Overview
Workers' Compensation is "insurance" paid in full by
UCF that provides coverage to an employee for a job-related injury
or illness from the very first day of employment. Employees, who
are injured or become ill due to the conditions of their job,
receive partial income replacement and/or payment of expenses
for medically necessary services under Workers' Compensation.
Job-related illnesses or injuries are not covered under the State
Self-Insured Plan or any of the health maintenance organizations
in the State Health Insurance Program. Claims for job-related
conditions should not be filed under any of these plans. Employees
sustaining a job related injury or illness must follow current
procedures. The following information is provided for all employees
including OPS and student assistants.
Responsibilities of the Supervisor
Injured employees must notify their supervisor within 24 hours to
complete a First
Report of Injury Form; the supervisor must then fax the First
Report of Injury Form to the Leave of Absence and Workers’
Compensation section of Human Resources at 407-384-2866, within
the next 24 hours. Injured employees must complete a First Report
of Injury Form regardless of whether they seek medical treatment.
If the injury requires medical attention, the supervisor should
complete a Centra
Care Authorization Form or a Student
Health Center Authorization Form (for student assistants and
graduate assistants only) and give the form to the employee. The
supervisor should then direct the injured employee to a Corvel Corporation
approved primary care provider listed in Corvel’s
directory. In a medical emergency, the supervisor should arrange
for transport of the injured employee to the nearest medical facility
or call 911 for emergency assistance.
Responsibilities of the Injured Worker
Injured employees must notify their supervisor within 24 hours to
complete a Report of Injury. Injured employees must complete a Report
of Injury regardless of whether they seek medical treatment. If
medical attention is necessary, an employee should obtain an "authorization"
form. Florida Hospitals new Centra Care Walk-In facility in
the Waterford Lakes area is the facility being utilized for all
main campus employees. In a medical emergency (see definition below),
an injured employee may be transported to the nearest medical facility
for stabilization, or call 911 for emergency assistance. Corvel
will also provide case management to injured employees. The Medical
Case Manager will assist injured employees and their primary care
physician in scheduling all of the health care needs relating to
the work related injury. Their expertise will allow them to assist
with any problems or questions employees may encounter during treatment.
Employees in doubt about where to go for treatment should call a
medical case manager at 1-866-786-3351.
Selecting a Primary Care Physician
At the time of injury/illness, employees are entitled to select
a network Primary Care Physician of their choice. The Medical Case
Manager can assist in this process by:
- Assuring injured employees can get an immediate appointment.
- Assisting injured employees in selection of a convenient geographic
location.
Changing Primary Care Physicians
If at any time an employee is dissatisfied with a Primary Care Physician,
the employee may initiate a change by calling the Medical Case Manager
at (866) 786-3351. Once a request is made, the Medical Case Manager
will assist the employee in selecting a new Primary Care Physician
within the Network.
Second opinions
An injured employee or the Division of Risk Management may request
a second opinion at any time regarding medical care or treatment
plan. Employees desiring a second opinion must contact the Medical
Case Manager at (866) 786-3351. The Medical Case Manager will arrange
and notify the employee of the appointment.
Independent Medical Examination (IME)
Should an employee or the Division of Risk Management wish an Independent
Medical Exam be performed due to a dispute concerning medical benefits,
or disability, the Medical Case Manager must be contacted immediately
(either verbally or in writing). The Medical Case Manager will coordinate
the Independent Medical Exam.
Emergency care outside the service area
In case of an emergency outside the service area, injured employees
should obtain the necessary medical care at the nearest facility
or call 911. However, the injured employee or the provider must
notify the Corvel Medical Case Manager as soon as possible of the
out-of-area emergency. The Medical Case Manager will coordinate
and authorize the emergency care treatment. If the injured employee
is hospitalized, the employee should request that the hospital contact
Corvel within 24 hours of admission or as soon as reasonably possible
to verify authorization.
Use of Pharmacies
Injured employees may use any Pharmacies, except Eckerd or CVS,
when filling prescriptions for work related injuries. There will
be no cost to the employee at these pharmacies. However, should
the employee elect to go to a non-contracted pharmacy, (outside
of the Network), the non-network pharmacy or the employee will receive
reimbursement. Receipts and/or bills should be mailed to the Corvel
claims office for reimbursement:
Corvel Corporation
Attn: Bill Review/Claims Department
3560 Cardinal Point Drive Bldg 100 Ste 101
Jacksonville, FL 32257
Worker' Compensation: Definitions
Urgent care out of the service area
The term "urgent" shall mean the circumstances resulting
in an employee receiving authorized medically necessary hospital
and medical services required in order to prevent deterioration
of an employee's health when the employee is temporarily absent
from the service area and the receipt of the necessary hospital
or medical services should not be delayed until the employee can
receive the services from a Participating Provider.
The Primary Care Physician (Medical Care Coordinator)
The term "Primary Care Physician" shall mean a participating
physician whose practice is limited to general practice, family
practice or internal medicine, who is designated as a Primary Care
Physician by Corvel, and who is responsible for providing initial
and primary care to employees, functioning as a "gatekeeper",
and maintaining the continuity of care received by employees. Such
term shall include Chiropractic "physicians licensed in accordance
with Chapter 460, Florida Statutes, as may be required by the Workers'
Compensation Law.
The Specialist Care Physician
The Primary Care Physician and Medical Case Manager will coordinate
all medically necessary referrals for specialty care. If the specialist
requires additional visits and/or testing they will need to speak
to the Primary Care Physician or your Medical Case Manager to obtain
required authorization for referrals.
Participating Provider
The term Participating Provider shall mean physicians, hospitals,
pharmacies, and other health care professionals or, facilities that
have contractually agreed to provide covered services to employees
in accordance with the managed care plan.
Medical Case Managers
Medical Case Managers are trained registered nurses employed by
Corvel to assist employees and Primary Care Physicians in scheduling
all of the health care needs relating to work related injury. Their
expertise will allow them to assist employees with any problems
or questions encountered during treatment. Employees will be assigned
a Medical Case Manager at the time of injury.
Emergency
"Emergency" means medical services provided after the
sudden or unexpected onset of a medical condition manifesting itself
by acute symptoms, including injury caused by an accident, which
are severe enough that the lack of immediate medical attention would
result in any of the following:
- The patient's life or health would be placed in serious jeopardy.
- Vital bodily functions would be seriously impaired.
- There would be serious and permanent dysfunction of a bodily
organ or part.
- Circumstances resulting in an employee hospital and medical
services that are furnished by an appropriate source other than
a Participating Provider because the employee was unable, due
to shock or unconsciousness, to specify a choice of providers.
Workers Compensation Grievance Procedure
Grievance Reconsideration Rights:
There are situations when injured employees have questions about
their coverage, or are dissatisfied with Corvel services. Such inquiries
and complaints will be handled in a timely manner. The person responsible
for the maintenance of records and for the supervision of the complaint/grievance
process is the Grievance Manager. A specific set of records will
be maintained to document grievances filed. Records will include
reason for grievance, date filed, consequent actions, and final
disposition. The Grievance Manager will centrally maintain them.
Step 1:
Corvel encourages employees to resolve individual inquiries and
problems without the initiation of a formal grievance. Any injured
employee covered by Corvel's managed care arrangement who has an
inquiry or complaint regarding a matter arising from the workers'
compensation managed care arrangement should contact their local
service area for verbal resolution. In Florida, call (407) 805-0060
or (800) 229-4637. The Grievance Manager will respond to the employee's
inquiry/complaint within three working days of the submission.
Step 2:
In the event an employee's complaint has not been settled at the
informal level and the employee is still dissatisfied, s/he will
be advised to file a formal grievance. Grievances must be submitted
within one year of occurrence. The written grievance shall contain
the following information:
- The employee's name and address, employer's name and address,
workers' compensation insurer and address, managed care arrangement;
- A summary of the grievance, any previous contact made with Corvel
and/or the workers' compensation insurer, and a description of
relief sought.
- The employee's signature; and
- The date the grievance is signed.
The written grievance shall be mailed to the address in the employee's
service area:
Corvel Corporation
Attn: Grievance Coordinator
725 Primera Blvd., Suite 220
Lake Mary, FL 32746
The Grievance Manager will acknowledge the complaint within five days
and shall investigate the grievance and notify the employee of a final
decision in writing within 60 days after the grievance. If the grievance
involves collection of information outside the service area, then
Corvel will have up to 90 days to respond to the grievance. If the
grievance is arbitrated pursuant to Chapter 682, FACE, then additional
time, not to exceed 210 days from receipt of the written request for
arbitration from the employee, is permitted. In the case of a medical
or quality of care grievance, the investigation shall include referral
to a medical advisor for consultation. If requested by the employee,
Corvel will provide a meeting between the Workers' Compensation Grievance
Committee and the employee at the market office. A representative
of the Workers' Compensation Insurer may attend. In the event of an
ultimately denied grievance or service, the member has the following
Grievance Reconsideration Rights. Grievance Reconsideration
Rights:
In the event of the receipt of a written denial by Corvel of the formal
grievance from the injured employee, the following grievance process
exists for reconsideration with the Department of Labor and Employment
Security, Division of Workers' Compensation. Written requests for
reconsideration should be filed with the following:
Division of Workers' Compensation
2728 Centerview
354 Forrest Building
Tallahassee, FL 32399-0680
Workers Compensation Leave, Timesheets, and Payroll Certification
Should a USPS employee lose time from work, the first seven (7) days
or forty (40) intermittent hours should be charged to disability with
pay (DIS) on the time card. DIS is paid by the university and should
not be charged to the employee's accrued leave. If the employee returns
to work within the first seven (7) calendar days and has not used
the entire forty (40) DIS hours immediately following the date of
the accident, s/he may use DIS on the date of the accident and may
use the remaining DIS hours intermittently for doctor visits, physical
therapy, etc. Once the intermittent DIS hours are exhausted, the employee
must use his/her accrued leave for doctor visits, physical therapy,
etc.
If the employee is unable to return to work within the first seven
(7) calendar days following the date of the accident, s/he shall be
eligible for the full forty (40) hours of DIS; however, s/he may not
use DIS on the date of the accident. Beginning on the eighth day of
disability, the employee will be paid by the Division of Risk Management
two-thirds (2/3) of his/her salary under workers' compensation (WC).
WC pays 5.25 hours per day of an 8-hour day. The employee is eligible
to supplement his/her WC wages with 2.75 hours of sick leave, annual
leave, or accrued compensation time.
WC hours are not calculated in the "total hours paid at base
rate," i.e., those hours are not certified for UCF wages. Only
personal leave, disability with pay (DIS), accrued compensation leave,
and actual hours worked should be certified when an employee is out
on workers' compensation. The employee will continue to accrue annual
and sick leave at the full rate. Those employed as student assistants,
Other Personal Services (OPS), or as adjuncts are not eligible for
disability with pay leave. Workers' compensation payments will begin
on the eighth day of disability at a rate of two-thirds (2/3) salary.
After twenty-one (21) consecutive days of authorized absence from
work, the employee will be paid retroactively for the first seven
days of disability.
PeopleSoft
Procedure Manual for Entering Workers Comp
Office Managers and others can find specific information on properly
entering Workers Compensation information into PeopleSoft in
this manual.
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Last modified: 10 September 2007 Human
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