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-1 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 of their choice. 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 district's workers' compensation carrier.

Contacting the Department

Employees may contact the Texas Department of Insurance - Workers' Comp by calling 800-252-7031. The department provides assistance concerning the claim free of charge.

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 worker's 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 Texas Department of Insurance 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 insurance carrier 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.

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

As the employer, subsequent reports may be required by department rules, form DWC-1 (PDF - requires free Adobe Reader software) - Employer's First Report of Injury Form. This report is faxed to the insurance carrier 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. A copy is mailed to the employee's home address.

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

As the employer, the District Human Resources Office is required to file a wage statement, form DWC-3 (PDF - requires free Adobe Reader software), 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 limited full-time and part-time employees (includes student assistants).

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 and Wage Statement are generated. Medical claims and/or receipts can be mailed to the District Human Resources Office for forwarding to the insurance carrier.

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 claims. 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.

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.