Worker's Compensation

Introduction

The Workers’ Compensation Reference has been compiled to assist you in your duties involving workers’ compensation injuries and claims.

Workers' Compensation is an insurance program that pays medical and disability benefits for work-related injuries and diseases. Under the State of New Hampshire Workers' Compensation Law RSA 281-A, every employee is covered. including faculty, staff, student employees, temporary employees and casual workers.

It is sometimes difficult to know whether a person’s injuries/illness will be covered by Workers’ Compensation. Although the university does not make the decisions as to whether a person’s injuries/illness is cover, we can give you’re the general guidelines which are used by our third party administrator in making these decisions. Please realize that while we can give you the general guidelines, claims still fall into many “gray areas.” If you have questions regarding a specific case, please feel free to call Barbara Pirkl, Workers’ Compensation Coordinator, at (603) 862-3939 so we can discuss it with you in more detail.

The Employee Guide to Workers’ Compensation - A one page fact sheet created describing the benefits concerning Workers’ Compensation.

Workers Compensation Brochure - A brochure has been created describing information concerning Workers Compensation. We encourage departments to print off this booklet and give it to their employees.

Department managers and supervisors need to be familiar with the information in As a manager or supervisor you will be responsible for following the University policy on Workers Compensation in accordance with NH Department of Labor Regulations.

We recommend you don’t wait until an employee has an injury before you read this. We hope this reference will be a useful tool and we welcome any comments or suggestions.

What is Workers’ Compensation?

Workers’ Compensation is a "no fault" system that protects employees from loss of salary and pays medical expenses in the event of an injury or occupational illness arising out of and in the course of employment. The University contracts with Maine Employee Mutual Insurance Company (MEMIC) to administer the claims.

The benefit structure defines what injured workers are entitled to receive when they sustain an injury “arising out of and in the course of” employment. Benefits available depend on the nature and severity of the worker’s injury. Potential benefits are:

• Medical Care – You are entitled to receive all medical and hospital treatment reasonably required curing or relieving your work related injury. The insurance carrier pays these fees directly to the physician.



• Disability Payments - Temporary Disability - These payments will be made according to state law and University policy. If you are unable to work more than three days you are eligible to receive income based on 60 percent of the employee’s average weekly wage. The average weekly wage is determined using the average of earnings for the 26 weeks prior to the injury.

Reporting an Injury

If injured while working a report of injury or illness must be reported within two (2) days of occurrence to your supervisor no matter how minor the job related injury or illness may seem. Report of Injury or Illness form may be obtained at the following website: www.unh.edu/hr/pdfs/injyrpt.pdf (Spanish version). This report must be faxed immediately to Barbara Pirkl at: (603) 862-1222.

Failure to file a report or injury after five (5) days may subject the employing department to a late filing penalty fine from the NH Department of Labor up to $2,500.00.

Payment or Denial of Claims

Once a claim has been submitted to MEMIC it will be assigned to a claim handler. MEMIC then has 21 days to conduct a thorough investigation and made a decision to either pay or deny the claim. If the injured worker is unable to work, they will have to use their accrued leave until a decision has been made. On all lost time claims you will be notified of this decision in writing. On claims for medical treatment only, you will receive a written notification if benefits are being denied.

Timeframes for Filing a Claim

All injuries should be filed with two (2) days of occurrences. The New Hampshire law states: RSA 281-A:19 "The injured worker has two (2) years from the date of injury to notify the employer of his/her injury in order to make a claim for benefits. In cases where an occupational illness develops gradually and an injury is not immediately recognized by the claimant, the claimant must provide a date he/she knows, or by reasonable diligence should have known, the nature of the injury and its possible relationship to the employment."

Please remember, the insurance carrier has a responsibility to investigate each claim thoroughly to determine whether a claim is legitimately compensable. Therefore, to avoid any question of a claim later on, do not delay in filing a report when an injury occurs.

Medical Treatment

If you have an employee who is injured/illness from a work related accident you will first need to send them for medical treatment if it deemed necessary. If the injury/illness appears life threatening, call 911.

Employees who require immediate medical attention for work related injury/illness during regular office hours (8AM – 5 PM, Monday through Friday), but are not in a life threatening situation should seek medical treatment with our medical providers of choice:

Seacoast Redi-Care 396 High Street Somersworth, NH 03878 Monday-Friday 8am-8pm (603) 692-6066

Occupational Health Services 26 Manchester Sq., Ste #2 Portsmouth Trade Port Portsmouth, NH 03801 Monday-Friday 8am-8pm (603) 430-9675

Employees who are injured or become ill after regular hours and on weekends should determine if they can wait until regular office hours to be seen by our providers of choice or go to hospital emergency room.

Medical Provider Selection

The insurance carrier has a network of medical providers who are especially attuned to the needs of workers who have been injured in the workplace. These providers have been selected based on quality, location and specialty. You may select a medical provider of your choice if they are affiliated with the managed care network of MEMIC. If you need help finding an appropriate medical provider please call MEMIC at (866) 636-4292 or visit website: www.unh.edu/ehs/pdf/provider_listing.pdf

Medical Benefits

All reasonable and appropriate medical expenses for treatment of your work related injury will be paid. These expenses include, but are not limited to, visits with doctors, therapists, diagnostic testing, prescription and medical related Mileage Reimbursement Form. Please forward all bills related to your injury to the Workers Compensation Coordinator, Barbara Pirkl, 2 Leavitt Lane, Durham, NH 03824 or to MEMIC, P.O. Box 3606, Portland, ME 04104.

Weekly Compensation Benefits Under NH law you must be satisfy a three wait period before you are eligible to receive weekly compensation benefits for loss of earnings and will be required to use their accrual leave balances. You will be compensated for the first three days of disability if you remain out of work for more than 14 days.

Workers' Compensation Payment and Leave Supplements
Days Disabled	Days Paid By
	Workers’ Compensation	Accrued ET, Sick Pool, Vacation or Sick
1-3 days	0%	100%
4-13 days	60%	40%
14 days or longer	60%	40%

Weekly Benefit Calculations

Under NH law an injured worker is to be paid 60% of their pre-injury average weekly wage while they are out of work due to a work related injury. These benefit payments are issued by MEMIC on a weekly basis and are tax free.

Supplemental Benefits

The University allows employees to use accrued leave (earned time, sick, vacation) to supplement the 40% portion that workers compensation does not cover. The injured employee is required to fill out Workers Compensation Accrued Time/Overpayment Agreement Form that is sent to the Workers Compensation Coordinator. Once your accrual leave balance is exhausted the injured worker will be on a leave without pay from the university as long as you are out of work.

Responsibility of Supervisor

• If immediate medical attention is necessary, assist employee. For more information refer to Medical Treatment
• Instruct the employee to complete the First Report of Injury or Occupational Illness form within TWO working days
• Advise employee about disability payments (loss wages). See Workers’ Compensation Benefits
• Advise employee regarding the Family and Medical Leave Act (FMLA) if out for more than five days
• Keep Barbara Pirkl, Workers’ Compensation Coordinator informed such as:
  a) Verify if employee is working, or last day of work if out
  b) Verify employees normal work schedule
  c) Following any physician visit(s)
  d) If there are any concerns or the condition worsens
  
• Investigate the accident, obtaining all details possible. If an accident results in a serious injury, contact Environmental Health and Safety (EH&S) immediately
• Stay in touch weekly, with the injured employee to ensure a smooth transitive back to pre-injury status
• Correct the unsafe conditions immediately
• Identify return-to-work options to find light or alternative duties that will get the employee back to work

Responsibility of Employee

• Inform supervisor of injuries or illness immediately
• Fill out employee section of Report of Injury or Occupational Illness Form and give form to your supervisor
• Seek appropriate medical attention to healthcare providers of choice who are within the insurance carrier managed care program. For a list of providers who participate in managed care program, visit website: www.unh.edu/ehs/pdf/provider_listing.pdf.
• Inform your doctor that modified duty will be provided if released with restrictions.
• Provide you supervisor and Workers Compensation Coordinator with NH Workers Compensation Medical Form each and every time following doctor visit
• Notify supervisor in advance of doctor or therapy appointments
• Maintain communication with supervisor
• Report any unsafe working conditions or hazards

Stretching for your health: Upper Body Stretches - This brief, two page brochure, recommends quick steps to help you implement a stretching program in your workplace.

Temporary Alternative Work Program

Temporary Alternative Work Program

Temporary Alternative Work Forms and Procedures

The University of New Hampshire has developed a Workers' Compensation Temporary Alternative Work Program (TAWP). This program is designed to develop temporary alternate work opportunities for injured employees. The TAWP prefers to establish work in the injured employee's home department. The primary case management team in conjunction with Human Resources will screen requests for employment and other unfilled positions that the University may have for a satisfactory temporary fit. It temporary work is established outside of the employing department, the salary of the employee will be split equally between the home and outside departments. When absolutely necessary, alternative methods of funding will be investigated. If you have any questions about this program, please contact Barbara Pirkl, Workers' Compensation Coordinator at: (603) 862-3939.

Worker's Compensation Claims Process