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Workers' Compensation

Workers' Compensation Insurance (WCI) provides employees with medical benefits and, in some cases, weekly income payments, if you suffer a work related injury or occupational illness. For an injury or illness to be work related, it has to originate  while you are engaged in the work your job requires you to do for the university.

You're entitled to medical aid, hospital services, and medication required at the time of injury, and afterwards, to treat the work related injury. In some cases, you may get financial benefits to make up for a portion of lost earnings and/or a permanent impairment from the injury.

WCI does not compensate you for damage to or loss of your personal property.

Injuries Covered

A covered injury is one that happens because of, and during the performance of your job duties. In this case, "injury" means damage or harm to the physical structure of the body. This includes diseases or infections which result from the damage or harm. The term "injury" also includes occupational diseases. Ordinary diseases of life are not covered under WCI.

An injury is not covered if:

  • You were intoxicated.
  • You intentionally attempted to injure yourself or someone else.
  • You were engaged in horseplay.
  • Someone else injured you on purpose because of personal reasons.
  • You chose to participate in off-duty recreational, social, or athletic activity which wasn't part of your work-related duties.
  • You experience mental or emotional stress that arises from a legitimate personnel action, including a transfer, promotion, demotion, or termination.
  • The injury was caused by act of God unless your position exposes you to a greater risk than would apply to the general public.
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Reporting an Injury

If you're injured as described above or get an occupational disease, you should immediately inform your supervisor and complete an Employee Injury/Illness form, read the Notice of Network Requirements [PDF] and complete the Network Acknowledgement form. These forms should be completed by you and given to your supervisor and/or department human resources (HR) contact as soon as possible and generally within 24-48 hours of the injury. If medical treatment is needed urgently, these forms may be submitted as soon as practicable after medical treatment has been provided.

Once your supervisor receives your completed Employee Injury/Illness form and your signed Network Acknowledgement form, he/she will work with your department HR contact to submit the Employer’s First Report of Injury that initiates your workers’ compensation claim.  Your claim will be managed by an insurance adjustor in the Office of Risk Management Workers’ Compensation Insurance at The University of Texas System.

Failure to report your injury (or appearance of an occupational disease) within 30 days from the date of injury may cause your claim to be denied.

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Seeking Medical Treatment

You're entitled to reasonable and necessary health care that treats your work related injury, promotes recovery and assists you to return to work. The HealthPoint Occupational Health Program (OHP) is an on-campus clinic available to treat employee work injuries in the Austin area. Visit the HealthPoint OHP webpage to learn more about the services provided, including the on-campus clinic location and hours of operation or call the HealthPoint OHP at 512-471-4OHP (4647).

If advanced medical care is needed, or the HealthPoint OHP clinic is closed, or you live outside of the Austin area, you must select a healthcare provider from the workers’compensation IMO Network if you live in a Texas service area covered by the network.  Failure to select a provider from the network may result in you being financially responsible for your treatment services.

If you do not live in the network service area, you are not required to receive health care from the certified IMO Network.  In this case, verify with the health care provider you select that they do accept workers’ compensation insurance prior to receiving treatment.

Additional information about the certified IMO Network including the covered service areas, medical pre-authorization requirements, and obtaining treatment from a specialist is found in the Employee Handbook.

 

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Finding a Provider in the IMO Network

You may contact the HealthPoint OHP clinic at 512-471-4OHP (4647) to determine if you can be appropriately treated in the on-campus clinic.  If advanced medical care is needed or you do not work in Austin, injury care and treatment must be coordinated through the Injury Management Organization (IMO) Network. 

  • You must choose a Treating Doctor from the list of providers in the IMO Med-Select Network.  Use the Find a Provider online search tool to locate an in-network provider 24/7 or call 1-877-742-4477, ext. 151, Mon.-Fri. from 8am-4:30pm CST for assisting in locating a provider.
  • If you need a specialist, your IMO Network Treating Doctor will make a referral. 
  • If you need emergency care, you may seek treatment from the nearest urgent care facility or hospital emergency room.
  • You may have to pay the bill if you obtain health care from someone other than a Network doctor without Network approval.
  • If you refuse to sign the Network Acknowledgement form, you are still required to use the Network.
  • Additional information relating to the IMO Med-Select Network is available on The University of Texas Systems website.

Changing Treating Doctors

Although changing a network treating doctor is allowed, you are limited to the changes you can make.  Information about how to change your network treating doctor is found in the Employee Handbook. The Request for Initial or Alternate Treating Doctor form and where to submit the completed form is found on the IMO Med-Select Network website.

If you need additional assistance in changing your treating doctor, partner with the UT System insurance adjuster assigned to your workers’ compensation claim.

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