Workers' Compensation

Introduction

Through the Workers’ Compensation program, Gallaudet provides for continued income and payment of medical expenses for work-related injuries and illnesses. Gallaudet’s Workers’ Compensation program is insured by Travelers. Claims are processed by Travelers and are adjudicated by the District of Columbia Government, Office of Workers’ Compensation (OWC). Travelers reviews each claim and the medical documentation carefully, provides ongoing monitoring, and may ask for additional information or a second medical opinion. Investigations of potentially fraudulent claims are conducted by Travelers Insurance’s special investigations unit.

In order to receive Workers’ Compensation, the injury or illness must be verified as work-related. If an employee is injured on the job, it is imperative that they notify their manager and Human Resources. Immediate notification will ensure that the correct forms are completed and that the employee receives prompt and appropriate medical attention, if needed.

The cause of each injury is carefully investigated to prevent future accidents. If the University has any reason to believe that the incident was not work-related, was caused by willful misconduct, or is otherwise invalid, it will inform the insurance company. This is not to discourage employees from filing a Workers’ Compensation claim; it is to ensure that Workers’ Compensation privileges are not abused.

While the University recognizes that employees may need time to recover, it also expects employees to return to work as soon as possible. Travelers will work closely with employees and their physicians to determine what accommodations, if any, may be needed, and the University will make light-duty, part-time, or alternative work arrangements available whenever possible.

The following guidelines should assist both employees and managers in processing a Workers’ Compensation claim. It is not intended to be all-inclusive. Travelers and Human Resources will provide additional information and assistance, if needed.

Please remember that claims may be denied or compensation delayed if forms are not submitted in a timely manner.

Procedures for Reporting a Work-Related Injury or Occupational Disease

Employees should report all injuries, even if they do not require medical attention and will not be absent from work, so that a file can be established with Travelers in case of future problems related to the injury.

If an employee is injured on the job, the employee must:

• Inform the manager of the injury or illness and how it occurred.
• Complete claim forms 7 DCWC and 7A DCWC and return them to Human Resources as soon as possible, but no later than three working days from the date of the incident.
• Attach the completed forms, including your signature, and submit them through ServiceNow for our HR Workers’ Compensation team to review.
• The forms will be reviewed and then submitted to Travelers so that a file can be established and a case manager assigned. The employee will be given a copy of the form.
• Keep the manager informed weekly, unless instructed otherwise, of the need to remain off work.
• Provide regular medical documentation to Human Resources.
• Inform attending medical personnel to forward medical bills and documents to Travelers. Medical bills should not be submitted to the employee’s health insurance carrier.

The manager must:

• Complete claim form 8 DCWC and return it to Human Resources as soon as possible, but no later than three working days from the date of the incident. The form will be reviewed by Human Resources and then submitted to Travelers. Workers’ Compensation benefits cannot be processed until the manager has completed this form.
• Attach the completed forms, including your signature, and submit them through ServiceNow for our HR Workers’ Compensation team to review.
• If appropriate, prepare a detailed statement describing all knowledge of what occurred or caused the illness or injury and forward it to Human Resources within three working days from the date of the incident. This is particularly important if there is any reason to believe that the injury or illness is not work related. Supervisors should consult with others who may have witnessed the incident when completing the record. If the claim is for an occupational disease, the statement should include:
  • A detailed description of the work performed by the employee.
  • The identification of any fumes, chemicals, or other irritants, or situations to which the employee was exposed, that allegedly caused the condition.
  • The nature, extent, and duration of the exposure, including hours per day and days per week.
  • A description of the safety precautions taken to ensure that the employee is not exposed to harmful fumes, chemicals, or other irritants.
  • An opinion on the accuracy of the employee’s statements.

If an employee needs immediate medical attention for a work-related injury or illness, the employee may seek initial care through Student Health Services (SHS) or another appropriate medical provider. SHS is not intended to provide ongoing medical care for employees. Any ongoing care for a work-related injury or illness should be coordinated through the University’s workers’ compensation process and the employee’s selected treating physician. Employees have the right to choose their treating physician under the D.C. Workers’ Compensation program.

For a serious or life-threatening injury, call the Department of Public Safety (DPS) at 202-651-5555 (VP/text/voice). DPS will contact 911 and coordinate the University’s emergency response.

It is essential that the supervisor contact Human Resources immediately so that Travelers can be informed of the illness or injury. At the hospital, the employee should inform emergency room personnel that he or she has been injured at work and that all medical reports and bills should be submitted to Travelers or Human Resources. Hospital and medical bills should not be submitted to the employee’s health insurance carrier. Form 8 DCWC must be completed by the supervisor and returned to Human Resources within three working days. Forms 7 DCWC and 7A DCWC should be completed by the employee as soon as possible. Travelers will contact the employee or the employee’s representative to ensure the necessary forms are completed promptly, minimizing delay in processing the claim.

OSHA Reporting Requirements and Medical Updates

In addition to following Gallaudet’s internal reporting procedures, certain serious workplace incidents must be reported to the Occupational Safety and Health Administration (OSHA):

• Fatalities must be reported within 8 hours.

• Amputations, loss of an eye, or hospitalizations must be reported within 24 hours.

Employees must also inform Human Resources and their manager of any changes to their medical documents or recovery status.

Workers’ Compensation Benefits

The District of Columbia Workers’ Compensation program provides for a temporary total benefit, if needed, of 66 2/3 percent of the employee’s average weekly wage up to a defined weekly maximum established by OWC. Benefits begin on the fourth day of the disability. The first three days are taken as sick leave, annual leave (staff), or leave without pay.

Workers’ Compensation payments are made directly by Travelers. Payments are usually made within 14 days of the incident. Hospital and medical bills are also paid by Travelers. Bills should not be submitted to the employee’s health insurance carrier. If the absence extends beyond 15 days, the first three days of the disability will be paid retroactively.

Prescription Processing Services

Injured workers are provided with a prescription card that enables them to obtain prescriptions at no out-of-pocket cost. Travelers is directly billed. All dispensed prescriptions are subject to a quality check to ensure they are valid and not refilled before needed.

Payroll Procedures

When an employee must be absent due to a work-related injury, the first three days of the absence are recorded as sick leave, annual leave (if sick leave is not available), or leave without pay. Thereafter, the employee may elect one of the following:

• Continue to use sick leave (and annual leave if necessary) in order to receive full pay; or
• Be placed on leave without pay status and collect workers’ compensation benefits (66 2/3 percent of pay).

The Employee is not Entitled to Both

If an employee elects to use accrued sick leave or annual leave in order to receive full pay, Travelers will forward the Workers’ Compensation benefits check directly to Human Resources. Human Resources will work with the employee and the employee’s department to repurchase some of the leave used.

If the employee does not want to use paid leave or has no paid leave, he must be placed on leave without pay status. Workers’ Compensation benefits will be paid by Travelers. Human Resources must be notified as soon as the employee goes on leave without pay.

If you need to use paid leave (such as sick or vacation time) during the waiting period or while out due to a work-related injury, please submit your request through the Absence Calendar in Workday. 

• Select the appropriate leave type.

• In the comments section, include the notation “WC” to indicate the absence is Workers’ Compensation-related.

Health Insurance and Other Benefits while on LWOP

As long as an employee is on paid leave, all benefits deductions continue. When an employee is on leave without pay status or when their salary is insufficient to cover the required withholdings, the employee is responsible for their share of all payroll-dedicated obligations, including health insurance premiums, if coverage is to continue. Payment may be made by direct payment to the Payroll Office, or the deductions will be made when the employee returns to a pay status. The employee may elect to terminate benefits coverage while on leave without pay status.

The Role of Travelers

Travelers does not simply provide compensation and pay medical bills. Travelers integrates an aggressive claims investigation with comprehensive managed care and disability management programs. Travelers contacts the injured worker within 24 hours of being notified of the injury. The case manager obtains additional information from the employee to assess the level and nature of the injury, helps direct the employee to the most appropriate medical provider if needed, arranges for special equipment if necessary, and establishes a regular communication routine to set the pace for an early return to work. If necessary, a nurse may contact the employee’s health care provider to begin developing an appropriate rehabilitation plan. For more serious injuries or occupational diseases, a Travelers rehabilitation nurse may be assigned to the case, and a medical advisor may be consulted for advice or to evaluate the injury. Employees who fail to cooperate with rehabilitation efforts forfeit their rights to Workers’ Compensation.

Light Duty or Alternative Duty

The Workers’ Compensation program emphasizes the importance of returning to work as soon as the employee is able. If an employee is unable to return to his or her regular position within a short period of time, the physician may release the employee for light duty or a part-time schedule, depending on the extent of the injury or illness. The employee’s department should try to make the accommodation. If the department cannot, Gallaudet has established several alternative work sites to which the employee may be assigned; however, the home department will be responsible for the employee’s salary. Unless the leave has been specifically designated by the University as FMLA leave, refusal to accept a light-duty or part-time arrangement that accommodates the employee’s limitations or restrictions will result in the immediate termination of Workers’ Compensation benefits.

Any person who knowingly makes a false statement, misrepresentation, concealment of fact, or any other act of fraud to obtain compensation or who knowingly accepts compensation to which he or she is not entitled is subject to felony criminal prosecution and may, under appropriate provisions, be punished by a fine or imprisonment, or both.

Gallaudet University is an equal opportunity employer/educational institution and does not discriminate on the basis of race, color, sex, national origin, religion, age, hearing status, disability, covered veteran status, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, source of income, place of business or residence, pregnancy, childbirth, or any other unlawful basis.