Worker's Compensation is a benefit program that pays for medical treatment and wages lost due to work-related injuries or illnesses as defined in the Wisconsin Statutes. At the time of the injury you must be an employee of UW-Parkside (employee-employer relationship). To be eligible for benefits, your injury or occupational illness must have occurred while performing services for your employer.
INJURY OR ILLNESS AT WORK
WHAT IF YOU ARE INJURED WHILE AT WORK?
Your safety is important to us. If you are injured while at work, the three most important things to do as soon as possible are to:
- Report your injury to your supervisor (employer) as soon as possible and provide the date, time, location and brief description of how the injury/illness occurred. Outside normal business hours, report the accident, injury or illness immediately to University Police (595-2455 or emergency # 595-2911).
- Get the medical attention you need; and
- Complete the Employee's Work Injury and Illness Report and provide to your supervisor within 24 hours (if possible).
Employee to complete:
Complete the e-Worker's Comp Claim
- Complete the Employee Authorization to Use or Disclose Health Information Authorization form and provide to Human Resources
- Tell your medical care provider your injury is work-related.
- Give certain paperwork that you may receive from your medical professionals to Human Resources, including medical releases, medical proof that injury is work related and certificate of work restrictions.
- Maintain frequent contact with your supervisor throughout your claim. Notify your supervisor of any injury status changes such as scheduled surgery, expected date of return to work, work restrictions, and release to return to work. If your absence will be 3 days or less, you must call your supervisor daily. .For absences greater than 3 days, provide a written doctor's excuse to your supervisor as soon as possible and call in daily until the doctor's excuse is provided.
- Maintain frequent contact with Human Resources throughout your claim as well. Provide HR with doctor's excuse for all time absent from work (i.e., Work Release) related to your injury.
- Complete Family and Medical Leave paperwork if you will be absent from work for three days or more. Any leave of absence (whether paid or unpaid) associated with this work-related injury/illness will run concurrently with any Federal, State and/or University Family Medical Leave absence.
- Complete Absence Requests for all time lost due to your work-related injury/illness. You may elect whether to use paid or unpaid leave, but must complete Absence Requests for all days/hours missed due to your injury/illness. Unpaid leave can be requested with leave take of Leave Without Pay. Paid leave can be requested using any of the leave types for which you are eligible (i.e., sick, vacation, personal holiday, etc.). Please add "WC" in the comment section of your Absence Request to notify your supervisor and HR that the absence is related to Worker's Compensation. NOTE: If you elect unpaid leave for your Worker's Compensation lost time, please contact Human Resources to determine how you will pay premiums for your benefit plans.
worker's compensation benefits
- Submit all medical bills related to this injury to Human Resources for payment processing.
- Provide your medical provider(s) with our address, Human Resources, University of Wisconsin–Parkside, 900 Wood Road, Kenosha, WI 53144 and indicate that all bills should be forwarded to this address.
- Provide your medical provider with our contact information for any questions they may have relative to billing: firstname.lastname@example.org
- Respond to Worker's Compensation Claim Examiner's information requests.
- Submit the Mileage Reimbursement form to Human Resources for mileage for travel to obtain reasonable medical treatment.
return to work
- Participate in any alternate duty assignment as directed by your supervisor.
- Notify your supervisor at least one full working day before you plan to return to work with or without work restrictions
- Provide your supervisor and Human Resources with a work release/fitness for duty statement from your physician before returning to work if you have been absent in excess of three days and/or whenever restrictions have been imposed.
WHAT TO DO IF YOUR EMPLOYEE IS INJURED WHILE AT WORK
- Encourage the injured employee to seek medical help if necessary;
- Initiate investigation of incident,contacting the Safety & Risk Management Officer, 262-595-2262, for assistance with investigation;
- Complete and submit to Human Resources at email@example.com within 24 hours of the date of the accident and no later than 3 days from date of injury: Employee's Work Injury and Illness Report (from employee), Authorization to Use or Disclose Health Information (from employee), Supervisor's Accident Analysis and Evaluation of Repetitive Motion and/or Material Handling Activities (from Supervisor); and Supervisor's Questions (form Supervisor) forms.
If the work-related accident results in death, please contact Human Resources immediately as the accident must be reported to the Department of Workforce Development within 24 hours. Failure to meet this deadline will result in significant fines.
If the injured employee misses any work time, the injury/incident must be reported to Human Resources within 24 hours of the injury/incident. If no time from work is missed, the forms must be received in Human Resources within 3 days of the incident.
- Forward any paperwork that you receive related to the claim to Human Resources, including medical releases, medical proof that injury is work related and certificate of work restrictions.
- Review the employee's time and absence record to ensure that all time lost due to worker's compensation is reflected in paid or unpaid leave (absence requests) and that this is noted in the comment section of the request as "WC." Approve absences once you confirm that the employee has recorded all lost time for the pay period.
- Verify that a Work Release returning the employee to work at full or partial duty has been received before allowing an employee to return to work or upgrade their duty status.
- Arrange for alternate light or medium duty work assignments for the injured worker per the Work Release and advise Human Resources.
- Maintain contact with the injured employee and Human Resources throughout the course of the claim.
- Maintain confidentiality of all information related to the claim.
DOCUMENTS TO COMPLETE
Employee to complete:
- Worker's Compensation: Employee's Work Injury & Illness e-Form
- Worker's Compensation: Authorization to Use or Disclose Health Information (DOC)
- Worker's Compensation: Mileage Reimbursement (PDF)
Supervisor to complete: