Policy 617 – On-The-Job Injury / Illness Program

Date Issued: 10/80
Date Revised: 07/08
(Effective April 1, 2002)

The Workers' Compensation Act of the State of Alabama does not apply to UAB. UAB provides, and pays for, the UAB On-the-Job Injury/Illness Program to cover an employee's medical expenses and lost wages incurred as a result of an on-the-job injury or illness. Expenses and wages are compensable under the On-the-Job Injury/Illness Program only if the injury/illness is sustained in the course of, and arises out of, employment at UAB. The Department of Human Resources administers the program. Human Resources may contract with a third party (the Administrator) to administer the benefits under the On-the-Job Injury/Illness Program on behalf of UAB. Human Resources and the Administrator have established specific guidelines and procedures for the program. Procedures for reporting an incident and other information regarding the On-the-Job Injury/Illness Program are provided in a separate publication that is available by contacting Human Resources or from the HRM World Wide Web site at www.hrm.uab.edu.

All UAB employees in all employment categories (status codes) are eligible for On-the-Job Injury/Illness benefits.

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, Human Resources, or the Administrator. The committee may refer claims to the State of Alabama Board of Adjustment for consideration. The committee also (1) will consider and approve proposed changes to the On-the-Job Injury/Illness Program procedures, claim processes, and coverage guidelines and (2) may recommend On-the-Job Injury/Illness Program policy changes.

Incident Reporting

1. An incident/accident must be reported verbally by the employee to the employee's supervisor as soon as possible but no later than two working days following the incident/accident or following the onset of the illness or disease. Failure to verbally report an incident/accident within two working days of occurrence or within two working days of the onset of the illness or disease may result in denial of On-the-Job Injury/Illness benefits.
2. A written or electronic incident report form must be completed and must be submitted to Human Resources within two working days of the first verbal report by the employee to his or her supervisor indicating an injury or a suspected illness or disease arising out of his or her work at UAB. Refer to the Human Resources web site for forms and instructions regarding incident reporting (www.hrm.uab.edu). Copies of the forms also are available by calling Human Resources.
3. In the case of injuries resulting from an assault, including sexual assault, the incident also must be reported immediately to the UAB Police who will report the incident to the employee's supervisor and to Human Resources Relations.

Medical Treatment

1. Any eligible UAB employee who suffers a compensable on-the-job injury or occupational illness or disease will be provided medical treatment by health-care providers designated or approved by Human Resources or the Administrator.
2. A Medical Evaluation Referral Form must be completed and must be signed by the employee's supervisor. The Medical Evaluation Referral Form is available on the Human Resources web site (www.hrm.uab.edu) or by calling Human Resources. The employee must present the signed form to the health-care provider before services will be provided that are to be paid by the On-the-Job Injury/Illness Program. An exception is made in the event of a medical emergency requiring immediate treatment. In that event, the employee should be sent immediately to the UAB University Hospital Emergency Department. A representative of the employee's department should advise the Emergency Department verbally that the employee was injured in the course of UAB employment so that billing can be handled properly.
3. Any employee seeking medical treatment for an on-the-job injury or occupational illness or disease must agree to a post-incident drug test. The only exceptions are injuries resulting solely from needle-sticks which are handled by the Rapid Response Team through Employee Health Services in the UAB University Hospital.
4. Incidents/injuries for which other, more specific, response plans are in effect and are documented as Hospital policies (such as needle-sticks) will be treated as specified in Hospital policies.
5. An employee who is injured in the course of employment while away from the UAB campus may seek emergency medical treatment from the nearest health-care provider. The employee must advise the health-care provider that he or she has been injured "on the job." The health-care provider may contact UAB Human Resources with questions regarding payment for services rendered. An incident report must be completed as soon as possible following the accident, and all follow-up treatment must be coordinated through Human Resources or the Administrator

Medical Benefits

1. The On-the-Job Injury/Illness Program will pay all approved medical expenses and all directly related transportation expenses arising out of an injury or occupational illness until the employee reaches maximum medical improvement as determined by the physician and agreed to by Human Resources or the Administrator.
2. Medical benefits under the On-the-Job Injury/Illness Program may not be provided if the employee chooses to seek benefits from a provider who has not been approved by Human Resources or by the Administrator.

Lost Time/Wages

1. The On-the-Job Injury/Illness Program will compensate an employee for time lost in excess of four calendar days as a result of on-the-job injury or illness. Time lost on the day of the injury (Day One) or the day the occupational illness is discovered (Day One) will be paid through the employee's department and should be charged to leave with pay. The next three calendar days (Days Two through Four) 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, vacation time, or personal holiday 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 (Days Two through Four) will be replaced at the same rate and maximum as outlined in item 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).
2. Beginning with the fourth day after the day of the incident/accident or onset of illness/disease (Day Five), the On-the-Job Injury/Illness 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 subject to a weekly maximum that is adjusted annually. All normal payroll deductions (including taxes, parking fees, credit union withholdings, etc.) will continue.
   
   The following is an example of how the process works:
   • Employee reports to work at 7:00 a.m. on Thursday and is injured at 9:00 a.m.
   • Employee goes to assigned physician and is advised that he or she may not return to work for two weeks.
   • Department should pay employee for a full day on Thursday (leave with pay). The three calendar day waiting period would be Friday, Saturday, and Sunday. If the employee was originally scheduled to work Saturday and Sunday of the waiting period, the employee may use accrued benefit time for Friday, Saturday, and Sunday; otherwise, the employee could use accrued benefit time only for Friday.
   • Employee is eligible for On-the-Job Injury/Illness Program wage benefits beginning on Monday.
3. Sick leave and vacation time will continue to accrue while On-the-Job Injury/Illness benefits are being paid.
4. Employees may use eligible accrued sick leave, vacation time, or personal holiday time in addition to the On-the-Job Injury/Illness benefit of 66 2/3% of regular pay (subject to the maximum wage benefit described above) to result in earnings equal to the employee's regular rate of pay. The sick leave, vacation time, or personal holiday 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% On-the-Job Injury/Illness wage benefit is capped by the weekly maximum described in item 2 above. No combination of the On-the-Job Injury/Illness wage benefit plus supplemental time may exceed 100% of the employee's regular rate of pay.
5. The employee must notify his or her department of the request for On-the-Job Injury/Illness benefits and of his or her desire to use eligible accrued time as a supplement. The employee is responsible for keeping the immediate supervisor or department/unit head apprised of his or her status and projected date for return to work. The department/unit is responsible for submitting time sheets to Human Resources for processing. If lost time resulting from an on-the-job injury or illness exceeds two calendar weeks, the employee will be placed on Family and Medical Leave (if eligible) retroactive to the date of the injury or the reporting of the illness. Family and Medical Leave and On-the-Job Injury/Illness Leave will run concurrently and will not "stack" one after the other.
6. On-the-Job Injury/Illness lost wages benefits are payable for a maximum of 180 calendar days from the date of the initial injury or the first written report of the occupational illness/disease. Lost wages benefits will cease at the end of the 180-day period or when an employee has been released to return to full duty by the assigned physician, whichever is earlier. The 180-day maximum benefit period is initiated from the date of the injury or the date the occupational illness/disease is first reported in writing, regardless of the date medical treatment is sought.
7. An employee who terminates employment (voluntarily or otherwise) is not eligible for lost wages benefits following his or her UAB employment termination date.
8. If an employee is not able to return to work within the 180-day period, application may be made for benefits under the UAB 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.
9. The On-the-Job Injury/Illness Benefits Review Committee will consider the status of any employee unable to return to full duty within 180 calendar days from the date of injury. A determination will be made regarding employment status and continuation of On-the-Job Injury/Illness wage benefits. An employee unable to return to full duty, or to modified duty if it can be accommodated by his or her department/unit, within 180 calendar days from the date of the injury or the date the illness is reported may be discharged from employment.
   
   The department/unit head will determine if the department/unit will be able to accommodate any modifications imposed by the treating physician.

Limitation on Claiming Benefits

A claim for On-the-Job Injury/Illness Program benefits must be brought within one calendar year of the date of the injury or the diagnosis of the illness. During the one-year period immediately following an on-the-job injury or illness, a claim for benefits may be brought only if proper notification was made to management and an incident report was completed as required at the time of the incident or diagnosis of illness.

General

1. Abuse, fraud, or misrepresentation of facts in connection with the On-the-Job Injury/Illness Program not only will jeopardize an employee's eligibility for benefits but also will subject the employee to disciplinary action up to, and including, discharge from employment.
2. Human Resources may assign a case manager to an employee who has incurred an on-the-job injury/illness. Failure to follow the instructions of the case manager with regard to appropriate rehabilitation or failure to cooperate with reasonable transitional work programs approved by the physician may result in denial of On-the-Job Injury/Illness benefits.
3. Authority is granted to Human Resources to establish guidelines for the administration of claims; to hire, coordinate, or terminate the services of a third party administrator; to designate providers of health-care services to employees who incur on-the-job injuries or illnesses; and to otherwise administer the On-the-Job Injury/Illness Program. The On-the-Job Injury/Illness Benefits Review Committee must approve major changes in processes and compensability guidelines.
4. An employee may contact the Administrator and/or the Director of Human Resources Relations if he or she wishes to question a ruling on a claim or to propose changes to the On-the-Job Injury/Illness Program.