• Overview
• Responsibilities of the Supervisor
• Responsibilities of the Injured Worker
• Selecting a Primary Care Physician
• Changing Primary Care Physicians
• Second opinions
• Independent Medical Examination (IME)
• Emergency care outside the service area
• Use of Pharmacies
• Worker’s Compensation Definitions
• Grievance Procedures
• Leave, Timesheets, and Payroll Certification
• PeopleSoft Procedure Manual for Entering Workers' Comp
• Frequently Asked Questions
• A Guide to Rehabilitation and Reemployment Services for Injured Workers
• First Report of Injury Form
• Centra Care Authorization Form

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 Hospital’s 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 Primary Care Physician (Medical Care Coordinator)
• The Specialist Care Physician
• Participating Provider
• Medical Case Managers
• Emergency

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:

1. The patient's life or health would be placed in serious jeopardy.
2. Vital bodily functions would be seriously impaired.
3. There would be serious and permanent dysfunction of a bodily organ or part.
4. 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.

Worker’s 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:

1. The employee's name and address, employer's name and address, workers' compensation insurer and address, managed care arrangement;
2. A summary of the grievance, any previous contact made with Corvel and/or the workers' compensation insurer, and a description of relief sought.
3. The employee's signature; and
4. 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

Division of Workers' Compensation
2728 Centerview
354 Forrest Building
Tallahassee, FL 32399-0680

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