* 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 your employee is stabilized, they will receive any necessary additional medical care within the established carrier health care network. Your employee should complete a First Report of Accident/Incident before the end of the shift of the day of the injury. Failure to report an on the 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 or your employee completes a First Report of Accident/Incident and submit it to the Office of Risk Management within the 48 hour time frame. The Office of Risk Management is located in room 170 of Dawson Service Center.
If the injury does not require medical care, complete a Department Incident Form. 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. Or, call 1-800-327-3636 and select 4 at the prompt to speak to one of the carrier representatives (available Mon 7:00AM Ð 6:00PM-CST).
The cost of medical care for your employee 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 they would not be responsible for deductibles or co-pays for authorized treatment. If they receive a bill from a medical provider, please advise them to bill Southern Methodist University's Workers' Compensation Carrier instead of your employee (or employee's insurance).
If your employee's injury requires medication, they will be provided with an Express Script pharmacy card to cover the cost of the prescription. The card is specific to medications for their 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 mediations provided. However, the cost of medical care and medication provided by the Emergency Room, Urgent Care, or other providers will be the employee's responsibility. Have them contact the Office of Risk Management at 214-768-3737 if they 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 your employee. We will review their injury ("claim") as quickly as possible and let them know the outcome of that claim as soon as we can. Their 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 a Risk Management Specialist. The Risk Management Specialist will interview your employee and/or 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 specialist may also consult with legal and/or medical personnel, and/or request to review the relevant medical records, and/or request additional information from you, the supervisor. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.
Generally, first contact with your employee to obtain additional information regarding the incident is made within the first day of receipt of the First Report of Accident/Incident and a determination regarding compensability is made after initial investigation of the claim. If your employee is unavailable or additional information is needed, the process will take longer. Please encourage your employee's to respond to a request for information from the Office of Risk Management as soon as possible.
The Risk Management Specialist will let your employee know the outcome of the review. The informal process is to let your employee know either in person or by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with their family physician).
You and your employee are welcome to contact the Risk Management Specialist in the Office of Risk Management regarding the decision. Your employee is also welcome to request that the decision be re-reviewed by the Assistant Director or Executive Director of Risk Management. If you or your employee 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 your employee at no charge who can help answer questions regarding claims and to help them through the process of appealing a decision if they do not agree with it.
To contact the Division of Workers' Compensation you can email them at email@example.com or call 1-800-252-7031
On the day of the injury, the time spent waiting for and receiving medical care because of the job related injury should be recorded as worked time. If your employee is sent home before the end of their shift, he or she should be paid as if the full shift had been worked. Follow-up visits that occur while your employee is treating with their physician or physical therapist should be recorded as sick or vacation time. Please work with your injured employee about making up time away from work.
Please see the manager's unable to work section if your employee will be out of work beyond their current shift.
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|