is Worker’s Compensation Insurance?
Answer: Worker’s compensation insurance is a system in which an injured worker receives medical and/or compensation benefits for injuries arising in the course and scope of their employment.
What happens if I am injured on the job?
Answer: Employees are required to report any work related injury to their direct supervisor. A supervisor’s report of injury (SROI) will be completed and if medical treatment is necessary, the employee can receive first aid from the school nurse. If medical treatment beyond first aid is necessary, the employee may be directed to go to the district’s Occupational Medical Clinic for treatment. If restrictions are received and light duty is recommended, the employee’s supervisor/administrator will discuss them with the employee and will advise the Supervisor of Loss Control in the Employee Benefits department if the restrictions can be accommodated. This information will be passed on to the Worker’s Compensation carrier/TPA.
What happens when an employee goes to the occupational clinic/doctor for a job related injury?
Answer: The Occupational medical clinic will give the employee a form to complete and sign. By signing the form, the employee has filed a claim and has applied for worker’s compensation benefits. The clinic will send a copy of the form to the Industrial Commission of Arizona (ICA), the employer, and our worker’s compensation carrier/TPA. The ICA and the district carrier will use this form and the employer’s report of injury to start the claim process on behalf of the injured employee.
Who is the Industrial Commission of Arizona (ICA)?
Answer: The Industrial Commission is a state agency and the governing body for Worker’s Compensation and is responsible for deciding disputes and monitoring the claim.
If I need care, may I go to my own doctor?
Answer: Yes, but the district does have the right to request you be seen by the district’s preferred occupational medical provider (Concentra) one time.
How are medical bills paid and by whom?
Answer: If the claim is approved, medical bills and covered services will be paid by our worker’s compensation carrier/TPA on behalf of Mesa Schools (we are self-insured for worker’s comp). Our preferred worker’s compensation occupational medical clinic (Concentra) will send all billing directly to our carrier for payment. If you are treating with someone outside of our preferred provider network, the employee becomes responsible to provide the physician’s office our worker’s compensation billing information. **Not all physicians will accept worker’s compensation claims.
How are lost wages paid if an employee is unable to work?
Answer: Entitlement to lost wage compensation is regulated by the ICA. There is a 7 day waiting period to meet before lost wages are considered and become payable on day 8. Entitlement to compensation is based on calendar days (not work days) and includes Saturdays, Sundays and holidays. If an employee is eligible for sick/vacation time, it will be used during this waiting period for compensation. The ICA starts counting days lost the day after the injury date.
Do I need to complete Leave of Absence paperwork?
Answer: Yes, if you will be off work for more than 5 days due to an injury, you are required to file with Human Resources for FMLA. The HR department will receive your medical information and dates missed from the Supervisor of Loss Control. If the injured employee is eligible for FMLA, the HR department will send a packet to the employee for them to request FMLA out in the mail. This paperwork needs to be completed by the employee and treating doctor and returned to HR. Follow the instructions provided in the packet.
do I contact if I have questions?
For information about your claim, medical bills, lost wages:
Call the carrier/TPA (presently Sedgwick Claims Management)
Christina Oros- Adjuster
For work restrictions or general
Wendy Mueller- Workers Compensation Supervisor
For questions about Family Medical Leave
District Human Resources