Reporting Workers Compensation Related Injuries

In accordance with the Minnesota 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 and meeting the following reporting deadlines:

• First Report of Injury - 8 business hours (1 work day)
• Supervisor Incident Investigation Report - 24 business hours (3 work days)

The State of Minnesota Department of Labor and Industry levies fines to the University for late reporting. Departments responsible for the late reporting will be charged back any fines.

The University of Minnesota is committed to making the workplace a safe and healthy environment, to preventing on-the-job accidents, and to the treatment, care and return to work of employees injured on the job.

The University of Minnesota is required by Minnesota Workers Compensation statute to reimburse employees for appropriate medical treatment and to indemnify employees for wage loss arising from a compensable work-related injury or disease. This policy provides information to employees and supervisors about the requirements and responsibilities relating to the reporting of work-related injuries.

• Reporting and Managing a Workers Compensation Claim

• UM 1536: First Report of Injury (PDF)
• UM 1533: Supervisor Incident Investigation Report (DOC)

Subject	Contact	Phone	Fax/Email
Report an Incident	Your supervisor
Area Claim Reporting Help TC-Facilities Management	Larry Thompson	612-625-6846	thomp419@umn.edu
Area Claim Reporting Help TC-Other	Peggy Handt	612-624-6019	orm@umn.edu
Area Claim Reporting Help Crookston	Jacquie Normandin	218-281-8346	jnormand@umn.edu
Area Claim Reporting Help Morris	Mary Zosel	320-589-6022	zoselmb@morris.umn.edu
Area Claim Reporting Help Rochester	Andrea Wilson	507-280-4650	wils1236@umn.edu
Area Claim Reporting Help Duluth	Cathy Rackliffe	218-726-6827	cracklif@umn.edu
Workers Compensation Claims Administrator	Sedgwick Claims Management Services PO Box 46999 Eden Prairie, MN 55344	952-826-3800	FAX: 952-826-3785 211@sedgwickcms.com

Claims Administrator

An external party hired by the University to provide services associated with the investigation and compensability of Workers Compensation claims.

Eligible Employee

While Minnesota Statue 176.011 and applicable Minnesota case law ultimately frame this determination, "Eligible Employee" generally includes all full-time, part-time, or temporary employees in the Faculty, Academic Professional and Administrative, Civil Service and Union Represented Staff Employee Groups. Generally excluded are students, visiting professors, consultants, volunteers, independent contractors and temporary agency employees. Specific eligibility questions are resolved on a case by case basis by the Claims Administrator.

Work-Related Injury or Disease

Any injury or illness that arises out of and in the course and scope of employment for which compensation is payable under Minnesota Workers Compensation statute.

Claims Administrator

The Claims Administrator is responsible for investigating and determining claim compensability, working with medical providers to ensure that employees receive high-quality, timely medical care and paying all approved medical bills and employee compensation that is due.

Employee

Immediately notify the supervisor that an injury occurred. Work with the supervisor and the Claims Administrator in the completion of all relevant documents.

Supervisor

Immediately assess the incident and assist the employee in seeking appropriate medical care or necessary treatment for any work-related injury. Report the work-related injury, accident or illness immediately in order to comply with State reporting requirements and avoid late reporting penalties. Provide employee with Temporary Prescription Drug ID Card. If penalties arise from late reporting, provide a departmental account number to charge.

• Designated Medical Providers (PDF)
• Minnesota Workers' Compensation System Information Sheet (PDF)
• Temporary Prescription Drug ID Card (PDF)

• Reporting Workers Compensation Related Injuries FAQ

• U of MN Department of Environmental Health and Safety
• Minnesota Workers Compensation Law, Minnesota Statute 176
• Minnesota Department of Labor and Industry

Amended:

August 2009 - Updated Contacts Section

Amended:

May 2009 - Updated Supervisor responsibilities to add providing employee with Prescription Drug Information. Added Prescription Drug Information to appendices.

Amended:

March 2009 - Clarified language in Statement and Reason. Combined Procedures: Reporting and Managing an Injury and Referring an Employee for Medical Care into one procedure. Removed unnecessary forms from forms section. Moved Minnesota Workers Compensation Information Sheet from Forms to Appendices. Added new appendix: Designated medical providers which replaces information currently shown in the contacts section. Definitions and Responsibilities sections updated. FAQ updated. Removed outdated information from Related Information.

Amended:

July 2008 - Workers Compensation Department no longer maintains centralized filing system for all work injuries and illness. Procedures and Responsibilities updated to reflect this. Primary contact and other contacts updated.

Amended:

August 2003 - Updated contacts section and procedures to reflect phone and fax number changes within the Workers Compensation Department.

Amended:

July 2002 - Updated contacts section.

Amended:

October 2001 - Updated contacts and responsibilities sections. Updated policy and both procedures to clarify that employees may choose to receive treatment from a doctor of their choice. Added the Minnesota Workers' Compensation System Employee Information Sheet to the forms section.

Amended:

December 2000 - Updated contacts section to reflect change of designated clinic for the Twin Cities campus from Healthworks to the Minnesota Occupational Health Clinic.

Amended:

June 2000 - Updated Contacts Section and minor corrections on Workability and Supervisor Incident Report Forms. Procedure responsible offices changed from University Workers' Compensation Administration to Office of Risk Management and Insurance.

Amended:

May 2000 - Changed the responsibility from the University's Workers' Compensation Department to the supervisors and managers for directly reporting injuries to the claims administrator. Clarified the choice of medical provider and increases the choices of designated clinics. Revised and added new forms.

Effective:

Supercedes:

1/1/99 Memo from Terry Teachout, Workers Compensation Director Re: Workers Compensation Policy and Procedures Revision 1999