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Workers' Compensation Program
- Reporting a Claim
- Notice of Healthcare Provider Panel
- Approved Health Care Provider Map & Directions
- Employer's Report of Occupational Injury or Illness Form
- Instructions for Completion
- Employee Notification Acknowledgement Form
- Frequently Asked Questions
Workers' Compensation Insurance is a statutory program that provides medical coverage and, in some instances, income maintenance to employees who are disabled as a result of a work related injury or illness. All full-time and part-time faculty, staff, and student employees (salaried or on wages) are eligible for workers' compensation coverage.Insurance Benefits and Method of Payment
Payment for all medical services, supplies, and medicines that are reasonable and medically necessary for rehabilitation, surgical, and hospital care (as determined by the workers' compensation insurance company) is allowed at no cost to the employee. Also included are the costs of orthopedic appliances and training in their use.
Employees who are disabled for more than seven (7) calendar days as a result of a work-related injury or illness may also be eligible to collect disability income payments at a rate of approximately 66-2/3% of their average weekly wage as defined by the Workers' Compensation Act.
Wage loss is not payable to an employee for the first seven (7) calendar days, unless the disability exceeds fourteen (14) calendar days. This is known as the waiting period. After fourteen (14) continuous calendar days of disability, the employee will retroactively receive approximately 66-2/3% of his/her average weekly wage for the first seven calendar days of disability.
During the first seven (7) days of disability, the employee may apply up to five (5) University provided sick leave days. In the event the disability exceeds (14) calendar days, payment for the first week of disability is made to the injured/ill employee as allowed under the Workers' Compensation Act. The employee will be required to reimburse the University for those sick days for which the employee was paid. The sick days will then be added back to the employee's sick time balance. Questions concerning the use of sick time as a result of a work-related injury should be directed to the Office of Human Resources.
When an employee receives Workers' Compensation disability payments at the rate of approximately 66-2/3% of his/her average weekly wage, his/her university salary will be made whole by accrued University short-term or long-term disability benefits that the employee has available. The employee can also use accumulated sick time to supplement workers' compensation income if neither short-term nor long-term disability income is available to him/her. The amount of compensation paid by the Workers' Compensation insurer to the injured worker is reduced from the employee's University gross payroll amount.Prescriptions (Express Scripts)
The University's workers' compensation insurer has signed an Agreement to participate in the Express Scripts Workers' Compensation Pharmacy PPO . Employees should not use their group prescription plan card for medicines that are compensable under their workers' compensation claim. Employees should take their prescription to one of the participating pharmacies and provide the pharmacist with their social security number and date of injury. The pharmacist will submit the bill directly to the insurer. In the event a pharmacist receives notice that Express Scripts cannot identify the injured employee or some other issue arises, the employee should pay for the prescription and submit the receipt to the Risk Management Office.Reporting a Claim
- Workers' compensation claims must be reported to the Risk Management Office within one business day of the accident.
- To report a claim, download the form Employer's Report of Occupational Injury or Disease Form or
- Claim forms can also be obtained by calling the Risk Management Office at 610.758.3899.
- Instructions for completing the text (LIBC-344-rev 1-02) can be found at this link.
- Working together, the injured employee and supervisor must complete the Employer's Report of Occupational Injury or Disease Form, providing as much information as possible regarding the injury. Completed forms must include the supervisor's signature.
- The completed Employer's Report of Occupational Injury or Disease Form (LIBC-344 rev 1-02) and the signed Workers' Compensation Employee Notification Acknowledgement Form should be faxed to the Risk Management Office at 610.758.5855. The completed/ signed original forms should be sent via campus mail to the Risk Management Office.
- Immediately provide as much information as you can about your injury or illness to your supervisor or departmental designee. This person will submit the requisite forms to the Risk Management Office.
- If you require medical treatment, follow the procedures and go to one of the healthcare providers as set forth on the Notice to All Employees - Healthcare Provider Panel and Procedures.
- Sign and give your supervisor the Workers' Compensation Employee Notification Acknowledgement Form for forwarding to the Risk Management Office.
- Direct your injured employee to the Healthcare Provider Panel & Procedures Notice to All Employees if they require medical treatment.
- Forward the completed original Employer's Report of Occupational Injury or Disease Form (LIBC-344) and the signed Workers' Compensation Employee Notification Acknowledgement Form to the Risk Management Office within one business day of your knowledge of the incident.
- Immediately notify the Risk Management Office if an employee misses at least one day of work because of the injury
- Notify the Risk Management Office when an employee returns to work after a workers' compensation leave.
Note: Should the employee be disabled for an extended time period (e.g., post-surgery, etc.), the supervisor and/or the employee should make every effort to keep the Risk Management Office informed as to the injured employee's progress. At a minimum, Risk Management must be provided with a status update following each doctor's appointment and be made aware of the next scheduled appointment.
Your supervisor has been provided with Workers' Compensation information and should be able to clarify any questions you may have. However, should you have additional questions concerning completion of the form, provider panel/procedures, etc., please contact the Risk Management Office at 610.758.3899.Am I required to treat with the PMA Insurance Group Panel of Physicians? If so, for how long?
Yes. The Pennsylvania Workers' Compensation Act requires that employees of an employer who has posted an approved healthcare provider panel treat with that panel for work-related injuries for 90 days from the first day of treatment. If an employee chooses to treat with a non-panel provider before the 90-day period has expired, the employer is not responsible for paying the non-panel provider for services.Who should I notify about my injury/illness?
Notify your Supervisor as soon as possible (claims filed later than 24 hours following an injury may be denied or encounter other processing difficulties) so that the appropriate Injury/Illness Report can be completed. This report (original) is sent to the Risk Management Office which will file the claim with the University's workers' compensation insurer.If I'm taken to the hospital or am seen by another medical provider and they want information about who they should send the bill to, what do I tell them?
The hospital/medical provider should forward invoices, along with the appropriate treatment documentation as required under the Workers' Compensation Act, to the attention of the University's workers' compensation insurer: PMA Insurance Group; P.O. Box 25248 ; Lehigh Valley , PA 18002-5248.What should I do with the medical bill if I receive it at my home?
You can either mail it to the University's workers' compensation insurance company at the above address or forward the bill to the Risk Management Office for processing.What do I do if I receive medical bills or a collection notice as a result of treatment for my work-related injury?
Lehigh University is responsible for medical bills deemed reasonable and necessary which are directly associated with a work-related injury. All bills associated with the treatment of a work-related injury should be forwarded to the University workers' compensation insurer - PMA Insurance Group, P.O. Box 25248 , Lehigh Valley , PA 18002-5248 . If you receive a notice from a credit agency regarding unpaid bills which are associated with your work-related injury, immediately contact the Risk Management Office at 610.758.3899.What do I do if my physician has prescribed physical therapy during working hours?
Physical therapy should be scheduled before or after working hours. Time away from work for physical therapy can only be authorized by your supervisor. Such time can be compensated only if you use excused absence or vacation time available to you.When will I get reimbursed for wage loss due to a work-related injury?
Workers' Compensation only covers time lost due to a medically certified disability. This means that a physician must restrict you from some activity that prevents you from doing your job. You must have this medical documentation in order to qualify. Once a doctor has certified your disability, there is a seven-day waiting period until workers' compensation benefits for wage loss begin. If you are entitled to any workers' compensation payments, the first check will be sent within 21 days from the first day of disability.Who do I call if I have not yet received my check for Workers' Compensation?
If your payment is late, contact the Risk Management Office at 610.758.3899.If I have missed work due to a work-related injury, what documentation is needed when I am released to return to work?
A medical release (listing restrictions, if any) should be given to your supervisor and a copy sent to the Risk Management Office.Should you have additional questions, please contact the University's Risk Management Office at 610.758.3899. For questions concerning the recording of time off as a result of a work-related injury and/or short-term or long-term disability benefits, please contact the University's Office of Human Resources at 610.758.3900.