Workers' Compensation Insurance and Temporary Modified Duty

I. POLICY AND GENERAL STATEMENT

The University of Texas Health Science Center at Houston ("University") participates in a program of self-insurance that provides workers’ compensation benefits for employees who suffer compensable injury or occupational disease while performing duties within the course and scope of their employment.  Any questions concerning Workers' Compensation Insurance coverage should be directed to Risk Management and Insurance ("RMI").

II. DEFINITIONS

Bona Fide Offer of Employment: A written offer of employment for temporary modified duty delivered to the employee during the period for which workers’ compensation benefits are payable shall be presumed to be a bona fide offer, if the offer clearly states the position offered, the duties of the position, a statement that the employer is aware of and will abide by the physical limitations under which the treating health care provider has authorized the employee to return to work, the maximum physical requirements of the job, the wage, and the location of employment.

Compensable Injury: An injury arising out of, and in the course and scope of, employment for which compensation is payable according to law.

Occupational Disease: A disease arising out of the performance of, and in the course of, employment that causes damage or harm to the physical structure of the body including other diseases or infections naturally resulting from the work-related disease.  An ordinary disease of life to which the general public is exposed is not considered an occupational disease unless it is the result of an incident related to a compensable injury or occupational disease.

III. PROCEDURE

A. Reporting Accidents, Injuries and Occupational Diseases

All on-the-job injuries, accidents and occupational diseases, regardless of the severity, must be reported by the employee to his or her supervisor immediately after occurrence.  The supervisor will complete the Supervisor's First Report of Injury (“First Report of Injury”) and the Workers’ Compensation Network Acknowledgment Form as soon as the injury is reported and will send it immediately to RMI.  An employee and his or her supervisor must report the injury to RMI using the First Report of Injury form as soon as possible but no later than 7 calendar days from the date on which the injury occurs or, if the injury is an occupational disease, no later than 7 calendar days from when the employee knows or should have known that the occupational disease may have been related to employment.  If an employee fails to report an injury and is unable to work the following day, that person will be required to obtain a Work Status Report (DWC73) from a health care provider or be considered absent without permission.  Additional information about reporting deadlines and requirements related to lost time, return to work and resignations or terminations is contained on the RMI website.

B. Seeking Medical Attention

Supervisors should direct injured employees to the list of providers on the IMO Health Care Network website.  Contacts with health care facilities for individuals who require medical attention and who are employed in the Texas Medical Center area are to be recommended as follows:

• refer all minor injuries to UT Health Services;
• refer major eye injuries to Cizik Eye Clinic; and
• refer all other major injuries to the Memorial Hermann Hospital - Texas Medical Center Emergency Department.

The employee has the right to refuse medical treatment.  The employee’s refusal should be noted on the First Report of Injury form.  If the health care provider is not a member of UT System’s IMO Health Care Network (as explained on the Network Acknowledgement Form accompanying the First Report of Injury), the employee may be responsible for the medical costs associated with the claim.  A list of providers in the IMO Health Care Network can be found on the network’s website.  Emergency treatment is an exception.

The supervisor may accompany any employee who requires medical attention to the appropriate medical facility.  An employee who is unable to return to work on the date of injury will be paid in full for the normally scheduled hours for that day.

C. Record-keeping and Leaves

When the injured individual is unable to work for time other than that required for initial medical treatment, a Workers' Compensation Insurance Employee's Leave Election form must be completed and signed by the injured individual and the supervisor.  This form must be submitted regardless of whether an employee elects to use paid leave to remain on the payroll during the period of absence. Such election should be noted on the form.

Lost time due to work-related injuries or occupational disease may qualify for coverage under the Family and Medical Leave Act, provided the employee meets the eligibility requirements. (HOOP 106, Family and Medical Leave). Employees may also qualify for a reasonable accommodation under HOOP 101, Disability Accommodation. 

If an employee elects to use paid leave, the employee must first exhaust sick leave. Once sick leave has been exhausted, he or she may choose to use other paid leave in lieu of receiving temporary income benefits (“TIBs”). Prior to making an election concerning the use of other paid leave, the employee will be advised that, although there is a seven-day waiting period where TIBs are not payable, should disability extend to the fourteenth day after the first day of disability, the carrier will then issue a TIBs payment for the waiting period. TIBs are not payable as long as paid leave is being used. When the designated portion of sick and other paid leave is exhausted, the employee will be placed on a leave of absence without pay until the earlier of:

• release by a health care provider that the employee is able to return to full or modified duty, or
• six months from date of injury at which time the employee may be separated from the University.  The employee may also apply for other open positions at the University or request a reasonable accommodation from the Office of University Relations and Equal Opportunity.

Any weekly benefits paid are in accordance with the Texas Workers' Compensation Act.  Additional guidelines apply to peace officers with compensable injuries. See UTS 185.

D. Return to Work

An employee placed on leave of absence for a compensable injury will be returned to work when a Work Status Report (DWC 73), which releases an employee to return to full-time or modified duty employment, is submitted to RMI or the supervisor.  This form must be submitted on the day of the health care visit or the following business day. 

An employee who is unable to return to work at the specified time must return to the health care provider for approval to remain off work; otherwise the person's absence will be considered unauthorized. Continued unauthorized absence may result in termination.

An employee who requires time off for medical treatment related to the injury may be required to provide his or her supervisor with a Work Status Report (DWC 73) to return to work for each incidence of time off.

E. Temporary Modified Duty

For employees who have sustained a compensable injury or occupational disease while performing duties within the course and scope of their employment, the University will, to the extent feasible, assist employees in these circumstances by temporarily modifying work assignments or duties, or arranging for a temporary transfer until the employee is able to resume regular duties. The assignment or duty modification or the temporary transfer may not exceed 180 days (excluding vacation, sick time and holidays). 

     1. Evaluation by a Health Care Provider

The attending health care provider must determine the temporary restrictions to be applied to the employee’s work duties and complete the required form DWC 73.  This information will be forwarded to the RMI or the case manager, who may contact the employee's attending health care provider to discuss modified duty and/or to provide information regarding the University's return-to-work procedures.

     2. Evaluation by the University

Upon receipt of the DWC 73, RMI or the case manager may forward to UT Health Services this documentation and a copy of the employee's job description provided by the employee's supervisor. UT Health Services may use this information to perform an evaluation for the purpose of clarifying the temporary work restrictions and/or temporary job accommodations. The results of the evaluation will be sent to RMI, the employee's supervisor, and the employee.

After the work evaluation, UT Health Services, the employee's supervisor, the case manager and/or RMI may meet to discuss the employee's work limitations (as assessed by the employee's attending health care provider and UT Health Services) and the feasibility of the employee temporarily returning to work in a modified capacity.

     3. Bona Fide Offer of Employment

If the supervisor/department can reasonably accommodate the employee with a temporary modified duty position, the employee and the employee's supervisor must agree in writing to the requirements of the temporary modified duty assignment as developed in accordance with the DWC 73. RMI or the case manager will assist in facilitating this agreement. The employee will be offered a Bona Fide Offer of Employment, providing the employee the opportunity to return to work in a temporary modified position, not to exceed 180 days. A copy of the signed agreement will be provided to RMI.

If the employee’s home department is unable to accommodate the employee’s need for modified duty, RMI or the case manager will determine if another position is available within the University.  If a position is available, the employee will be returned at 100% of his or her regular pay with full benefits. The employee’s home department will be responsible for paying the employee’s regular wages during the reassignment. Upon release to return to work in the employee’s original position, the employee will return to his or her regular position and/or duties in the home department.  For temporary or permanent accommodations beyond 180 days, see HOOP 101, Disability Accommodation, or contact University Relations and Equal Opportunity.

If the employee is not released by his or her attending health care provider to return to regular duties at the end of 180 days or if, during the 180 day period, the employee's health care provider determines it is no longer practical or feasible to continue the temporary modified duty assignment, the employee will be informed of his or her options and may be separated from the University. .

If an employee is released by his or her attending health care provider to temporary modified duties, the employee will perform his or her temporary modified position in accordance with the Bona Fide Offer of Employment. If the employee refuses or does not acknowledge a Bona Fide Offer of Employment for temporary modified duties presented in person or sent via certified or regular mail, the insurance carrier, after five working days from mailing or presentation of the Bona Fide Offer of Employment, may reduce the indemnity benefits of the employee, and the employee may be subject to termination.

While an employee is on a modified duty assignment, medical re-evaluation by the employee's health care provider must be performed monthly at the expense of the Workers' Compensation Insurance program, as provided by that program.

     4. Pregnancy-Related Conditions

Employees with a pregnancy-related condition may also be eligible for temporary modified duty (see HOOP 101, Disability Accommodation).  Employees seeking temporary modified duty due to a pregnancy-related condition should follow the procedures outlined in HOOP 101.   A formal Bona Fide Offer of Employment is not required in such cases.

F. Death Benefits

If the death of an employee results from a compensable injury or occupational disease, death and survivor benefits are payable to the legal beneficiaries in accordance with the Texas Workers' Compensation Act.

IV. CONTACTS

• • Risk Management and Insurance
  • 713-500-8100
  • https://www.uth.edu/safety/risk-management-and-insurance/

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