Table of Contents

• Purpose
  
• Forms
  
• Payment of Premiums
  
• Individuals Covered
  
• Workers' Compensation Benefits
  
• Medical Treatment
  
• Disability Leave - Employer Paid
  
• Indemnity Benefits
  
• Family Medical Leave Act
  
• How to File a Claim
  
• Fraud
  
• References
  

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Purpose

The purpose of this policy is to specify the requirements and benefits associated with Workers’ Compensation Insurance.

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Forms

Format			Form Number	Form Name
web	doc	pdf
			EHS 11-1	First Report of Injury or Illness
			EHS 11-2	Accident Investigation Report

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Payment of Premiums

Workers’ Compensation is a statutory required insurance that all employers must provide. Premium rates for workers’ compensation are assessed annually to departments based upon the department’s claims experience and possible exposure.

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Individuals Covered

All employees of Florida State University, including Faculty, University Support Personnel (USPS), Administrative and Professional (A&P), and Other Personnel Services (OPS) are covered by Workers’ Compensation Insurance while in the course and scope of employment. Work Study Students receiving payment from Florida State University and Volunteers are also covered by Workers’ Compensation Insurance as long as they are performing work which is within the course and scope of their employment for which the University receives a benefit. A Volunteer must adhere to and meet the requirements of OP-C-7-J5.

University Police are covered while in the course and scope of their duties during their usual work shift, and at other times when they may be called on to perform such duties that are the primary responsibility of law enforcement officers regardless of pay status or relationship with the University at the time of the accident.

Individuals not covered by workers’ compensation include any individual injured in an accident where work preformed was not the major contributing cause of the injury. Other examples of non-covered individuals include students receiving fellowships, visitors, student athletes, and independent contractors and their employees.

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Workers' Compensation Benefits

Florida State University provides workers’ compensation coverage to all employees in accordance with Florida Statutes 440. These benefits consist of medical treatment and indemnity benefits (loss of wages). The Department of Financial Services (DFS) is responsible for adjusting all claims on behalf of Florida State University.

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Medical Treatment

For all claims reported after January 1, 2009 all medical benefits are coordinated though OptaComp, a division of Blue Cross Blue Shield Association. OptaComp is responsible for ensuring that an injured employee receives prompt medical treatment. All medical treatment must be authorized by OptaComp prior to receiving treatment with the exception of emergency situations. The Department of Financial Services works directly with OptaComp and Florida State University to insure all appropriate medical treatment is provided in a timely and efficient manner.

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Disability - Employer Paid

Florida State University provides forty hours of disability leave to employees injured in the course and scope of their employment per accident. These benefits are available to all employees with the exception of Other Personnel Services (OPS), Volunteers and Work Study Students. The purpose of this benefit is to alleviate an employee having to exhaust his/her personal leave time, as the indemnity portion of workers’ compensation benefits do not begin unless disability exceeds seven days.

Employees may use this benefit intermittently or all at one time. The employee must provide his/her supervisor with documentation from an authorized treating medical provider supporting any time away from work when using this benefit.

To record this time, the supervisor or designated office personnel will need to complete a Work Group Change Form, which can be found on the Human Resources (HR) Website and submit it to HR-Leave and Attendance to be eligible for this benefit. This form will allow HR to add a new leave time classification to the employee’s time sheet in OMNI so that he/she can properly classify leave. Contact EH&S or HR with further questions.

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Indemnity Benefits

There are several classifications of disability benefits under Workers’ Compensation which are paid to employees for loss of income as a result of a work-related injury. These benefits are paid by the DFS and are sent directly to the employee’s home.

Temporary Total Disability - These benefits are paid if disability extends beyond seven days. Benefits are payable at a rate of 66 2/3rds of the average weekly wage based upon the income of thirteen (13) weeks prior to the injury.

Temporary Partial Disability - These benefits are usually paid if the employee has been released to return to work light duty but has a loss of income because of physical restrictions. Taking 80% of the average weekly wage, subtracting the income earned and paying 80% of the value remaining calculates these benefits.

An employee is only entitled to receive a total of 104 weeks of temporary benefits per accident.

There are other types of benefits available depending upon the progression of the work-related accident. The adjuster at the DFS assigned to the claim will be able to assist with any questions or the employee can contact EH&S Insurance and Claims Manager at 644-6895.

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Family Medical Leave Act

All leave paid or unpaid, used by an employee during recovery from his/her work related injury may be designated as Family Medical Leave in accordance with the Family Medical Leave Act (FMLA). FMLA provides the employee with certain benefits/protections that are described in the FSU Personnel Procedures. FMLA questions and disputes should be directed to Human Resources at 644-7936.

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How to File a Claim

All accidents should be reported to OptaComp at 1-877-518-2583 with the exception of First Aid accidents. (accidents or incidents that occur that do not require medical treatment). If an employee sustains a work-related injury that requires emergency medical treatment, they should go directly to the hospital or if needed call emergency medical services by dialing 911. The supervisor or designated employer representative should immediately contact OptaComp and provide the injured employee name, where they are going for treatment and the employee date of birth. OptaComp will immediately contact the medical facility to initiate medical case management. OptaComp will contact the supervisor once the emergency situation is under control. The supervisor/designated Department representative will need to make sure that a FSU Accident Investigation Report is completed and forwarded to the EH&S.

If an employee is injured and requires non-urgent medical treatment, the employee must immediately report the accident to the supervisor/designated Department representative which will immediately report the claim to OptaComp. This will initiate medical treatment. The claim will then be assigned to an OptaComp nurse who will initiate medical case management. The FSU Accident Investigation Report shall be completed and forwarded to the EH&S within 48 hours.

An employee who has sustained a work-related injury where no medical treatment is needed shall notify his/her supervisor/designated Department representative to complete a First Report of Injury or Illness form and a Accident Investigation Report These forms are located at www.safety.fsu.edu and are to be forwarded to EH&S after completion. If no medical treatment is required DO NOT CALL OPTACOMP.

Should an injury occur resulting in the death of an employee, the supervisor/designated Department representative shall immediately report the death to EH&S at 644-6895 and the Division of Workers’ Compensation Claims at 1-800-219-8953. Once this has been done, the accident shall be called into OptaComp.

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Fraud

The Department of Insurance has established a Workers’ Compensation Fraud Hotline at 1-800-378-0445. Anyone reporting fraud is immune from civil liability unless the person making the report knows it to be false.

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References

1. Attendance and Leave
2. Personnel Rules of the State University System
3. Florida Administrative Code
4. Florida Statutes, Chapter 440

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