Workers' Compensation: Resources for Supervisors

The First Report of Injury of Illness is available in two formats:

• Microsoft Word template: Open the file and use the "Save As" command, saving the file as a .doc. The form can be completed in Word, then sent as an e-mail attachment. Complete fields highlighted in yellow. Instructions are included on page 2.

• Adobe Acrobat (pdf): Users with the full Adobe Acrobat application can complete the form, then use the "Save As" command to save the completed form to the desktop. The form can be sent as an e-mail attachment.

Users with Adobe Acrobat Reader (not the full Adobe Acrobat application) cannot save the form. In this case, print the form and send the original to Human Resources Management, mail stop 9603, 150 McArthur Hall, fax 662 325-0753.

Email: employment@hrm.msstate.edu

• What is Workers' Compensation and who is covered?

• What if there is an accident that results in death, serious injury, or injury that requires surgery within 48 hours, or one that involves a third party?

• What must an injured worker do in the event of injury?

• What does the immediate supervisor do when a work-related injury or illness first occurs?

• Can the supervisor communicate directly with the employee's health-care provider?

• Who handles the Workers' Compensation claims, and what are their responsibilities?

• What medical expenses are paid on an approved claim?

• How much is the employee paid for wage loss while absent from work due to work-related injury or illness? When does payment begin?

• What is the employee required to do while absent due to a work-related injury or illness?

• What are the leave options for an employee who is absent from work? What about FMLA and Workers' Compensation?

• Is a department required to grant the employee Leave of Absence Without Pay when all leave options (including FMLA) have been exhausted?

• What happens to the employee's benefits while on Workers' Compensation?

• When can the department allow the employee to return to work? What about "light-duty" work?

• What does Workers' Compensation pay after the employee returns to work?

• Can MSU terminate an employee while they are on Workers' Compensation?

• What should a supervisor do if they find out that the employee has hired an attorney, or an attorney contacts the supervisor or department for information?

Excerpts from The Rules of the Workers' Compensation Commission

• Selection of Medical

• Waiting Period

What is Workers' Compensation and who is covered?

• Workers' Compensation is a no-fault insurance plan that is mandated by state law. It pays medical expenses of employees resulting from work-related injury or illness, including roundtrip mileage to receive medical treatment from an approved provider.

• The coverage provides compensation for absence from work, partial or total disability, and loss of life due to injury on the job without regard to fault as to the cause of the injury or occupational disease.

• All MSU employees, including student workers, are covered by Workers' Compensation at no cost to the employees.

• There is no waiting period. Employees are covered from the date of employment.

• MSU pays premiums based on the actuarial studies, which consider loss history and projected future losses.

• The Workers' Compensation law of Mississippi holds the employer responsible for reporting work related injuries and illnesses within 10 days. Any employer who refuses or neglects to make reports is subject to penalties by the Workers' Compensation Commission.

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What if there is an accident that results in death, serious injury, or injury that requires surgery within 48 hours, or one that involves a third party?

• Report the accident/injury by telephone immediately to FARA at 877 561-3272 or 601 956-9061 and the Department of Human Resources Management (HRM) at 662 325-3713.

• Employer's First Report of Injury or Illness should be completed immediately. It is available as a Microsoft Word template, which can be saved as a .doc file and sent as an e-mail attachment to employment@msstate.edu.

  It is also available as an Adobe Acrobat .pdf file. Users who can save .pdf files may send the file as an e-mail attachment.

  Or, the completed form can be faxed to the Department of Human Resources Management at 662 325-0753, delivered to 150 McArthur Hall, sent through campus mail to HRM, mail stop 9603, or mailed to HRM, Box 9603, MS State, MS 39762.

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What must an injured worker do in the event of injury?

• Notify the supervisor or other person designated by the employer.

• Seek medical treatment, if needed. For the initial visit, the employee can choose the medical provider. Tell the medical provider that they are claiming this as a work-related injury and that the bill for his/her service should be filed under Workers' Compensation.

• An injured employee should try to give the employer notice of the injury within 30 days. Prompt and accurate reporting is essential.

Note: If no disability benefits are paid to the injured worker by the employer or carrier within two (2) years of the date of injury, then the right to any and all benefits is barred unless the employee files a claim with the Workers' Compensation Commission during this two-year period. This is what is known as the two-year statute of limitations.

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What does the immediate supervisor do when a work-related injury or illness first occurs?

• Make sure the employee seeks medical treatment, if required. Advise the employee to tell the medical provider that he or she is claiming this as a work-related injury and that the bill for his/her service should be filed under Workers' Compensation. The injured employee may go or be taken to any physician or medical institution to obtain appropriate medical service.

• Secure the accident site so that appropriate personnel can investigate. Do not restore the workplace until the investigation has concluded.

• Complete the Employer's First Report of Injury or Illness. The injured employee should not complete this form. This is the supervisor's responsibility, even though they may not be sure whether the injury or illness is work-related.

  The form should be completed for any on-the-job injury or illness causing pain or discomfort, even when immediate medical service is not required.

  The form should be forwarded to Human Resources no later than 24 hours following the incident. Penalties can be imposed on MSU if incidents are not reported in a timely fashion.

  • Follow instructions on the back of the form

  • Make sure employee is aware of the clause on the back of the form, which states:

    Any person who willfully makes any false or misleading statement or representation for the purpose of obtaining or wrongfully withholding any benefit or payment under this chapter (Mississippi Workers' Compensation Law) is guilty of a felony and on conviction thereof may be punished by a fine not to exceed Five Thousand ($5,000) or double the value of the fraud, whichever is greater, or by imprisonment not to exceed three (3) years, or by both fine and imprisonment.

  • Begin with the Employee/Wage section

  • Answer all questions in the Occurrence/Treatment section

  • If you consider the claim to be non-work related, contact HRM at 662 325-3713, or FARA at 877 561-3272 or 601 956-9061.

• Send the completed Employer's First Report of Injury or Illness to Human Resources Management, mail stop 9603, or Box 9603, MS State, MS 39762

• Human Resources Management forwards the completed report to FARA, the claims administrator.

Notes:  If the employee loses time from work due to the accident or illness, FARA will send the affected employee an Authorization to Release Medical Information form, which contains a Statement of Claimant. This is the form on which the employee details the injury or illness.

If a supervisor/department is contacted by a medical provider regarding authorization to treat an employee, refer the provider to FARA at 877 561-3272.  FARA administers the Workers' Compensation claims for MSU.

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CAUTION: If an employee is on FMLA leave, there cannot be any communication between the employer and the medical provider(s). Also, employers cannot ask for a Medical Certification more often than every 30 days for an employee on FMLA.

In order to process the claim, FARA may require the employee to sign an Authorization to Release Medical Information and Employment Information, which authorizes the health care provider to release to the employer and/or its Workers' Compensation claim handler, medical information regarding the claim.

However, supervisors are cautioned that the information requested should be the minimum necessary for the intended purpose (for example, to determine when the employee may be released to return to work without limitations). Also, to avoid violation of the HIPAA Privacy Rules, HRM recommends that any questions regarding the claim be directed to FARA.

Typically, a medical provider will not release medical information by phone because they have no way of verifying that the person requesting the information has been given written authorization by the employee.

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Who handles the Workers' Compensation claims, and what are their responsibilities?

• FARA is the third party administrator that processes the claims for the IHL self-funded insurance Workers' Compensation Plan, which includes Mississippi State University.

• Human Resources Management sends the completed Workers' First Report of Injury or Illness to FARA.

• If the claim involves potential payments for lost time (the employee misses work due to the injury or illness), FARA contacts the affected employee and obtains:

  • Authorization to Release Medical Information

  • Employment Information and Statement of Claimant.

• FARA may contact the employee's supervisor or department to verify circumstances of the injury or illness.

• FARA approves or denies payment based upon information from the Employer's First Report of Injury or Illness and medical records provided by the medical provider.

• FARA continues to monitor the treatment and progress of the injured employee.

• FARA continues to investigate the circumstances of the claim, if necessary, and may contact the employee's supervisor/department for information.

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What medical expenses are paid on an approved claim?

Once FARA has approved the claim, the following are paid:

• Medical Expenses

  • Medical expenses are paid regardless of the number of days missed from work.

  • Workers' Compensation pays reasonable and necessary medical expenses required to treat the injury and achieve maximum cure, including:

    • Doctor

    • Hospital services

    • Nursing services

    • Medication

    • Physical therapy

    • Crutches and other apparatus or medical service

  • Mileage expenses for trips to the doctor

  • Certain rehabilitation services

  • Medical expenses resulting from workplace illness or injury should not be filed on the State of Mississippi's State and School Employees' Health Insurance

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How much is the employee paid for wage loss while absent from work due to work-related injury or illness? When does payment begin?

• Wage Loss payment

   

  • Disability of fewer than 14 days: No wage loss payment is made for the first 5 work days ("waiting period") the employee is absent from work. Benefits start to accrue on the 6th work day.

  • 14 or more days of disability: Wage loss payments are made for the entire period of disability, including the first 5 work days.

  • The maximum weekly wage loss payment is a maximum of 66 2/3 percent of the worker's average weekly wage, up to a maximum weekly amount of $387.68 (for calendar year 2007, adjusted annually).

    All weekly compensation benefits payable for loss of time or other disability are based upon a five-day work-week, so that the daily compensation benefit payable would be the total weekly compensation benefit divided by five (5), provided the employee works a 5-day work week. However, if an employee works, for example, a 3-day work week, the total weekly compensation benefit would be divided by 3.

  • Payments are made beginning with the 14th day of disability, and on a bi-weekly basis until the employee is released to return to work.

  • While the worker is under the care of a doctor and is unable to work, this benefit is known as a "temporary disability" payment.

  • Compensation is paid for a maximum of 450 weeks.

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What is the employee required to do while absent due to a work-related injury or illness?

• FARA will send the employee an Authorization to Release Medical Information and Employment Information and a Statement of Claimant. The employee is required to return the completed forms to FARA.

• The employee must submit appropriate leave forms (including Leave of Absence Without Pay) and Medical Certifications for time absent from work.

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What are the leave options for an employee who is absent from work? What about FMLA and Workers' Compensation?

Note: Employees can conserve their remaining leave balance by taking only the amount of leave hours required to maintain their benefits eligibility.

Remember that nothing in law or policy prohibits an employee from using leave up to 100 percent, while at the same time being paid the maximum amount per week by Workers' Compensation.

Leave options for first eight hours employee is absent due to an on-the-job injury or illness:

• 9-month faculty does not accrue Personal Leave. Note: Some MSU faculty have converted from 12- to 9-month positions and may have personal leave that they are entitled to take under State law.

  • Take the first 8 hours from Major Medical Leave.

  • If there is no Major Medical Leave balance, or less than 8 hours, the employee will take the difference as Leave Without Pay (see instructions below).

• Exempt regular full-time employee (regularly scheduled to work one half time or more) - including 12-month faculty

  • Take the first 8 hours from Personal Leave balance.

  • If there is no Personal Leave balance, or less than 8 hours, the employee will take the difference as Leave Without Pay (see instructions below).

• Non-exempt employee (regularly scheduled to work one half time or more)

  • Take the first 8 hours from either compensatory time or Personal Leave balance (as mandated by State law).

  • If the employee has less than 8 hours of Personal Leave, and no compensatory time, the employee's pay will be reduced for the number of hours that cannot be taken from Personal Leave.

• Intermittent employees do not earn personal leave and would be in unpaid status.

• Rehired retirees do not earn personal or medical leave and would be in unpaid status.

• Temporary employees do not earn personal or medical leave and would be in unpaid status.

To process Leave Without Pay:

For a non-exempt employee, the employee completes an Application for Leave of Absence Without Pay form for the number of hours difference between 8 hours and the available personal leave balance. Once approved by the department, the form is sent to Human Resources Management. The department uses the earn code DOC to reduce the employee's pay for the current pay period (when keying time for semi-monthly payroll).

 

For an exempt employee, the employee completes an Application for Leave of Absence Without Pay  for the number of hours difference between 8 hours and available personal leave balance, and sends it with a completed Employment Action Form to reduce the employee's pay for the current pay period. Under Section G, check Short Term Leave of Absence (w/o pay) and the number of hours used.

• For all employees who earn Major Medical Leave, beginning with day 2, use Compensatory time (if available), or Major Medical Leave.

• Once the employee exhausts Major Medical Leave and any available Compensatory time, they may:

  • Use Personal Leave to remain in paid status.

  • Begin to use FMLA leave, if they qualify. (Note: An employee may invoke FMLA leave at any time.)

    • Regular full-time (50 percent or greater) MSU employees are entitled to FMLA leave.

    • Employee must have a serious health condition, as verified by a medical provider.

    • FMLA leave is up to 12 weeks duration during the fiscal year (July 1 through June 30).

    • Department should send employee Notification to Employee of Family and Medical Leave Rights When Leave is Exhausted/About to Be Exhausted.

    • FMLA leave may be taken on an intermittent basis. Example: The employee has been released to return to work, but is required to travel to a medical provider for ongoing physical therapy. FMLA might be used on an intermittent basis for this treatment.

    • MSU continues to pay the employee's individual health insurance premium during FMLA leave, whether or not the employee is in paid status. If the employee does not return to work at the end of FMLA leave, the premiums paid by MSU for the employee will be collected from the employee, unless the failure to return is due to continuation, recurrence, or onset of a serious health condition, or something beyond the employee's control.

  • Once FMLA leave is exhausted, employee may apply for Leave of Absence Without Pay. Approval of a Leave of Absence is at the discretion of the employee's responsible administrator. The leave will not be granted unless the employee intends to return to work at the University at the end of the absence.

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Is a department required to grant the employee Leave of Absence Without Pay when all leave options (including FMLA) have been exhausted?

HRM policy #60-210, Leave of Absence, states, "A leave of absence without pay may be granted to regular employees for a period of up to one (1) calendar year at the discretion of the employees' responsible administrator."

Supervisors should contact the employee's Human Resources Generalist at 662 325-3713 to discuss options before the employee runs out of FMLA leave.

If the employee is a faculty member, contact Human Resources Management at 662 325-3713 and the Office of the Provost at 662 325-3742.

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What happens to an employee's benefits while he/she is on Workers' Compensation?

• MSU will pay the employer's share of the Mississippi State and School Employee's Health Insurance Plan premium while the employee is on Workers' Compensation as long as the individual is in paid status of 50 percent or more.

• If the employee on Workers' Compensation is in paid status less than 50 percent, and are not on approved FMLA leave, they are responsible for premiums for insurance coverages, including state health and life. Contact the Benefits section of Human Resources Management for information on continuation of coverage.

• If the employee is on approved FMLA leave, the University continues to pay health insurance premiums, regardless of the employee's leave status.

• Workers' Compensation continues to pay medical expenses and mileage associated with the workplace injury or illness as long as the employee is on Workers' Compensation.

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When can the department allow the employee return to work? What about "light-duty work?"

• The employee's supervisor must inform their Human Resources Generalist within 24 hours of an employee's return to work. Call 662 325-3713.

• Before returning to work, the employee is required to submit a Medical Certification for Major Medical Leave or Family and Medical Leave, Medical Leave of Absence, Excuse/Release to Work.

  • The doctor or health-care provider completes Section B, indicating:

    • Whether the employee is able to perform the essential functions of his/her job,

    • When the employee will be able to return to work without restrictions,

    • The degree at which the employee may work, and specific limitations

• The department reviews the Medical Certification and determines whether the employee can perform the essential functions of their job.

• The department does not have to allow the employee to return to work if the listed limitations would keep them from performing the duties of their job.

• Departments may return employees to a vacant position for which they qualify and are capable of performing (may be called "light duty" or "restricted duty") on a temporary or regular basis, provided they:

  • Have such a job available, and

  • Contact HRM about adjustments in pay, title, etc.

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• Wage loss payments end.
• Workers' Compensation continues to pay medical expenses associated with the claim as long as the claim is active.

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Can MSU terminate an employee while they are on Workers' Compensation?

Yes, but with caution. If an employee has exhausted all leave options (including FMLA), the department is not obligated to grant a Leave of Absence Without Pay and should contact the employee's Human Resources Generalist at 662 325-3713 to discuss options before the employee's leave is exhausted.

Also, taking disciplinary action against an employee who has filed a Workers' Compensation claim could be considered retaliation if the supervisor has not previously documented similar performance or behavior problems.

HRM policy #60-210, Leave of Absence, states, "A leave of absence without pay may be granted to regular employees for a period of up to one (1) calendar year at the discretion of the employees' responsible administrator."

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What should a supervisor do if they find out that the employee has hired an attorney, or an attorney contacts the supervisor or department for information?

• Refer the attorney (or his/her representative) to the Department of Human Resources Management at 662 325-3713. The Human Resources Generalist assigned to the employee's department will handle the attorney's inquiry.

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SELECTION OF MEDICAL. The employer shall select competent physicians, hospitals, and other attendance or treatment and immediately furnish such services, including all emergency services, to the injured employee. The injured employee shall have the right to accept the services furnished by the employer or, in his discretion, to select one (1) competent physician of his choosing and such other specialists to whom he is referred by his chosen physician to administer medical treatment according to the guidelines set forth in Mississippi Code Annotated section 71-3-15 (1) (1972), as amended. Such physician(s) selected by the employer or the employee, including any authorized referral, shall be located in an area reasonably convenient to the place of the injury or the residence of the injured employee, and the medical services shall be reasonably suited to the nature of the injury.

The employer may have the injured employee examined by a physician of its choice for the purpose of evaluating temporary or permanent disability or medical treatment being rendered. If such an examination is desired by the employer, the employer must make an appointment with the physician for the injured employee at a time reasonably convenient to the injured employee, prepay mileage at the prevailing statutory rate, pay all reasonable expenses for the attendance of the injured employee as well as the charges by the physician. The Commission must be notified in writing of such appointment for the examination, and copies of all reports must be promptly furnished to the Commission and the injured employee. If at any time the injured employee unreasonably refuses or fails to submit to such medical examination, the Commission or Administrative Judge may, by order, suspend the payment of future compensation during such time as such refusal continues, and no compensation shall be paid at any time during the period of such suspension.

Upon proper showing by any party of interest that the injured employee is suffering from improper medical attention or lack of medical treatment, further medical treatment may be ordered by the Commission or Administrative Judge at the employer's expense. If at any time during such period the injured employee unreasonably refuses to submit to medical or surgical treatment, the Commission or Administrative Judge shall, by order, suspend the payment of further compensation during such time as such refusal continues and no compensation shall be paid at any time during the period of such suspension.

Any hearing required by the Commission or Administrative Judge under this Rule may, in the discretion of the Commission or Administrative Judge, be held no sooner than five (5) days after notice to determine (1) if compensation payments should be suspended for refusal or failure to submit to a medical examination or to proper medical treatment or (2) that the injured employee is suffering from improper medical attention or lack of medical treatment.

Medical reports must be furnished by all treating or examining physicians to the Commission and the employer or carrier within twenty (20) days of the first treatment and periodically thereafter on a form prescribed by the Commission to which there may be attached office notes or narrative reports. (The HCFA 1500 form will be accepted in lieu of the Commission Forms B-9 and B-27, provided appropriate office/progress notes are attached.) The failure to furnish such reports may result in the claim for medical and surgical treatment being unenforceable against the employer unless excused by the Commission or Administrative Judge.

In the event an injured employee should be eligible for and desirous of treatment at any Veterans Hospital, or at the expense of the State Division of Medicaid or the Mississippi Department of Rehabilitation Services as a result of a disability under the Workers' Compensation Act, the employer or his carrier shall not be liable for such medical treatment as in other cases, unless the officials of the Veterans Hospital, the Division of Medicaid or Department of Rehabilitation Services to whom the injured employee is referred complies fully with Code section 71-3-15, and the Commission Rules.

This Rule shall be in force and effect on and after April 1, 2001.

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GENERAL RULE 11

WAITING PERIOD. If the injured employee is paid in full for the date of the accident, disability should be computed as beginning with that day next following the date of accident. If the injured employee is not paid in full for the date of accident, disability should be computed as beginning as of the date of the accident.

For purposes of determining whether an injured employee has satisfied the waiting period requirement of section 71-3-11 of the Law, a day of disability is considered to be any day on which the injured employee is unable, because of injury, to earn the same wages as before the injury, and neither the five (5) day period of disability nor the fourteen (14) day period of disability has to consist of consecutive days.

This Rule shall be in force and effect on and after April 1, 2001.

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Last modified July 10, 2007

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