FIU Workers’ Compensation Program What You Need to Know… February 7, 2010 Florida Statute, Chapter : " Any person who, knowingly and with intent to injure, defraud, or deceive any employer or employee, insurance company, or self-insured program, files a statement of claim containing any false or misleading information commits insurance fraud, punishable as provided in s "

2 Content Overview Purpose of FIU Workers' Compensation Program…. 3 Eligibility for Benefits……………………………… 4 When an Injury Occurs…………………………….. 5 –Medical Emergency……………………………………….. 6 –Non-Medical Emergency………………………………….. 8 Benefits: –Medical Treatment………………………………………… 9 –Lost Time Wages………………………………………….. 10 –Pharmacy/Prescriptions…………………………………… 12 Assistance Directory……………………………….. 13 FIU Workers’ Compensation PC 224

3 What Is the Purpose of The FIU Workers’ Compensation Program ?  To provide legally mandated benefits to workers who are injured at work, or who develop a job- related illness as a result of their employment.  Benefits may include payment for medical bills, mileage, lost wages and vocational rehabilitation.  The Florida Division of Risk Management determines eligibility for coverage based on the circumstances reported, not the FIU.

4 Am I Eligible for Workers’ Compensation Benefits?  All FIU employees are covered under the State of Florida Workers' Compensation Program from their first day on the job.  Coverage is available for full-time, part-time, and temporary employees, whether they are Faculty, Administrative & Professional (A & P), University Support Personnel System (USPS), Temporary Employees, Graduate Assistants, Student Assistants or College Work Study. (Conditions apply for temporary employees)  Registered volunteer workers are also covered.  Coverage is not available for independent contractors or vendors who provide services to state agencies.

5 What To Do When Injured on the Job? Actions Required of the Injured Worker and/or Supervisor: 1.MEDICAL EMERGENCY GO! REPORT! FILE ! 2.NON-MEDICAL EMERGENCY REPORT! REQUEST! FILE! Supervisors MUST assure injuries are reported promptly.

6 MEDICAL EMERGENCY GO! REPORT! FILE! GO to the nearest emergency medical facility ON-CAMPUS emergency transportation CALL Public Safety at Closest Emergency Medical Facility: MODESTO MAIDIQUE CAMPUS Kendall Regional Medical Center Bird Road (305) BISCAYNE BAY CAMPUS Mount Sinai Aventura Emergency Room, Physician Offices, and Diagnosis Center 2845 Aventura Boulevard (305) OFF-CAMPUS emergency transportation CALL 911 BE SURE TO INFORM THE EMERGENCY MEDICAL FACILITY AND RESPONDING PERSONNEL THAT THE INJURY IS WORK-RELATED

7 REPORT! (by injured employee or supervisor) To OptaComp at (877) OptaComp Providers are available 24 hours a day 7 days a week To FIU Worker’s Compensation Program Coordinator at (305) FILE Workers Compensation claim report Online at HR Workers CompHR Workers Comp By phone to FIU Worker’s Compensation Program Coordinator at (305) Participate in Accident/Injury Investigation, as required MEDICAL EMERGENCY (2) GO! REPORT! FILE!

8 NON-MEDICAL EMERGENCY REPORT! REQUEST! FILE! REPORT! (by injured employee or supervisor) To supervisor To FIU Workers’ Compensation Program Coordinator at (305) FILE! Workers Compensation claim report –Online at HR Workers CompHR Workers Comp –By phone to FIU Workers’ Compensation Program Coordinator at (305) REQUEST! Medical appointment, if required. Note: FIU Workers’ Compensation Insurance Program Coordinator will coordinate the initial treatment with an approved Managed Care Network Provider. Medical treatment from an unauthorized Managed Care Network Provider may jeopardize your eligibility for Workers' Compensation benefits.

9 BENEFITS: MEDICAL TREATMENT Injured employees will be referred to an approved participating network healthcare provider. Failure to properly report or schedule non-emergency injuries will jeopardize your workers' compensation benefits. If you have questions regarding medical treatment, benefits or a Managed Care Network Provider, please contact the Workers' Compensation Program Coordinator for further information at or at The Procedure: 1)Injured worker or injured worker’s supervisor completes the on-line Workers’ Compensation Injury Report. HR Workers CompHR Workers Comp 2)Workers’ Compensation gathers information and reports the claim to the Medical Provider – OptaComp. 3)OptaComp Case Manager contacts injured worker and coordinates treatment between injured worker, Workers’ Compensation Coordinator and provider. 4)State of Florida – Division of Workers’ Compensation sets up claim 5)Workers’ Compensation Coordinator notify FIU Payroll Department, Benefits Department and Employee Relations of any lost time due to the work related injury. 6)Office of Employee Assistance also available to provide assistant, if needed.

10 BENEFITS: LOST TIME & WAGES Injured FIU employees may be eligible for workers’ compensation wage benefits while away from work (for more than 7 days) as a result of a work-related injury. Eligibility begins on the eighth day (8) of partial or total disability: IF: a) Documentation from an approved Managed Care Network Physician or medical facility is submitted to the Workers’ Compensation Coordinator, WHICH substantiates the employee's inability to return to work as a result of the injury. OR b) The employee is certified to return to work on full or modified duty with restrictions, but the supervisor and/or department is unable to provide reasonable accommodation. SUPERVISORS ARE STRONGLY ENCOURAGED TO IDENTIFY APPROPRIATE MODIFIED DUTIES FOR EMPLOYEES WHO HAVE BEEN RELEASED TO WORK WITH RESTRICTIONS.

11 BENEFITS: LOST TIME & WAGES (2)  The first 40 hours of missed work will be paid under Administrative Disability Leave. This includes intermittent visits to an authorized Managed Care Network Physician.  After the first 40 hours, two-thirds of the injured employee’s wages are paid by the Workers' Compensation Program, while the remaining one-third may be paid by applying available accrued personal leave (sick, annual and compensatory). This allows the injured employee to receive their standard paycheck by making up the differences between Workers' Compensation wage benefit and his/her normal bi- weekly wage.  Temporary employees DO NOT receive disability leave or payments, unless they have been medically disabled for a minimum of 21 consecutive days. After this time, Temporary employees will be eligible to receive retroactive pay for the first 7 days after the incident occurred.  The injured worker is responsible for keeping the supervisor and the Worker's Compensation Coordinator informed regarding their work status, follow-up appointments, and physical therapy.  Supervisors are responsible for maintaining communication with the injured worker while he/she is unable to work, and facilitating return to work.

12 BENEFITS: PHARMACY  The cost of medically necessary prescriptions for treatment and or recovery from work-related injuries is covered under the Workers' Compensation Program. A Cypress Card will be provided on your first doctor’s visit.  Any pharmacy within the State of Florida may be used to fill a prescription.  In most cases, pharmacies will charge OptaComp directly with no charge to the injured employee. However, some pharmacies may require the injured employee to pay for medications out-of-pocket. To obtain reimbursement for these charges you must make a copy for your records and submit the original receipt to: Florida Department of Financial Services Division of Risk Management Bureau of State Employees WC Claims P.O. Box 8020 Tallahassee, FL

13 Assistance Directory WORKERS COMPENSATION PROGRAM COORDINATOR (Serves All Campus Locations) Division of Human Resources Modesto Maidique Campus, PC 224 Phone : (305) Fax: (305) DIVISION OF RISK MANAGEMENT Bureau of State Employee's WC Claims P.O. Box 8020 Tallahassee, FL OptaComp P.O. Box Jacksonville, Florida