* Remember, you must submit the First Report of Accident/Incident form to the Office of Risk Management within the required 48 hour time frame.
If the injury requires emergency medical care, call 911 to seek immediate treatment at the nearest Emergency Room. After you are stabilized, you will receive any necessary additional medical care within the established carrier health care network. You should complete the First Report of Accident/Incident form before the end of the shift of the day you had the injury. Failure to report a job related injury within 48 hours will result in a late reporting fine and/or potential denial of a claim.
If the injury does not require emergency care but still requires medical treatment, please contact the Office of Risk Management first to locate the nearest carrier approved facility. Please make sure that you and your supervisor complete the First Report of Accident/Incident form and submit it to the Office of Risk Management within the required 48 hour time frame.
If the injury does not require medical care, complete a Department Incident Log. Knowing where and how injuries occur enables us to investigate, track and take corrective action before someone else is injured.
For approved local hospitals, urgent care centers and medical providers, please click here. Or, call 1-800-327-3636 and select 4 at the prompt to speak to one of the carrier representatives (available Monday thru Friday, 7:00 a.m. - 6:00 p.m. CST).
On the day of your injury, the time spent waiting for and receiving medical care before the end of your shift should be recorded as worked time. If the doctor takes you off from work and you are sent home you will be paid as though you had worked a full shift. Your follow-up visits with your treating physician or physical therapist should be recorded as sick or vacation time. Please work with your supervisor/manager about making up time away from work.
Please visit "If you are unable to work" for more details on when sick/vacation time can be used if you are placed out of work beyond your current shift.
The cost of your medical care is paid through workers' compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers' compensation claim. This means you would not be responsible for deductibles or co-pays for authorized treatment. If you receive a bill from a medical provider, please advise them to bill Southern Methodist University's Workers' Compensation Carrier instead of you (or your insurance).
If your injury requires medication, you will be provided with an Express Script pharmacy card to cover the cost of the prescription. The card is specific to medications for your workers' compensation injury and does not require any co-pays, just prior authorization. There are nearly 53,000 pharmacies in the Express Scripts network (ex. CVS, Walgreens, Wal-Mart).
If the injury is later determined not to be work related, Southern Methodist University generally pays the initial cost of medical care and medications provided. However, the cost of medical care and medicines provided by the Emergency Room, Urgent Care, or other providers will be your responsibility. Contact the Office of Risk Management at 214-768-3737 if you have questions regarding whether the services will be covered.
We understand the importance of getting medical care and knowing in advance if there is a potential for out-of-pocket costs to you. We will review your injury ("claim") as quickly as possible and let you know the outcome of that claim as soon as we can. Your timely completion of the incident report speeds the review process so that questions regarding whether the injury and the associated costs are covered can be answered as quickly as possible.
Each incident report is forwarded to the Office of Risk Management. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are given to the Workers' Compensation Manager. The Workers' Compensation Manager will interview you regarding the incident, relevant medical history, and outside work activities to gather the necessary information to determine whether the injury can be covered under workers' compensation. If the circumstances are very complex, the WC Manager may also consult with legal and/or medical personnel, and/or request to review the relevant medical records, and/or request additional information from your supervisor. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.
The Workers' Compensation Manager will let you know the outcome of the review. The informal process is to let you know either in person or by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with your family physician).
You are welcome to contact the Workers' Compensation Manager in the Office of Risk Management regarding the decision. You are also welcome to request that the decision be re-reviewed by the Assistant Director or Executive Director of Risk Management. If you still have questions, you may also contact the Division of Workers' Compensation under Texas Department of Insurance.
In addition, the Division of Workers' Compensation Board is the state's administrative agency responsible for administering all workers' compensation claims in the state. An ombudsman at the Board is available to you at no charge who can help answer questions regarding claims and to help you through the process of appealing a decision if you do not agree with it.
To contact the Division of Workers' Compensation you can email them at WorkersCompCustomerServices
@tdi.state.tx.us or call 1-800-252-7031. You can also access their website at TX Division of Workers' Compensation.
No. Only treatment that is authorized and provided by a carrier approved medical provider is paid through workers' compensation. Also, Southern Methodist University's health plans don't provide coverage for work injuries. This means that if you go to your own doctor, you may be responsible for the cost of the care provided.
Only the treatment for the job related injury is covered under workers' compensation; the cost of medical care for non-work related injuries would continue to be your responsibility (or the responsibility of your health plan if applicable). Where possible, the physician treating your work injury will separate out care that is provided for your work injury and refer you back to your regular physician for treatment of any non-work related health condition.
Generally, one treating physician (or physician's assistant) in workers' compensation will be providing your medical care. If you wish to have an alternate treating physician provide your care, contact the Workers' Compensation Manager.
You can change doctors one time without prior approval as long as you notify the workers' compensation carrier and the doctor is a carrier approved medical provider. Any additional changes will require approval from the workers' compensation carrier and/or the Division of Workers' Compensation.
Inpatient treatment and inpatient or outpatient surgery are all types of medical care that are covered under workers' compensation. Unless the situation is an emergency, preauthorization from the Workers' Compensation carrier is required.
Physical therapy is also a type of medical care covered under workers' compensation when ordered by your approved treating physician. Services are generally provided at occupational or other approved clinics.
The Office of Risk Management is located at 3030 Dyer Court (Dawson Service Center), room 170 and the staff contact information is as follows:
|Sandi Geerts||Workers' Compensation Managerfirstname.lastname@example.org||214-768-3737|
|Anita Ingram||Executive Director of Risk Managementemail@example.com||214-768-4047|