Understanding Workers' Compensation
Workers' Compensation Insurance (WCI) provides university employees with medical benefits and, in some cases, weekly income payments in the event that they suffer injuries while performing their job duties.
Employees are entitled to medical aid, hospital services, and medication required at the time of injury, and afterward, to treat occupational injuries or diseases. In some cases, employees may get financial benefits to make up for a temporary loss of earnings and/or a permanent impairment from an injury. WCI is not health insurance and it doesn't compensate employees for damage to or loss of personal property.
A covered injury is one that happens because of, and during, the performance of your employee’s job duties. In this case, "injury" means physical damage to an employee’s body. This includes diseases or infections that result from the damage or harm incurred while on-the-job. "Injury" also includes occupational diseases.
Life's ordinary diseases are not covered under WCI, so you should instruct employees to refer to their medical insurance information when they seek advice about non-work-related illnesses.
When an injury is not covered
- Employee was intoxicated
- Employee attempted to injure one’s self or someone else on purpose
- Employee was engaged in horseplay
- Someone else injured the employee on purpose because of personal reasons
- Employee chose to participate in off-duty recreational, social, or athletic activity that wasn't part of his or her work-related duties
- The injury was caused by an act of god (note: there can be exceptions under which an "act of god" is covered, especially if an employee's position exposes him or her to a greater risk than would apply to the general public)
It is against university policy to discharge or, in any other manner, discriminate against an employee because the employee has filed a workers' compensation claim. However, an on-the-job injury does not guarantee an employee a job with the university. An employee may be disciplined or discharged for a number of valid reasons, including making fraudulent statements concerning an injury, or for other reasons that would generally lead to discipline or discharge under stated university policy.
As a departmental HRS representative, you are responsible for coordinating efforts with managers and taking action to achieve the following:
- Reduce Workers' Compensation Insurance (WCI) claims by preventing injuries to employees through daily safety awareness and action in the identification and elimination of workplace hazards
- Control costs and loss of productivity to your department, the institution, and the taxpayers of Texas by investigating injuries when they occur
- Immediately report all injuries, occupational diseases, and fatalities to your departmental WCI representative—all injuries must be reported in a timely manner
- Encourage and facilitate an employee's return to work as soon as a release is issued by an employee's treating physician
NOTE: The university is required to report all occupational diseases and on-the-job injuries resulting in more then one day of disability to the Texas Department of Insurance (TDI) within eight calendar days. Failure to timely file the Employer's First Report of Injury could subject the university to a fine of $25,000/day for each violation. Your department should complete an Employer's First Report of Injury within four calendar days using *WCMENU, command FAD. For more information about completing the Employer's First Report of Injury, read the First Report of Injury instruction page.