1. Workers’ Compensation Program What You Need to Know… Florida Statute, Chapter 440.105: "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. 817.234."817.234.

2. Content Overview 2 Purpose Eligibility When an Injury Occurs Medical Emergency Non-Medical Emergency Benefits: Medical Treatment Lost Time Wages Pharmacy/Prescriptions Return-To-Work Program Assistance Directory

3. What Is the Purpose of The FIU Workers’ Compensation Program? 3  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 of medical bills, mileage, lost wages and vocational rehabilitation.  The State of Florida, Division of Risk Management determines eligibility for coverage based on the circumstances reported. Eligibility is not determined by Florida International University.

4. Am I Eligible for Workers’ Compensation benefits? 4  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), 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? 5 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. FILE REPORT 6

7. MEDICAL EMERGENCY REPORT! FILE! GO! GO to the nearest emergency medical facility Closest Emergency Medical Facility: OFF-CAMPUS emergency transportation CALL 911 BE SURE TO INFORM THE EMERGENCY MEDICAL FACILITY AND RESPONDING PERSONNEL THAT THE INJURY IS WORK-RELATED Biscayne Bay Campus Parkway Regional Medical Center 160 NW 170th Street (305) 651-1100 Modesto M. Maidique Campus Kendall Regional Medical Center 11750 Bird Road (305) 223-3000

8. MEDICAL EMERGENCY (2) GO! REPORT! FILE! REPORT! (by injured employee or supervisor) To AmeriSys at (800) 455-2079, available 24 hours a day 7 days a week To FIU Worker’s Compensation Coordinator at (305) 348-7960 FILE Workers’ Compensation claim report Online at http://hr.fiu.edu/Injuryhttp://hr.fiu.edu/Injury By phone to FIU Worker’s Compensation Coordinator at (305) 348-7960 Participate in Accident/Injury Investigation, as required

9. NON-MEDICAL EMERGENCY REPORT! REQUEST! FILE! 9 REPORT! To (or by) Supervisor To FIU Workers’ Compensation Coordinator at (305) 348-7960 REQUEST! Medical appointment, if required. During Business Hours: FIU Workers’ Compensation 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. Non-Business Hours: Call AmeriSys at (800) 455-2079 FILE! Workers’ Compensation claim report Online at http://hr.fiu.edu/Injuryhttp://hr.fiu.edu/Injury By phone to FIU Workers’ Compensation Coordinator at (305) 348-7960

10. BENEFITS: MEDICAL TREATMENT 10 What to expect?  Injured employees will be referred to an approved participating network healthcare provider. Failure to properly report or schedule non-emergency injuries will jeopardize all 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 305-348-7960 or email at cruzma@fiu.edu.cruzma@fiu.edu

11. BENEFITS: MEDICAL TREATMENT 11 The Procedure: 1.Injured worker or injured worker’s supervisor completes the online Workers’ Comp Injury/Accident Report. 2.Workers’ Comp Coordinator files claim to the Managed Care Network AmeriSys. 3.AmeriSys’ Case Manager and Workers’ Compensation Coordinator coordinates the first medical appointment for the injured worker. 4.Employee contacts Workers’ Compensation Coordinator after each medical appointment to provide a copy of the medical report and/or work status. 5.Workers’ Compensation Coordinator provides a copy of the medical report to case manager and adjuster to authorize further medical treatment as prescribed by the authorized physician. 6.Workers’ Compensation Coordinator emails the WC Notification Letter to supervisor, Payroll and Benefits Department. 7.Office of Employee Assistance is also available to provide assistance, if needed.

12. BENEFITS: LOST TIME & WAGES 12 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: 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 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.

13. BENEFITS: LOST TIME & WAGES 13  The first forty (40) hours of missed work will be paid under Administrative Disability Leave/WC, code WCH, in Panthersoft. This includes intermittent visits to an authorized Managed Care Network Physician.  After the first forty (40) hours, two-thirds of the injured employee’s wages are paid by the State’s 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 injured worker normal bi-weekly wage.  Workers’ Compensation Coordinator completes injured worker time in Panthersoft after injured worker has exhausted the first forty (40) hours of administrative leave.

14. BENEFITS: LOST TIME & WAGES 14  Temporary Employees DO NOT receive disability leave or payments, unless they have been medically disabled for a minimum of twenty-one (21) consecutive days. After this time, temporary employees will be eligible to receive retroactive pay for the first seven (7) days after the incident occurred.  The injured worker is responsible to provide the Workers’ Compensation Coordinator a copy of the medical report, DWC-25 (Florida Workers’ Compensation Uniform Medical Treatment Status Reporting Form) provided by the physician’s office after each medical visit.  Workers’ Compensation Coordinator is responsible for maintaining communication with the injured worker and supervisor regarding the work status, follow-up appointments, and physical therapy.

15. BENEFITS: PHARMACY 15  The cost of medically necessary prescriptions for treatment and or recovery from work-related injuries is covered under the Workers' Compensation Program. The “Progressive Card” is a prescription card which will be provided to the injured worker on the first doctor’s appointment.  Any pharmacy within the State of Florida may be used to fill a prescription.  In most cases, pharmacies will charge AmeriSys 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 32399-0314

16. RETURN-TO-WORK PROGRAM  STATEMENT OF POLICY: The Return-To-Work Program is promoted in order to bring back to work injured employees who are able to perform on modified duty or alternate duty within the limitations established by the authorized treating physician, and will bring the employee back to work as quickly as medically possible.  PURPOSE AND SCOPE: To establish procedures to facilitate the re-integration of eligible injured employees into the workplace by providing accommodation within the limitation as determined by the authorized treating physician.  DEFINITIONS: Medical documentation: The DWC-25, which is the Florida Workers’ Compensation Uniform Medical Treatment Status Reporting Form, is a written report from the authorized treating physician providing information on management/medical treatment, referrals, functional limitations and restrictions, maximum medical improvement/permanent impairment rating and follow up appointments. 16

17. RETURN-TO-WORK PROGRAM  DEFINITIONS: Continuation Functional Limitations and Restrictions: Identification of the employee’s ability or lack of ability to perform stated activities and the degree to which these activities may be performed. Functional limitations and restrictions are identified on the DWC-25 provided to the employee by the authorized treating physician after each doctor’s appointment. Alternate Duty: Temporary duties established away from employee’s regular work area/responsibilities and within the “functional limitations and restrictions” Modified Duty: Duties established within the employee’s regular position and within the functional limitations and restrictions as reflected on the DWC-25. 17

18. RETURN-TO-WORK PROGRAM DEFINITIONS: Continuation Workers’ Compensation Notification Letter: An acknowledgement between the employee, supervisor and Workers’ Compensation Assistant that provides the specific standard alternate/modified duty task with the limitations and restrictions established on the DWC-25 form by the authorized treating physician. Maximum Medical Improvement (MMI): The medical condition at which the injured worker is no longer in the process of recovery and will not medically improve any further. In other words, an injured worker is medically as well as they are going to be. 18

19. ASSISTANT DIRECTORY FIU DIVISION OF HUMAN RESOURCES 11200 SW 8 th Street, PC 224 Miami, FL 33199 Phone : (305) 348-7960 Fax: (305) 348-6462 http://hr.fiu.edu DIVISION OF RISK MANAGEMENT Bureau of State Employee's WC Claims P.O. Box 8020 Tallahassee, FL 32399-0314 AmeriSys P. O. Box 160729 Altamonte Springs, Fl. 32716 1-800-455-2079 19