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Workers’ Compensation And Work-Related Injuries and Illnesses
Frequently Asked Questions
What is Workers’ Compensation? What types of injuries or illnesses are covered?
The Workers’ Compensation Act is a part of the Iowa Code designed to provide certain benefits to employees with Iowa State University (including students who are employed by ISU) who sustain injuries, occupational illnesses or occupational hearing loss arising out of and in the course of their employment. Benefits are payable regardless of fault and are the exclusive remedy of the employee against the employer. Benefits are administered according to Iowa law.
What types of benefits does the law provide?
The law provides for the payment of all reasonable and necessary medical care incurred to treat the injury and weekly compensation due to incapacity to work or permanent impairment. The employer has the right to choose the medical provider. Reasonable and necessary transportation expenses are also provided. Mileage for use of a private auto is reimbursed at a rate set forth in 876 IAC, 8.1(2).
Who handles the claim services?
The Department of Administration Services (DAS) has contracted with Sedgwick Claims Management Services to handle workers’ compensation claims for state employees. Sedgwick CMS is responsible for determining compensability , (accepting or denying a claim), authorizing the use of any alternate medical care provider, issuing benefits to employees based on lost work time, payment of medical bills and paying permanent impairment benefits related to claims as required by Iowa Workers’ Compensation law.
Human Resource Services (HRS) is the ISU contact for workers’ compensation issues. HRS will answer workers’ compensation questions, assist departments with appropriate and timely return to work for employees with physician restrictions and assist with questions concerning payroll reporting for employee’s receiving workers compensation benefits. They can be reached at 515-294-3753 or workerscomp@iastate.edu.
· Life threatening injuries require immediate medical attention. Call an ambulance by dialing 911 and notify the employee’s supervisor as soon as possible if they are not already aware of the situation.
· Non-life threatening injuries or illnesses should be reported to the employee’s supervisor who will arrange medical care with:
Occupational Medicine, McFarland Clinic, P.C.
1215 Duff Avenue
Ames, IA 50010
For appointments call: 515-239-4496
· Occupational Medicine, McFarland Clinic, P.C. will coordinate treatment and refer to an appropriate specialist for additional care, if necessary.
· After-hour treatment or emergencies will be seen at the Mary Greeley Medical Emergency Department. Please notify medical staff when treatment is due to workplace injury or illness, so that they can initiate the proper paper work. If follow-up care is needed, the employee will need to be seen at Occupational Medicine at McFarland Clinic.
· University employees who live and work outside of the Ames area should refer to the list of approved medical centers for the treatment of work-related injuries. This list is available online at the Human Resource Services (HRS) web site. http://www.hrs.iastate.edu/workerscomp/MedicalProviders.pdf
Can employees choose to receive treatment with their personal physician?
No. Iowa State University has a list of approved medical providers to provide treatment for work related injuries or illnesses. Employees who choose to be treated by any other treatment center and/or physician may not qualify for any workers’ compensation benefits and may be responsible for all medical costs related to the incident. This is in accordance with state law. If an employee is dissatisfied with the care offered, the employee should discuss the problem with their supervisor, the Workers’ Compensation Coordinator at Human Resource Services and/or their claims examiner at Sedgwick Claims Management Services (CMS) (515-327-4874).
Can employees make appointments for physical therapy on campus?
The Cyclone Sports Medicine Physical Therapy department in Lied Recreation Center is an approved provider for physical therapy treatment. This may be used, but must be directed and authorized by the treating physician.
Do employees have to purchase medications prescribed by the physician at a specific pharmacy? No. Employees may use any pharmacy.
Prescription Procedures
Sedgwick CMS, has contracted with MSC (Medical Services Company) Pharmacy Network for filling medications relating to workers' compensation injuries. A letter with a card will be sent to an injured employee within 24 hours of receipt of a First Report of Injury by Sedgwick CMS. The card should be presented to the pharmacy filling the prescription so the pharmacist can gain on-line access to information regarding that employee's eligibility for workers' compensation benefits. The employee will have the right to select any pharmacy to fill his or her prescriptions however the letter will contain a list of participating pharmacy chains. If the employee does choose to go to a pharmacy outside of the network, he or she will have to pay for the prescription and submit the receipts to Sedgwick CMS for reimbursement.
When the employee will need to fill a prescription prior to receiving a prescription card( i.e. following an initial medical appointment), Occupational Medicine at McFarland Clinic will give the employee the MSC Workers’ Compensation Rx Program form. This form will have information for the employee to give the pharmacy and provides some of the names of participating pharmacies as well as a toll-free number (1-800-860-4819) for the pharmacy to call and receive authorization.
If problems occur, please call the ISU Human Resource Services at 515-294-3753.
What are the employee responsibilities?
- Maintaining workplace safety.
- Notifying the employee’s supervisor of any work-related injury (work-related injuries, illnesses or hearing loss) as soon as possible.
- Obtaining medical care from an authorized medical provider.
- Keeping records of dates of medical appointments, mileage, and expenses incurred in obtaining medical treatment.
- Attending scheduled appointments related to the workers’ compensation claim. Failure to attend scheduled appointments may cause subsequent work absences to be charged to the employee’s sick leave, or as recorded as LWOP (leave without pay) as appropriate.
- Providing the supervisor with a Work Status Report completed and signed by the authorized medical provider within one business day of the medical appointment.
- Reviewing the information on the Work Status Report with the supervisor and confirming temporary work situations that may occur due to physician restrictions.
- Follow physician-recommended restrictions at work and at all non-work activities.
What are the supervisor responsibilities?
- Arranging the initial medical appointment for the injured worker with Occupational Health Works. Occupational Health Works will request that the injured employee bring a copy of their job description and essential functions with them to their initial appointment when the work place injury involves repetitive motion, back injuries, strains or sprains. The physician needs this information to determine the need for work restrictions. If the position description (PIQ / PDQ) or essential functions are not available for the initial appointment, the supervisor should send the copies as soon as possible by fax (515-239-4767) to Occupational Health Works.
- Completing the First Report of Injury Form and electronically sending it to Human Resource Services. The supervisor must either fill out the form or review the form with the employee if he or she fills it out. The supervisor should forward any comments or concerns to Human Resource Services as soon as possible, including any concerns about the work-relatedness of the injury.
- Updating the employee’s work status (i.e., lost work time, return to work restrictions, inability to accommodate restrictions, etc.)
- Completing the Lost/restricted Time report and submitting it to HRS by 5:00pm on Monday for the preceding week.
- Verifying that the employee is placed on a leave of absence if they are missing time and choose not to supplement workers’ compensation benefits with accrued leave.
- Determining if the provisions of the Family Medical Leave Act (FMLA) apply. Questions concerning FMLA should be directed to the Benefits Office at benefits@iasate.edu or 515-294-7680
- Informing the injured/ill employee that they must bring Work Status Report form to you, in person if physically possible, within one business day for each medical visit (physician, specialist or physician's assistant).
- Reviewing the employee’s Work Status Report, comparing any restrictions with the employee’s daily work duties. (Work Status Reports will be given by the physician to the employee.) The employee will confirm temporary job situations with the supervisor before returning to work.
- Provide the employee with the following forms*: (all available on the HRS website)
- Mileage and Prescription Reimbursement Form ( http://www.hrs.iastate.edu/workerscomp/mil_reimb.shtml)
- P28 Benefits Election Form - administer after three calendar days have been missed. ( http://www.hrs.iastate.edu/workerscomp/benefit_election.shtml)
- Physical Therapy Contact Form – at your discretion, when employee is scheduling multiple physical therapy appointments
- Transitional Work Plan - completed when the employee is returning to work with restricted duties for an extended time period and work accommodations are such that confirmation of physician approval is warranted. (http://www.hrs.iastate.edu/workerscomp/workplan.shtml).
Reporting Injuries, Illness or Hearing Loss
How do employees report an accident, injury or illness?
Supervisors or the injured employee will need to log into AccessPlus, go to the Employee's Tab, select Work Injury, and then select Continue to view the FROI home page. After completing the FROI, the Supervisor must send the report electronically to the Workers Compensation Office. If the employee completes the FROI, it must be reviewed and submitted by the Supervisor.
How do employees and/or supervisors decide if an injury or illness should be reported to Human Resource Services?
All accidents and injuries occurring at work or in the course of employment must be reported to the employee's supervisor, even if no medical attention is required. The supervisor or employee is responsible for completing a First Report of Injury form and the Supervisor is responsible for reviewing this and electronically submitting it to the Human Resource Services. Incidents that are not reported may cause an employee to be ineligible for future benefits related to this injury or illness. The filing of an accident report is not an admission of liability. Each report will be evaluated by the state's third party administrator to determine whether the claim meets the criteria to be classified as workers' compensation. The supervisor should make no representation to the employee that the claim will be accepted or denied.
Work-related injuries or illnesses must also be documented for Occupational Safety and Health Administration (OSHA) reporting purposes if an event or exposure that occurred in the work environment caused, contributed to a condition or significantly aggravated a pre-existing condition. This potentially includes injuries while the employee is on break, in the restroom, traveling on business or engaged in work activities such as training required by the employer.
When an employee believes he/she has experienced an occupational illness or injury that was acquired gradually (i.e. repetitive motion condition), what injury date is used when filling out the First Report of Injury Form?
Use the date the employee first sought medical treatment for the condition or the date the employee first became aware of the symptoms.
Benefit Payment Information
Workers' compensation provides benefit payments for medical care with an authorized provider and disability benefits. The first appointment for a work-related injury at the authorized medical provider is paid by ISU at 100%. Continued treatment and associated costs will be reviewed by Sedgwick CMS and if accepted as compensable and authorized, will also be paid at 100%. Payment of unauthorized care may be denied by the workers compensation insurer (Sedgwick) so it is important that treatment is authorized by Sedgwick CMS.
Denied claims
Sedgwick CMS will notify the employee in writing if a claim is denied. The employee should then submit this information to their personal insurance carrier. Appeal rights/processes will be detailed in this letter.
Accepted claims
When is an employee paid for time off from work?
Payment of lost wages begins when these conditions have been met:
1. The employee’s claim has been accepted by Sedgwick CMS as work-related.
2. The injury results in more than 3 calendar days missed.
3. The time missed is for one of the following:
· The employee has a work status form from an occupational medicine physician placing the employee off work. Note: this means that the employee would have been incapacitated from any work.
· The employee has a work status form from an occupational medicine physician with work restrictions and the employer is unable to accommodate the restrictions resulting in lost time for the employee.
Lost time benefits begin on the 4th calendar day of disability following the injury. (The actual date of injury is not counted as a part of the 3-day waiting period.) However, the 3-day waiting period is payable if the disability exceeds 14 calendar days.
Definition of 3-day waiting period: 3 calendar days of full or partial incapacity (Iowa Code 85.27). To qualify as a waiting period day, the time missed must be physician-directed for the employee and meet one of the conditions below:
a. Employee is incapacitated from any work.
b. Employee is incapacitated for a portion of the day, with or without other restrictions.
Does an employee need to use sick leave or vacation when going to a medical appointment? Will workers’ compensation pay an employee for work time missed for follow-up treatment (such as doctor visits or physical therapy) after they have returned to work?
If an employee is required to miss work to attend physician appointments due to a work related injury/illness (that cannot be scheduled outside his/her normal work schedule) the employee is to be paid by ISU as if he/she were working. Personal leave is not charged/used.
Physician appointments include appointments for physical therapy.
* Please note that Iowa Statute specifically allows an employee to be paid for a full day of work on the date of injury regardless of what time the employee leaves work. Thus, an employee would not be required to use sick leave or vacation when seeking medical care on the actual date of injury.
Who determines the claim’s status?
The status of a workers compensation claim (whether or not it is compensable) is determined by Sedgwick CMS. Sedgwick representatives are available by calling (866) 342-3920 (toll-free phone number) for inquiries concerning whether a claim has been accepted or denied.
How long will lost wages be paid?
Benefits will end when:
1. the employee has returned to work, or
2. when the occupational medicine physician releases the employee from treatment, or
3. the physician determines the employee to be medically capable of returning to substantially similar employment.
How much will an employee be paid?
Injured employees who are unable to work in any capacity (full or partial days of work), are entitled to approximately 2/3 of their normal gross salary based on rates set forth by the workers' compensation commission. However, employees may elect to "supplement" with their previously earned university benefits (sick leave, vacation time, compensatory time) in order to receive a full paycheck. Payment for the waiting period (employee's first three calendar days away from work) is not paid unless the employee is off 14 or more calendar days.
Does an employee have to use personal leave for time missed due to work-related illness or injury? (other than for medical/physician appointments)?
Yes. Iowa law requires the employee to take personal leave the first 3 days. BUT, if the time off exceeds 14 days, the first three days of workers’ compensation benefits will then be paid.
Do university benefits (sick leave, vacation, health insurance, etc.) continue while the employee is off work?
Benefits accrue normally for persons on modified duty or who are supplementing, but do not when an employee elects to receive workers’ compensation payments only.
Can an employee be reimbursed for travel expenses going to and from medical appointments?
Yes. The third party administrator, Sedgwick, will review requests for mileage reimbursement for mileage accrued traveling to and from appointments. Mileage reimbursement forms are available online or by contacting the Human Resource Services at 515-294-3753. The completed form may be sent by mail to 3680 Beardshear Hall or sent directly to Sedgwick CMS, PO Box 14620, Lexington, KY 40512.
Who should be contacted if the employee receives a medical bill?
When an employee receives a medical bill for work-related injury or illness treatment, forward a copy of the bill to Sedgwick CMS, PO Box 14620, Lexington, KY 40512 or contact the Human Resource Services, 515-294-3753 with questions or concerns regarding payment.
Working with Medical Restrictions
Who determines employee medical restrictions?
The attending physician or medical provider determines medical restrictions.
How will the supervisor be informed of restrictions?
Employees should receive a Work Status Report at each appointment that should be provided to their supervisor one business day of the appointment. The medical provider will indicate on this report one of the following:
- Employee is released to regular duty on (specific date).
- Employee may return to modified duty on (specific date) and work restrictions are specified. Work restrictions can be either time spent working or function related.
- Employee may not return to work until re-evaluated.
At each subsequent physician visit, the employee will receive a new work status form or some form of written documentation pertaining to restrictions. The employee must always give a copy of this information to his/her supervisor after each visit and before returning to duty.
What is the difference between temporary and permanent work restrictions?
Temporary restrictions are restrictions that will be in effect for a specific period of time. These will and should change as an injured employee receives medical treatment and their condition improves.
Permanent restrictions are restrictions in effect for the duration of a person’s working life or as long as the employee remains permanently disabled. The medical provider assesses these restrictions after the employee has reached maximum medical improvement. Maximum medical improvement is the point at which the physician believes the employee’s condition is not going to improve any further.
What if an employee experiences injury/illness related problems while performing assigned duties?
The employee should be encouraged to inform his/her supervisor of any problem and the supervisor will contact the approved medical provider for a follow-up appointment or contact Human Resource Services to discuss return to work accommodations.
If an employee is offered "modified duty" due to physician’s restrictions, and refuses, will benefits be lost?
Yes. Refusal of light-duty assignments, when the physician recommends work restrictions, may affect the employee’s legal right to workers’ compensation benefits. Contact Human Resource Services if there are questions concerning the light-duty assignment to facilitate additional follow-up with both the physician and supervisor or to ask the assistance of Human Resources/Employee Relations.
Can the supervisor send an employee home due to temporary restrictions?
Yes. If the supervisor cannot modify job tasks temporarily, an employee can be sent home until the employee’s next medical appointment or until the work status form verifies a change in work restrictions. Our goal is to provide accommodation whenever possible during a temporary healing period due to a work related injury/illness.
Other Questions or Concerns
When an employee has been treated for a job-related injury in the past and the symptoms have reoccurred, who should be notified?
The supervisor should contact Human Resource Services who will assist in the scheduling of an appointment at Occupational Health Works.
How should an employee report situations where they believe the work environment is causing or contributing to an injury or illness?
Employees are encouraged to notify their supervisor immediately if they suspect their work environment could cause an injury or illness. The department will determine what arrangements should be made to investigate the situation or incident. This can be internal; however, the Department of Environmental Health and Safety (515-294-5359) is also available to assist with work site health and safety consultation, environmental monitoring, ergonomic work station assessment, or accident investigation.
When should a supervisor notify an injured employee who is missing time from work of her/his Family Medical Leave Act (FMLA) rights?
When an employee misses more than three (3) consecutive work days whether work-related or not the department should notify the employee of FMLA rights. Questions concerning FMLA, should be directed to the Benefits Office in the Department of Human Resources at 515-294-7680.
FMLA Medical Certification:
A physician signed Work Status Report will serve in place of FMLA Medical Certification. Departments are to accept the Work Status Report as verification of need for absence when the work related injury does not permit the employee to work and the absence is an FMLA event. The intended duration of the absence will coincide with the next medical appointment as indicated on the Work Status Report.
Are there any other benefits that may need to be coordinated?
Long term disability status may be approved after 90 days of continuous sickness or accident disability or the expiration of accrued sick leave, whichever is later. However, employees do not have to wait until all vacation and sick leave has been exhausted to apply for long term disability. Departments can assist employees with this process by either notifying the Office of Human Resource Services /Benefits Office directly when an employee has been on any medical leave for one month. This action will allow the Office of Human Resource Services/Benefits Office to provide the employee with an application for long term disability in a timely manner.
Are injuries received while coming or going from work covered by workers compensation?
Injuries that occur while going or coming to work are considered on a case-by-case basis. In Iowa, the general rule is that the course of employment commences after the employee reaches the work premises where her/his actual work begins and is carried on and ceases when he/she leaves.
Contacts for specific questions and concerns:
Questions or requests for more information on workers compensation or job-related accidents, injuries or illnesses, should be directed to the ISU Human Resource Services at 515-294-3753.
Note: This document is provided for informational purposes only and changes may occur as necessary. This document does not replace any contract or written policies governing workplace injuries.
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Information pertaining to the rights and duties of those covered by Iowa’s workers compensation law have been reproduced from the text of the
Iowa Division of Workers Compensation Guide to Workers Compensation,
Iowa Workforce Development, Fourth Edition.