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Workers' Comp

HROG Section:
Work/Life Benefits
Document Title:
DCCCD Workers' Compensation Program
Initial Date Posted:
Jan. 1, 1991
Board Approval:
Applies To:
All DCCCD Employees
Source:
District Human Resources and the Texas Department of Insurance - Workers' Comp
Related TASB Policy:
DEC (local)
Last Date Revised:

May 4, 2006
February 16, 2011

Purpose

The Dallas County Community College District is self-insured for workers’ compensation coverage.  TRISTAR Risk Management is a third party administrator, (TPA) that handles all workers’ compensation claims for the district.  The Texas Department of Insurance, Division of Workers’ Compensation prohibits employers, by law, from suspending, terminating, or discrimination against any employee because he or she in good faith reports an alleged occupational health or safety violation.

Background

Workers' compensation is a state-regulated insurance program that pays medical bills and replaces some lost wages for employees who are injured at work or who have a work-related disease or illness.

Definitions

Eligibility

Procedures

Employee Reporting Procedures
 
An employee who is injured on the job or while at another location performing their job is covered by workers' compensation insurance. The employee must report the injury to the immediate supervisor and to location Human Resources within 30 days of the injury, or within 30 days of the date the worker first knew the illness might be work-related.

The injured worker completes a claim form, DWC Form 001, Employees First Report of Injury, with assistance of the Location Human Resources office.

Seeking Medical Care

The employee has the right to seek medical treatment for a job-related injury or illness from a licensed practitioner or physician of their choice who accepts workers' compensation.  The injured worker must disclose to the physician that the injury or illness is job-related.

If the injured worker becomes dissatisfied with the medical treatment or care provided by the physician, or the physician is unable to continue treating the worker, the worker cannot change doctors except with the authorization of the TPA.

Contacting the Division

Employees may contact the Division of Workers' Compensation who provides assistance concerning the claim free of charge.

1515 W. Mockingbird Lane, Suite 100
Dallas, Texas 75235-5078
(214) 350-9299
FAX (214) 350-3750

Medical Treatment and Lost Wages Compensation

The workers' compensation insurance will pay for the medical treatment or for an injury or illness that occurred at work or the disease or illness that is job related. It will replace workers lost wages if the injury or illness causes the worker to lose some compensation or all income for more than seven days.

The employee shall receive the maximum amount of weekly benefits established by the Commission based on an employee's base salary, usually 70 percent or the maximum amount, whichever is less.

If the employee does not have any lost time, or returns to work before the seven-day period has expired, the TPA does not pay weekly benefits. Weekly benefits begin on the eighth day.

Insurance Carrier Responsibilities

The carrier shall promptly initiate the payment of income benefits as required by the Texas Department of Insurance and pay all medical claims related to the employee's injury or illness.

Employee Responsibility

HR Responsibility

Location Claim Filing Procedures
 
When an employee completes the claim form, the location Human Resources office is responsible for filing the claim with the TPA and District Human Resource and applying applicable benefits.

As the employer, subsequent reports may be required by department rules, DWC Form 001 - Employer's First Report of Injury Form. This report is faxed to the TPA no later than the eighth day after the receipt of notice of an employee's injury or from the first day of the employee's absence due to an injury or death. The original form is forwarded to the District Human Resources office and a copy is mailed to the employee's home address or given to them at work.

When the employee returns to work or at the end of sixty (60) days, the location must complete the Employer's Supplemental Report of Injury, DWC Form 006 and forward to District Human Resources. The employee is provided a copy of this form by mail to the home address or given to them at work.

DWC 6 should be faxed to TRISTAR the day the employee returns to work or a change in employment is made; retirement, termination, deceased.  If the DWC 6 needs a signature call TRISTAR and inform them the reason for the change in work status and a DWC 6 will be sent to them.  This way TRISTAR can stop the next TIBS check before it is printed which causes overpayment. 

Who is Responsible in Sending This to the Employee?

As the employer, the District Human Resources office is required to file a wage statement, DWC Form 003, with the carrier within 30 days of the date of receipt of notice of the injury, but only if the employee is disabled for at least eight days. The wages are calculated in relationship to 13 continuous weeks before the date of the injury as an average weekly wage for full-time employees or an hourly wage for part-time employees (includes Student Assistants.)

Third Party Administrator, TPA, Responsibilities

The TPA shall promptly initiate the payment of income benefits as required by the Commission and pays all medical claims related to the employee's injury or illness. The adjuster for the TPA is available to help employees with any questions or issues on their claim.

District Human Resources Responsibilities

The District Human Resources Office handles the workers' compensation claim upon receipt of the claim form. Employer's Supplemental Report of Injury DWC Form 006 and Wage Statement DWC Form 003 are generated. Medical claims and/or receipts can be mailed to TPA.

District Human Resources is responsible for ensuring the claim process and payments of benefits are made promptly and correctly. 

A separate file is kept for employees' workers' compensation claim. This information is never combined in the employee's personnel file. The employee has a right to privacy and information concerning the claim will only be presented on a need-to-know basis.

Exceptions To Policy

Other Notes

Americans With Disabilities Act (ADA) and Family Medical Leave Act (FMLA)

Under the Americans With Disabilities Act, an employee who has a job-related injury or illness and is a qualified individual with a disability (impairment does not have to be related to the worker injury or illness) is eligible for FMLA. If the employee requests FMLA, other paid leave benefits will not run concurrently since the leave is due to workers' compensation.

If the employee is unable to return to work after 12 weeks of FMLA, the location may extend leave to the employee as a reasonable accommodation. If the employee returns to work, the employee is reinstated to the original position, benefits and wages.

Continuation of Benefits

If the employee cannot return to work after the FMLA expires and the employee loses insurance coverage, the employee is eligible for continuation of benefits for leave without pay or COBRA for continuation of medical and dental insurance benefits.

If continuing benefits under leave without pay, the employee must pay all applicable premiums, including the State portion, for up to 12 months.

If the employee does not want to continue benefits, the location must offer the employee COBRA health and dental coverage. COBRA coverage premiums are paid out of pocket by the employee directly to Employees Retirement System of Texas (ERS). COBRA will be administered by ERS. The benefit maximum period is 18 months for the employee and 36 months for eligible dependents. The COBRA maximum period for the employee may be increased to 36 months if by application to Social Security, the employee is found to be unfit for any job duties.

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