Each University of Texas Institution has responsibilities to the injured employee, The University of Texas Workers' Compensation Insurance (WCI) Office, and the Texas Department of Insurance, Division of Workers' Compensation Insurance (TDI/DWC). WCI Representatives are responsible for ensuring timely compliance by the employing Institution.
Responsibilities to the Injured Employee Include:
- Notifying the injured employee that his or her injury may be covered under the workers' compensation program.
- Arranging for appropriate medical treatment in emergency situations. Keep in mind the injured employee has the right to select his or her own treating physician. It is inappropriate to force the employee to see a health care provider if the employee does not want medical attention. If medical treatment is required, it may be necessary to assure the provider the injured worker is covered by workers' compensation insurance. Please use the following statement in these instances:
- "I confirm The University of Texas System is self-insured for workers' compensation. Employees of The University of Texas System who are injured in the course and scope of employment are entitled to reasonable and necessary medical treatment which will be covered and paid for in compliance with Texas Department of Insurance, Division of Workers' Compensation regulations. Please direct further inquiries regarding this claim to CCMSI."
- It is not appropriate to "guarantee" payment for services. Other than verifying coverage for initial medical treatment, all calls from health care providers should be referred to the IMO.
- Accommodating the injured employee in appropriate situations by modifying work schedules, equipment, and/or duties to enable the employee to enjoy equal employment opportunities.
Responsibilities of the UT System WCI Office and TDI/DWC:
- Gathering all pertinent information regarding the job-related injury to be reported to CCMSI. This will include witness statements if circumstances warrant.
- Maintaining a detailed record of the job-related injury, even if the employee did not lose time from work as a result of the injury. This record must be maintained for at least five years after the date of injury. Employers who fail to maintain such records may be assessed an administrative penalty not to exceed $500 per record.
- If required, the First Report of Injury form (DWC-1) must be submitted to CCMSI electronically (utilizing iCE) within 24 hours, if possible. Timely reporting of injuries to CCMSI is critical. Employers who fail to file the report timely without good cause may be assessed an administrative penalty not to exceed $500. A $25,000 fine may be assessed for repeat violations.
- If the employee is injured while traveling or working outside of the United States, please follow instructions for completing international claims.
- In the event of critical injury or death, immediate telephone notification should be given to CCMSI followed by the electronic submission of the First Report of Injury form.
If Employee loses time:
- Submit a Supplemental Report of Injury form (DWC-6) to CCMSI and the injured employee as follows:
- Within three days after --
- the injured employee returns to work; or
- the injured employee, after returning to work, experiences an additional day(s) of disability as a result of the injury.
- Within 10 days after --
- the end of each pay period in which the employee has a change in earnings as a result of the injury; or
- the employee resigns or is terminated.
- Please complete the DWC-6 form carefully. Once the form is completed, it may be submitted electronically to CCMSI utilizing "iCE". Do not send this form to Texas Department of Insurance, Division of Workers' Compensation.
- Within three days after --
- Submit the "Employer's Wage Statement" (DWC-3) to CCMSI and the injured worker if the injured employee misses one day of work due to the injury. An employer (UT System Institution) shall file a signed wage statement with The University of Texas System Workers' Compensation's third party administrator (CCMSI) within seven days for any claim with one day of lost time or more to ensure accurate wage reporting and timely and accurate payment of benefits.
- The DWC-3 form will be electronically filed with CCMSI utilizing iCE.
- If the injured employee was not employed by the institution listed in item #5 for the 13-week period immediately preceding the injury, then a "similar employee" who performs similar service should be identified. Identify that the wages reported are from a same or similar employee in the appropriate block on the form. "Similar employee" means an employee with training, experience, and skills that are comparable to the injured employee. Age, gender, and race are not to be considered. A "similar employee" does not necessarily earn the same wages as the injured employee.
- Under the Pecuniary Wage Information section of the form, include the gross amount of all money paid as wages or salary. Also, include money paid to the employee even if the employee was not on the job, such as sick leave, vacation, holidays, if actually paid during the 13-week period reported on the wage statement. Do not include money counted in item #12, "Fringe Benefits."
- Under the Non Pecuniary Wage Information Section of the form, check each item to indicate whether or not this was regularly included in the employee's pay. Include any payment or gain that is not on the list in the other box. (Longevity pay should not be included here. It should be included in item #11). Give the actual amount if known. Estimate amount if the actual amount is not known.
- NOTE: Accrued vacation and sick leave is not reported. Only vacation and sick leave that has actually been paid during the 13-week period preceding the date of injury should be reported on this form.
- Employers who fail to file the report within 30 days without good cause may be assessed an administrative penalty not to exceed $500.
- Submitting a Request for Paid Leave Form (Form-23) if the employee chooses to utilize any accrued sick leave or vacation leave for the time lost due to the injury.[Note: The employee has the right to elect not to utilize accrued paid leave for this lost time.] Once the employee understands the difference between electing to use Paid Leave and electing to use TIBs and once the number of hours of accrued leave is known, the Form-23 should be completed and the employee's signature obtained. As soon as the form has been completed and signed, the original should be forwarded to CCMSI or the form may be filed electronically utilizing iCE.