Reporting and Managing a Workers Compensation Claim

 

In accordance with the Connecticut Workers Compensation statute, the University provides for the payment of medical expenses and wage loss benefits to eligible employees who experience a compensable work-related injury or disease. Employees must report job-related injuries/illnesses as soon as practicable to the employee's supervisor. Supervisors are responsible for submitting the following forms as timely as possible following the proposed guidelines: First Report of Injury - 8 business hours (1 work day).
 
Employee Responsibilities:

  • Immediately notify your Supervisor. (Your Supervisor will assess the situation, assist with arranging proper medical care and begin the injury reporting process)
     

  • Promptly cooperate with your Supervisor and the Claims Administrator in the completion of all relevant documents.    
     

  • An accident report MUST be filled out and forwarded to the Office of Human Resources, 554 Mt Carmel Ave, Mail-drop: OF-HMN, Fax 203-582-5347 (attached as QU First Report of Injury)
     

First point of contact for all injuries needs to be St. Paul-Traveler’s CorVel Designated provider: Concentra at one of the following locations:

1.       370 James Street (Suite 304), New Haven, CT 06513
          Phone: 203-503-0482  
          Hours: Monday – Friday 8:30AM to 5:00PM  

2.       900 Northrop Road, Wallingford, CT 06492
          Phone: 203-949-1534
          Hours: Monday – Friday 8:00AM to 5:00PM
  • If you seek medical attention outside of the hours of 8:00 am to 5:00 pm M-F, please see Yale New Haven Hospital Emergency Room, 20 York Street, New Haven, CT 06510, Telephone: 203-688-4242.
     
  • Please ensure that any obtained documents are sent to the office of HR as well, including Patient Visit Summary and Instructions, Follow-up care requirements, and/or Work Status Report etc.
     
  • Keep your supervisor informed of any restrictions, special requirements, ability to work etc. 
     
  • Notify supervisor in conjunction with HR about doctor’s appointments, physical therapy appointments, etc. in advance of the time scheduled with approved physician.
    • Every effort to make appointments before or after work hours is expected, appoints should be made where necessary at the beginning or end of a shift so not to disrupt the work day. 
       

 
Supervisor Responsibilities
  
  • Immediately assess the incident, offer first aid if applicable, and assist the Employee in seeking appropriate medical care or necessary treatment for any work-related injury. If an injury is a potential life-threatening emergency, call 911. 
     
  • Ensure First Report of Injury Form is sent to Human Resources in one work day. (8 hours) 
     
  • Provide the Employee with the University Authorization to Treat Form (includes locations & directions), a list of Designated Medical Providers and the contact information for the Worker’s Comp HR designee, Nicole Lambusta. 
     
  • Please ensure that any obtained documents are sent to the office of HR as well, including Patient Visit Summary and Instructions, Follow-up care requirements, and/or Work Status Report etc. 
     
  • Work with injured employee to stay informed of any work status restrictions, return to work dates and for hourly employees that all time is correctly coded in Kronos.  
     
  • Try to determine actions to prevent similar accidents from reoccurring in the future.

Returning the Employee to Work:  
 

When an injury occurs, it is incumbent upon the university to help the injured employee to return to work as soon as possible.    
 
The university structures the return-to-work program around each individual case. This program involves maintaining frequent contact with the employee and the treating doctor, providing a modified work environment and/or work assignment, or providing alternate-duty assignments that return the employee to the workplace within his or her physical abilities.   
 
All employees whom are placed on light duty, have restrictions or are out of work for more than one day need to have a return to work note from their treating physician in forced to start the immediate next shift at the University. The Return to Work Note needs to indicate when the Employee can return to work and whether job modifications are required to accommodate physical restrictions. The Employee will provide a copy of the note to HR and their supervisor.

  • Provided this note is supplied, employees without restrictions can return to their usual work duties.
     
  • If the treating physician reports work restrictions, the supervisor and Human Resources will review the job modifications that are required to comply with the restrictions. Every effort will be made to accommodate the employee's restrictions. If work is available within the restrictions, the Employee will return to suitably modified work. The Supervisor will monitor the Employee's recovery on a weekly basis and report the Employee's recovery progress to Human Resources.
     
  • Employees with work restrictions are designated to work four hours (half day) while on restrictions or light duty until the treating physician deems the employee can return to Full Duty.

 

Timekeeping for Worker’s Compensation:

  • Employees placed on Light Duty, Restrictions, or Lost Time (days away from work) that are 1-3 days in duration, will not be reimbursed by Travelers, thus will need to account for this time by using sick, vacation or personal time in lieu. Please designate in Kronos for each specific date and hours the codes: SK, VA, or PE.
  • For those leaves exceeding 3 days, please code lost time (time away from work) as WC, this time will be sent to Travelers for payment.
    • WC should only be used for: doctor’s appointments with approved providers, travel time to appointment, days out of work due to temporary disability.
    • Exact calculation of time should be submitted, please do not round time for reporting.
    • If you are unable to come in before or after an appointment to work, SK, VA, or PE time must be used for this time absent from your job.
    • Any questions, please contact: Nicole Lambusta (x8724)  

** Employees who experience an aggravation or re-injury of a previous work-related injury should be directed for medical treatment.   
 
**FMLA and Worker’s Compensation run concurrently at Quinnipiac University.

 

Frequently Asked Questions:  
 

Who is covered?

A Quinnipiac University employee who sustains an injury or occupational disease in the course of employment is entitled to receive compensation under the State Workers’ Compensation System. In the case of a fatality, the deceased employee’s legal beneficiaries are entitled to benefits.    
 
Generally speaking, a University employee is a person who is in the service of the university and is on the university payroll. However, the following people are not considered employees for purposes of workers’ compensation:  

  • Independent contractors (1099 employees)
  • Volunteers
  • Persons covered by federal workers’ compensation
  • Consumers or patients of a state institution or agency
  • Non-employed students receiving a scholarship stipend  

Who will handle my claim?
 
Quinnipiac University contracts with a Third Party Administrator (Travelers) to handle the administration of Workers Compensation claims. Your claim will be assigned to an adjuster under contract with the University.   
 
What does it pay for?

As it pertains to medical services payments, Travelers will pay only for those services or prescriptions that are determined to be reasonable and necessary and related to the injury.

  • Medical providers should bill on the prescribed forms and according to the medical fee guidelines established by Worker’s Compensation statutes.   

As it pertains to income benefits (loss benefits): In the event of a temporary disability, you are entitled to receive wage-loss benefits if you are unable to work more than three days because of a work related injury or illness. The first three days are considered a waiting period and are not paid unless you are off four or more days due to the injury. If this is the case, the first three days will be reimbursed (paid retro-actively). The wage loss benefit replaces up to two-thirds of the before tax average weekly wage you received at the time of your injury, and is generally not taxable. The State sets minimum and maximum rates and maximum benefit durations.      

** Employees placed on Light Duty, Restrictions, or Lost Time (days away from work) that are 1-3 days in duration, will not be reimbursed by Travelers, thus will need to account for this time by using sick, vacation or personal time in lieu.   

  • Payment of compensation for time lost from work due to an on-the-job injury is made directly to the employee on a weekly basis, unless other arrangements are stipulated.

My claim was denied and I don't understand why. Now what?
 
The Workers Compensation system is governed by decades of case law. The rules are not intuitive, and certain denials may be hard to understand. Please know that any and all denials the TPA proposes to make have been personally reviewed by the University's Worker’s Compensation official in HR. If you do not understand a denial, discussion with Travelers on your claim to clarify the decision can be done at: 1-877-828-4110.  

I'm not sure if my injury is work-related. What should I do?
 
If you are not sure that an injury is related to work, file the claim. Our TPA will help make the determination.  

Must I return to work after my physician releases me to return with restrictions?
 
The University’s top priority is getting you well quickly and having you rejoin our University community. Working, even if only in a limited capacity, gets you up and moving and keeps you in a healthy routine. Studies show that employees heal more quickly and completely if they remain active and at work with co-workers. Most physicians are careful regarding work restrictions, and it is unlikely you will re-injure yourself when following their instructions and guidelines. If you are concerned that the job provided is not consistent with the restrictions, discuss the issue with your supervisor, your adjuster, and/or your doctor.