Reporting Workers Compensation Related Injuries FAQ
Printed on: . Please go to http://policy.umn.edu for the most current version of the Policy or related document.
- What is Workers Compensation?
Workers Compensation is statutory, no-fault system of legal rules that provides for the payment of medical expenses and wage loss replacement for employees who are injured or contract an illness as a result of, and in the course and scope of, their job duties.
- How do I file a Workers Compensation claim?
Please refer Reporting and Managing a Workers Compensation Claim.
- Who will handle my claim?
The University of Minnesota contracts with a Third Party Administrator (TPA) to handle the administration of Workers Compensation claims. Your claim will be assigned to an adjuster at Sedgwick CMS, the TPA under contract with the University.
- What benefits am I entitled to?
Very briefly, under the Minnesota law, you are entitled to:
- Medical services related to your work injury.
- Part of your wage loss or inability to earn a full income.
- Benefits to dependents for work related death.
- Compensation for permanent loss of use of or loss of body function.
- Vocational rehabilitation services if you cannot return to the job or to the employer you had before the injury.
- How long do I have to file my claim?
University policy requires Employees to submit claims immediately. Minnesota law states that Employees have a maximum of 30 days to inform their Employer of a workplace injury.
- Will I need a lawyer to file my claim or receive benefits?
The charge of the University's Director of Risk Management and Insurance to the University's Claims Administrator is simple and direct:
Immediately pay University employees' Workers Compensation claims to the full extent required by Minnesota's Workers Compensation law.
While you are always free to hire an attorney, we have made real efforts to make sure no employee feels they need an attorney to file a claim or to collect benefits.
- Will my workers compensation recovery change if I hire a lawyer?
The law allows attorneys to take 25% of the first $4,000 of your benefits, and 20% of the next $60,000 of your benefits. If you can resolve your claim without attorney involvement, you will keep more of your awarded benefits.
- 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 Claims Administrator proposes to make have been personally reviewed by the University's Director of Risk Management and Insurance, whose stated goal is to immediately pay University employees' Workers Compensation claims to the full extent required by Minnesota's Workers Compensation law.
If you do not understand a denial, discussion with one or more of these resources will help clarify the decision:
- Who pays for Workers Compensation claims?
The University is self-insured for Workers Compensation. This means we all pay for workers' compensation claims.
- 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 Claims Administrator will help make the determination.
- Do I have to treat with a Designated Medical Provider?
You have the right to choose and treat with your own physician.
- Are there advantages to treating with a Designated Medical Provider?
We believe so. The University's Designated Medical Providers are:
- Staffed by physicians who are trained in occupational medicine.
- Conveniently located close to the various campuses.
- Committed to seeing injured employees within 24 hours.
- Accustomed to the way the University handles claims, minimizing your problems with paperwork and billings you may encounter elsewhere.
- How are my wage loss benefits calculated?
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 ten or more days due to the injury. If this is the case, the first three days will be reimbursed. 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.
- For compensable Lost Time injuries, what are my wage replacement options?
Under Minnesota Statute, you will receive 2/3rds of your wages tax-free (subject to the current statutory maximum) from Sedgwick Claims Management upon the approval of your Lost Time claim. Your leave balance(s) will be unaffected.
In addition to the statutory benefit, you may also consider two supplemental wage replacement options:
- An additional 1/3rd of your wages from the University. Your leave balance(s) would be adjusted for the 1/3rd wages paid by the University.
- For Lost Time Claims that have not yet been accepted as compensable, you may choose to receive 100% of your wages from the University, subject to paid leave being available to you. Upon the acceptance of the claim, you will receive the statutory 2/3rds of your wages tax-free (subject to the current statutory maximum) from Sedgwick Claims Management backdated to the inception of your claim. Your leave balance(s) would be adjusted for the full wages paid by the University. This option results in an overpayment of wages. You will be required to repay the University any amount paid to you in excess of what would have been paid under supplemental wage replacement option "1" in full.
- 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.
- I want to return to work, but need some assistance. Who can help?
- Your supervisor should be your primary resource.
- Assistance is also available from the University's Disability Services Office. This Office has branched out into helping workers recovering from injuries re-engage in their workplace.
- Who should complete the First Report of Injury? The injured employee? Their supervisor? Someone else?
Although the State of Minnesota does not specifically indicate who must complete the First Report of Injury, we recommend as a 'Best Practice' that the Supervisor complete this form in close consultation with the injured employee. The most important aspect of the First Report of Injury is to complete it to the best of your ability and submit it immediately.
- I have more questions. Where should I go for answers?