POLICY 06:34:00

WORKERS’ COMPENSATION

Please refer to The State of Tennessee Treasury Department – Workers’ Compensation.

Purpose

Pellissippi State’s workers’ compensation coverage provides benefits to employees who suffer an injury or illness that is specifically and clearly caused while the employee is in the course and scope of their employment. This policy provides guidance on the workers’ compensation process.

Policy

In the event of an on-the-job injury (or work incurred illness) which requires treatment by a medical professional or facility, the faculty or staff member should file a claim for coverage under the workers’ compensation law. Such an incident should be initially reported to Campus Police and/or Human Resources, who will refer the individual to a physician or facility designated by the contracted administrator, if necessary. Campus police will initiate an incident report form. The completed incident report form should be returned to the Human Resources Department for submission to the workers’ compensation contracted administrator. It is very important that all accidents be reported, and all claims be filed as soon as possible. The statute of limitations for filing a Tennessee Workers’ compensations claim is one year from the date of work incurred injury (or illness). All injuries are to be reported in 30 days or less to the employee’s supervisor, campus police, and the Human Resources Department.

1. Who is Eligible?
   Generally, persons are eligible for workers’ compensation benefits if employed by the state and receive a state payroll check. Persons not eligible for workers’ compensation benefits include anyone who is compensated through a contract with the state.
2. What is a Compensable Injury?
   To receive workers’ compensation benefits, one must be injured while performing some activity which falls within the workers’ scope of employment. In other words, an accident which causes an injury must be related to work. These are referred to as compensable injuries. Not all accidents which happen at work would be compensable under the workers’ compensation law.
   No clear-cut definition is available to describe when an injury is or is not compensable. Job duties should be performed in a careful manner. Any conditions in the workplace which are hazardous should be reported to the appropriate officials. It is every employee’s responsibility to help prevent accidents and to assist in providing a safe workplace.
3. Reporting the Accident
   If an on-the-job accident occurs, immediately notify the supervisor and campus police of exactly what happened, how it happened, who saw what happened and whether the injury is a result of the accident. If you observe an accident in which a fellow employee is injured severely enough that the involved employee cannot notify their supervisor, attempt to notify the supervisor and campus police for them. In addition, notify the Human Resources department.
   1. Steps to Reports the Accident:
      1. Immediately notify the supervisor and campus police of the incident
      2. Explain how the incident occurred
      3. Name any witnesses
      4. Tell the supervisor and campus police if injuries were sustained as a result of the incident
4. Seeking Medical Treatment
   If an on-the-job accident requires medical treatment, choose a provider who is authorized in the state’s workers’ compensation network. This list is available upon calling the state’s workers’ compensation administrator. This will be the only physician authorized to treat the compensable injury. This means that the state will only accept and pay medical expenses submitted by this physician, unless this treating physician notifies the workers’ compensation administrator that a referral to another network physician for treatment has been made. The state will not pay any medical expenses incurred from a physician other than the treating physician or a network physician to whom the treating physician refers the employee.
   When seeking medical treatment, the employee should notify the doctor’s office that the injury occurred while at work and that a claim for workers’ compensation benefits with the state will be filed.
   1. Steps to seek medical treatment:
      1. Call the 24/7 nurse triage line to report an injury
         1. Call the center with the supervisor (or designee) present at 1-866-245-8588 option #1, immediately after the incident occurs
            1. A registered nurse will consult with the employee to determine options
            2. Employee may be directed to a medical provider
            3. A provider who is authorized in the State workers’ compensation network must be chosen and will be the only physician authorized to treat the employee for a compensable injury.
            4. Follow-up appointments must be arranged by CorVel (or the contracted administrator)This does not apply in situations requiring immediate emergency room treatment for serious or life-threatening injuries.
            5. Emergency room visits may involve different follow-up procedures
      2. Complete the reporting process
         1. 1. Ask the nurse (see step 2) to be transferred (with supervisor or designee) to the First Notice of Loss Unit after nurse has entered the notes.
            2. Call First Notice of Loss Unit directly at 1-866-245-8588, Option #2.
      3. Human Resources personnel may also call or complete the First Notice of Loss online via CareMC if the employee and supervisor did not call the registered nurse and the incident was reported to Human Resources and was non-medical.
5. Filing an Incident ReportCampus police will file an incident report. Information contained in this report enables the claims adjuster to determine whether the injury is compensable under the workers’ compensation law. If all of the information requested is not provided or the report is not signed, no decision can be made. This will result in a delay in payment of the medical bills. Generally, notification as to whether the injury is compensable will be received within 90 days of the date your completed report is received by the workers’ compensation administrator.
6. Payment of Workers Compensation ClaimsPayment of workers’ compensation claims is made by the contracted administrator. Given the timely reporting of work-related injury and cooperation by the employee, the employee’s supervisor and the attending physician, the eligibility decision can normally be made within 14 days of filing. Once compensability is determined, the contracted administrator will make medical expenses and lost time payments on the state’s behalf in accordance with state law including payment of permanent disability amounts when appropriate.
   Things to remember when filing claims to ensure a successful claims process
   1. Notify the doctor’s office of injury and claim
   2. Fill prescriptions under workers’ compensation, NOT the general health insurance carrier
   3. Do NOT present your health care card for medical treatment
   4. Do NOT request drug tests from the workers’ compensation medical provider
   5. Keep the supervisor and/or HR department notified daily regarding work status while out of work on workers’ compensation.
      • Provide explanation of medical care prescribed
      • Provide current condition information
      • Provide copies of all paperwork issued by the treating physician stating when the employee can return to work, if follow-up visits are necessary, and the need for physical therapy.
      • The written documentation must be forwarded to Human Resources.
      • Due to HIPAA compliance, ONLY the HR Department will store the medical records related to an employee’s injury on the job.
   6. A case manager may be assigned to review the case and assist the employee.

Please refer to The State of Tennessee Treasury Department – Workers’ Compensation guidance, and Tennessee Claims Commission for additional information.

Reviewed/Recommended: President’s Council, March 27, 2023
Approved: President L. Anthony Wise, Jr., March 27, 2023