead?

No. Only treatment that is authorized and provided by a carrier approved medical provider is paid through workers' compensation. Also, Southern Methodist University's health plans don't provide coverage for work injuries. This means that if you go to your own doctor, you may be responsible for the cost of the care provided.

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I need medical treatment for my job injury, but I am also receiving treatment for a non-work related health condition. How does that work?

Only the treatment for the job related injury is covered under workers' compensation; the cost of medical care for non-work related injuries would continue to be your responsibility (or the responsibility of your health plan if applicable). Where possible, the physician treating your work injury will separate out care that is provided for your work injury and refer you back to your regular physician for treatment of any non-work related health condition.

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Can I request a change in physician?

Generally, one treating physician (or physician's assistant) in workers' compensation will be providing your medical care. If you wish to have an alternate treating physician provide your care, contact the Workers' Compensation Manager.

You can change doctors one time without prior approval as long as you notify the workers' compensation carrier and the doctor is a carrier approved medical provider.  Any additional changes will require approval from the workers' compensation carrier and/or the Division of Workers' Compensation.

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I've been told I will need to have surgery. Is that covered?

Inpatient treatment and inpatient or outpatient surgery are all types of medical care that are covered under workers' compensation. Unless the situation is an emergency, preauthorization from the Workers' Compensation carrier is required.

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I've been told I need physical therapy. Is that covered?

Physical therapy is also a type of medical care covered under workers' compensation when ordered by your approved treating physician. Services are generally provided at occupational or other approved clinics.

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Where is the Office of Risk Management located?

The Office of Risk Management is located at 3050 Dyer Court (Dawson Service Center), room 100.

How am I paid while I am out of work?

First, you must submit a Strategic Tracking Employee Pay System (STEPS) Form (also known as a work status report) to the Office of Risk Management as verification that your treating physician has taken you off work due to your work related injury. The first seven calendar days are a "waiting period" and are not paid by workers' compensation; however, Southern Methodist University does not want to see an employee do without wages so you are paid under a "WC1" code which logs normal hours/pay. After you are out of work for seven calendar days due to the injury, the Workers' Compensation Carrier will provide a weekly payment directly to you. This weekly amount is generally 70% of your average weekly wage up to the 2012 (10/1/11 thru 9/30/12) maximum of $787 per week.

If you make less than $8.50/hr then you are paid at 75% of your average weekly wages with the same maximum amount per week. No taxes or deductions are taken from this weekly check, so it is important that you continue to make any voluntary deductions (e.g. your usual health, retirement or dental plan premium) directly to the SMU Department of Human Resources so that your participation in these plans continues. Contact the SMU Department of Human Resources at 214-768-3311 with any questions you have regarding your SMU benefit plans.

Please see a Benefits Specialist in the SMU Department of Human Resources for information about how a Workers' Compensation absence can affect your benefits.

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I normally get paid biweekly or monthly. Why is this paid weekly?

The workers' compensation law requires that this payment be made weekly.

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When should I receive my first benefits payment from the carrier?

Payments are generally mailed or sent each Friday. After you have been out of work for the waiting period (i.e. seven calendar days), you should anticipate your first check being mailed the following week. You must notify the Office of Risk Management with a work status report that you are out of work so that the wage replacement process can be initiated as quickly as possible. Failure to comply with this procedure could result in your sick/vacation time being impacted.

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Can I use benefit time?

Yes, you can use accrued vacation or sick time while you are out on a work related injury to make up the difference of your pay during any missed time. You may not use a full day of sick/vacation pay each day you are out as this will result in payments of more than what you would have made if you were able to work and may result in you owing the University money. You would need to speak with your supervisor about coding this time on your timecard; the Office of Risk Management is available to help you with this process as needed.

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How is my "average weekly wage" calculated? 

Typically, the average weekly wage is calculated by dividing your gross wages over the past 13 weeks. Before your injury, for example:13 weeks pay (prior to injury) $10,729.29/13 weeks equates to: $825.33 AWW

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Who determines when I am medically ready to return to work?

Your treating physician is responsible for providing your medical treatment and keeping you informed about how soon he/she anticipates you will be medically able to return to work, any job restrictions or the duration of any restrictions. You are encouraged to regularly communicate with your supervisor about your medical progress so that you can both be planning for your return. Southern Methodist University recommends "modified work" for those whose treating physician deem them able to work but with limited duties. The Office of Risk Management partners with each department to seek job tasks that can be performed by employees while remaining within the restrictions provided by their doctor. Statistics have proven that an employee heals quicker when allowed to be a productive member of the work force.

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Will my job be held until I can return?

Family Medical Leave Act (FMLA) runs concurrent with the first missed day of work due to the on-the-job injury. If you meet the FMLA requirements, your job must be held for at least twelve weeks. For more information about FMLA, please see the Benefits Specialist in the SMU Department of Human Resources. There are times when the business operations of a unit require that a position be filled on a temporary basis. If this happens, you will have priority status when you are released to return back to work. Keeping an on-going line of communication directly with your supervisor is recommended so that you can both plan appropriately.

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What happens to my employee benefits? 

Please see the Benefits Specialist in the SMU Department of Human Resources for information about how a workers' compensation absence can affect your benefits. Generally, employees are placed on leave and the majority of your employee benefits are preserved. Because there are no deductions taken from your workers' compensation check, you will need to establish a process to make sure your portion of any premiums or deductions continue. Contact the SMU Department of Human Resources at 214-768-3311 with any specific questions you may have about your benefits.

I've been released to return to work with temporary work restrictions. What does this mean?

Returning back to work, even with temporary work restrictions, is perhaps the most significant way you can speed your full recovery. Your work restrictions may relate to the number of hours you can work, the amount of weight you can lift, the length of time you can stand, and/or other physical limitations. These restrictions will require both you and your supervisor to have a good understanding of how the restrictions translate into your day-to-day job responsibilities. For example, if you have a temporary 5 lb. lifting restriction, both you and your supervisor will need to know what portions of your job that you may not be able to do, whether this task is a key job responsibility, or a task you may need assistance to complete. Additionally there might be alternative job responsibilities that you can pick up while others are picking up a portion of your usual job.

You must provide the Office of Risk Management with a Modified Duty Agreement which clearly states that you may return to work with restrictions and what your restrictions are. We will then partner with your supervisor to ensure that you are only doing tasks within your restrictions and what the duration will be. After each doctor visit, you should ensure that you provide the Modified Duty Agreement and that you are in constant communication with your supervisor as to your doctor's instructions for you.
The Office of Risk Management is available to speak with you about your work restriction(s) and the anticipated duration of those restrictions.

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I've been released to return to work, but my work restrictions are permanent and I can no longer perform my prior job. What happens now?

You must contact the SMU Department of Human Resources.

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What is a "suitable" position?

While you are still in the healing process, a suitable position is one which enables you to add value to Southern Methodist University's mission while maximizing your skill set and is within your physical restrictions. After you have recovered as much as possible (i.e. there may be some permanent limitations compared to your physical abilities before the injury), a suitable position must also be one which SMU would recruit and fill irrespective of whether you were a candidate for the job. Your treating physician and/or rehabilitation professional may, for example, review information about the position, speak with the supervisor for the position about the job requirements and physical demands, observe other staff performing the job, and/or request an ergonomic evaluation of the physical demands of the position in developing an opinion regarding whether the demands of the position are within your physical restrictions and abilities.

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My department cannot comply with my temporary restrictions. Is there other work I can do at SMU until my restrictions change?

Southern Methodist University strives to find work within your department to comply with temporary restrictions. If your department does not have any tasks that are within your restrictions, then every effort will be made to find work at the University that allows you to be productive but remains within your restrictions. Please speak with Risk Management for more details about this program.

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Contact Us

Juan M. Azcarate III
Assistant Director of Workers' Compensation and Risk Management
214-768-3737

Anita Ingram
Associate Vice President and Chief Risk Officer
Risk Management
214-768-4047
anitai@smu.edu  

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