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UWHC,UWMF,

Policies,Administrative,UW Health Administrative,Human Resources

Workers Compensation (9.17)

Workers Compensation (9.17) - Policies, Administrative, UW Health Administrative, Human Resources

9.17

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Administrative (Non-Clinical) Policy
This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals
and Clinics Authority (UWHCA) as integrated effective July 1, 2015, including the legacy operations and
staff of University of Wisconsin Hospital and Clinics (UWHC) and University of Wisconsin Medical
Foundation (UWMF).

Policy Title: Workers Compensation
Policy Number: 9.17
Effective Date: December 19, 2017
Chapter: Human Resources
Version: Revision

I. PURPOSE

This policy outlines how the University of Wisconsin Hospital and Clinics Authority (UWHCA)
Worker’s Compensation Program operates, what is required of UWHCA employees, and UWHCAs
commitments under the program.


II. DEFINITIONS

This policy applies to all regular full-time, part-time, and temporary employees, Graduate Medical
Education trainees, employees-in-training, and student employees assigned and paid to perform work at
UWHCA or at other work locations per leased employee arrangements or clinical rotations. It does not
apply to volunteers, who are not covered by Wisconsin Worker’s Compensation law.


III. POLICY ELEMENTS
A. The Wisconsin Worker’s Compensation Act ("the Act") requires employers to provide benefits in
the event that an employee requires medical treatment, is disabled from working or dies due to an
occupational injury or disease. UWHCA provides these benefits by paying appropriate claims
falling within the scope of the Act. Claims fall within the scope of the Act when all of the
following conditions occur:
1. An employee sustains an occupational injury. Injury is defined by the Act as "mental or
physical harm to an employee caused by accident or disease, including damage to or
destruction of artificial members, dental appliances, teeth, hearing aids and eyeglasses".
Damage or destruction of hearing aids and eyeglasses are only compensable if they result
from an accident that also causes personal injury that results in disability or requires
treatment.
2. At the time of the injury, the employee is performing service growing out of and
incidental to his or her employment.
3. The employee's injury has not been self-inflicted.
4. The accident or disease that causes the employee's injury must arise out of, that is, result
from a hazard of the employment. For example, if an employee falls while walking down

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the hall at work, and the fall is not caused by any hazard associated with the work
environment, then Worker’s Compensation likely would not cover any resulting injury.
Cement floors and other hard floors are not considered a special hazard of employment.
B. The three (3) major benefits that UWHCA provides are described below:
1. Medical Payment. The reasonable cost of all necessary medical treatment for the
occupational injury or disease will be provided in accordance with the provisions of the
Act. The employee has the right to choose a physician; however, UWHCA may request
an independent medical examination by a physician of its choice for purposes of
determining the nature of the injury and/or the appropriateness or reasonableness of the
medical care. UWHCA requires timely reports from medical providers for care,
treatment, diagnosis and prognosis prior to payment for medical services or issuance of
disability payments.
2. Disability Payment. If the period of wage loss or limitation due to a work-related injury
lasts more than three (3) working days, benefits for temporary disability are available.
Where wage loss is total, the employee is entitled to temporary total disability (TTD)
benefits equal to two-thirds of the employee's average weekly wage as defined by the
Act, with special minimums and maximums established. Where wage loss is partial, the
employee is entitled to temporary partial disability (TPD) benefits based upon his or her
proportionate wage loss, if any.
Such payment will be effective beginning on the fourth working day of disability and will
continue as long as UWHCA agrees the employee is disabled from employment as
documented by appropriate medical evidence. If the disability lasts longer than seven (7)
calendar days from the first day of absence resulting from an injury or illness, the first
three (3) day waiting period will be paid to the employee. At the option of the employee,
sick pay or vacation pay may be used for the first three (3) days of disability, and will be
re-credited to the employee if the agreed disability lasts longer than seven (7) days. If an
employee is determined to have a remaining permanent disability after he or she has
healed as much as possible from the injury, the employee is entitled to permanent
disability benefits as determined by the Act.
3. Death Benefit. When an employee dies due to an occupational injury, or when a
permanently totally disabled employee dies from any cause, his or her dependents are
entitled to a death benefit. If the deceased employee leaves one or more persons wholly
dependent upon him or her for support, the benefit is four times the employee's average
annual earning, subject to maximum and minimum limitations. A burial expense
allowance for injuries sustained after January 1, 1996 is also provided under the Act.
IV. PROCEDURE
A. Employee Responsibilities
1. If an employee sustains a work-related injury or illness during Employee Health Services
(EHS) business hours (7:00 a.m. - 4:00 p.m. M-F) and needs medical attention, he or she
should report to their direct supervisor and contact EHS. At other times or in an
emergency, the employee should report to a UWHCA Emergency Department (ED). In
such cases, the employee must advise the ED that the injury or illness is work-related.
The ED will forward copies of the treatment report to Employee Health Service (EHS).
2. As soon as possible but no later than the next business day following any injury or illness
an employee believes to be work-related, the employee should complete the relevant
portions of the on-line Occupational Injury/Illness report (if the employee is able).
UWHC and UWMF employees and supervisors have separate on-line reports to
complete. Please use the correct form based on your employer:

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a. Employee Occupational Injury /Illness Report - complete the Employee
Information and Employee Injury/Illness Information portions of the form.
b. This form can be accessed and completed through U-Connect. Once completed,
the on-line form will be submitted to the employee's supervisor so that the
supervisor can complete the employer portion.. Even if the employee does not
request treatment, the employee should still report any work-related illness or
injury to the employee's supervisor through the above on-line process to
document the event .
c. If the employee is physically unable to complete the report, the Worker’s
Compensation Department will take a telephone statement and complete the
report for the employee.
d. An employee may also complete a Patient Safety Net (PSN) report to alert for
system and/or process hazards. This report is secondary to the Employee
Occupational Injury/Illness Report which must be completed.
3. If an employee has lost time from work due to a work-related injury or illness, the
employee must report to and be cleared through EHS before returning to work.
4. If the work-related injury/illness has resulted in lost work time and/or if medical expenses
have been incurred, the employee is responsible for submitting the following information
to the Worker’s Compensation Department as soon as possible after each doctor's
visit/medical appointment:
a. Medical reports, recommendations, and work restrictions, if any, related to the
injury/illness. All compensation and medical payments are based on medical
reports from the employee's doctor/health care provider. If a doctor/health care
provider does not make prompt and regular reports to the insurance company, the
employee's payments may be delayed. The employee should explain this to
his/her doctor/ health care provider.
b. Medical and medication bills related to the injury/illness.
c. Mileage for follow-up health care appointments related to the injury/illness.
5. An employee may see a provider of their personal choice. However, UWHCA has the
right to question the appropriateness of medical care given prior to the payment of
charges.
6. Employees must cooperate with UWHCA in meeting both employee and operational
needs. This includes but is not limited to scheduling medical appointments outside of the
employee's regular working hours whenever possible, and agreeing to light duty or an
"alternate assignment" within the employee's physical capabilities through UWHCA's
early return-to-work/Alternate Assignment program. It is important that the employee
makes every effort to return to work, within medical restrictions, as soon as possible after
an injury.
B. Supervisor Responsibilities
1. As soon as possible after receipt of the "Employee Occupational Injury/Illness Report",
the supervisor must complete the employer portions of the form through the on-line
process available on U-Connect.
2. Supervisors must notify the Worker’s Compensation Department immediately once it is
known that a claim will involve time lost from work.
3. If an employee has lost time from work due to a work-related injury or illness, the
supervisor shall not allow the employee to return to work until the employee has been
cleared through EHS.
C. Worker’s Compensation Department Responsibilities
1. The Worker’s Compensation Department will coordinate benefits and care with the the
insurance carrier and contact the injured employee, his/her supervisor, EHS, and/or other
medical providers for additional information as appropriate, or as needed.

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D. Fraudulent Claims
UWHCA is required to report false or fraudulent Worker’s Compensation claims. Should an
employee, including but not limited to the injured employee's supervisor, suspect that a claim for
Worker’s Compensation is fraudulent, that employee should report that suspicion to the Worker’s
Compensation Department and/or to an Employee Relations Consultant (ERC) in Human
Resources. The Worker’s Compensation Department and the ERC will work together to
investigate allegations of fraud. Employees found to have engaged in fraudulent conduct will be
subject to discipline, up to and including termination.
E. The Worker’s Compensation Department shall notify the Safety Director of any injury or illness
which may have been caused by hazardous conditions. The Worker’s Compensation Department
shall notify the Human Resources Department and the employee's supervisor when an injury
absence is likely to exceed 5 days or if any other unusual circumstances occur, such as restricted
duties or partial return to work.
F. If the injury sustained results from a biohazardous exposure, the employee must follow UWHCA
Administrative policy #9.28 - Management of Exposure to Blood or Bodily Fluid. If the injury
involves exposure to blood or body fluid, the employee should identify the source. Because
Worker’s Compensation forms are a public record, patient names must not appear on them to
preserve confidentiality, instead a medical record number may be used.
G. If an employee death or catastrophic injury or illness occurs, it must be reported immediately to
the employee's supervisor and/or department manager and the Safety Director. If an employee
death or catastrophic injury or illness occurs, the department supervisor will contact the Hospital
Administrator on Call.
H. H. An employee who is off of work receiving Worker’s Compensation benefits will be eligible to
maintain coverage for Group Health Insurance (including Medical and/or Dental) during an
absence. An employee will not accrue sick and/or vacation time off during any period of absence
due to an occupational injury or illness in which the employee is out of pay status.
I. An employee who is permitted to return to work with restrictions will be referred to their
immediate supervisor. A statement from Employee Health Services will be provided to the
supervisor stating the nature of the restrictions.
J. FMLA time runs concurrently with Worker’s Compensation.
V. FORMS

UWHC Employee Occupational Injury/Illness Report
UWMF Employee Occupational Injury/Illness Report


VI. COORDINATION

Sr. Management Sponsor: SVP, Chief Legal Officer
Author: Director, Risk Management
Reviewer(s): Employee Health Services Manager; Director, Safety;

Approval Committee: UW Health Administrative Policy and Procedure Committee


SIGNED BY

Elizabeth Bolt
UW Health Chief Administrative Officer