1) What is workers' compensation?
The Worker’s Compensation Act is a part of the Iowa Code designed to provide certain benefits to employees who sustain injuries, occupational illnesses, or occupational hearing loss arising out of and in the course of their employment. Benefits are payable regardless of fault and are the exclusive remedy for the employee. Benefits are administered according to Iowa law.
2) What types of workers' compensation benefits does the law provide?
Iowa law provides for the payment of all reasonable and necessary medical care incurred to treat the injury or illness and weekly compensation due to incapacity to work or permanent impairment.
3) Who handles work related claims?
Iowa Department of Administration Services (DAS) has contracted with Sedgwick Claims Management Services to handle workers' compensation claims for state employees. Sedgwick CMS is responsible for determining compensability (accepting or denying a claim), authorizing the use of any alternate medical care provider, issuing benefits to employees based on lost work time, payment of medical bills, and paying permanent impairment benefits related to claims as required by Iowa Workers' Compensation law.
University Human Resources (UHR) is the university’s contact for workers' compensation questions or concerns. UHR will answer employees work-related questions, assist departments with appropriate and timely return to work for employees with physician restrictions, and assist with questions concerning payroll reporting for employees receiving workers' compensation benefits. Questions should be directed to 515-294-8917 or to firstname.lastname@example.org
4) Where should university employees go for medical treatment?
If a life-threatening emergency should arise, dial 911 and go directly to the nearest emergency medical facility for treatment. Non-life-threatening injuries or illnesses should be reported to the employee’s supervisor who will arrange medical care with:
Occupational Medicine, McFarland Clinic, P.C.
1215 Duff Ave
Ames, IA 50010
For appointments call: 515-239-4496
For cases that are non-life-threatening and that do not require an immediate referral to a clinic/hospital, employees may use Occupational Medicine located in the Technical and Administrative Services Facility (TASF) to treat their injury or illness. Occupational Medicine: 515-294-2056
5) Can employees choose to receive treatment with their personal physician?
Iowa Department of Administrative Services and Sedgwick CMS have a list of approved medical providers Approved WC Provider List page to provide treatment for work-related injuries or illnesses. Employees who choose to be treated by any other medical provider may not qualify for workers' compensation benefits and may be solely responsible for all medical costs related to the incident. This is in accordance with Iowa law.
6) Are Iowa State student employees covered under workers' compensation?
Student employees who sustain a work-related injury/illness while working (i.e., paid status) are typically covered under workers' compensation and should report their injury or illness to their manager/supervisor.
7) What if I am unsure about the actual date of my injury/illness?
Employees should use the date you first sought treatment, the date you first became aware of the symptoms, or the date you reported your incident to a manager/supervisor.
8) What are my workers' compensation reporting responsibilities?
- Notifying the employee's supervisor of any work-related incident by completing the Online First Report of Injury (FROI) via the ISU Incident Portal
- Obtaining medical care from an authorized medical provider.
- Keeping records of dates of medical appointments, mileage, and expenses incurred in obtaining medical treatment on a Mileage and Prescription Reimbursement Form.
- Attending scheduled appointments related to the workers' compensation claim. Failure to attend scheduled appointments may cause subsequent work absences to be charged to the employee's sick leave, or as recorded as LWOP (leave without pay) as appropriate.
- Providing the supervisor with a Work Status Report completed and signed by the authorized medical provider prior to returning back to work.
- Reviewing the information on the Work Status Report with the supervisor and confirming temporary work situations that may occur due to physician restrictions.
9) Are Accident Investigation Forms required to be completed for all work-related injuries/illnesses?
Although there is not a separate Accident Investigation Form for work-related injuries or illnesses, the questions previously reported on this form are part of the email that is sent to the listed supervisor when a claim is submitted. Supervisors are required to respond to the email with the necessary information within 24 hours of receiving the email. Supervisors who do not have accident investigation experience can contact Environment Health and Safety (EH&S) at 515-294-5359 for guidance and assistance in accident investigations, especially when a serious injury or major loss occurs. This information will automatically collected by EH&S when the supervisor responds to the email.
10) What if I need to have a prescription filled?
Sedgwick CMS has a list of participating pharmacy chains. Sedgwick CMS has contracted with Express Scripts for filling medications relating to workers' compensation injuries. A letter with a card will be sent to an injured employee within 24 hours of receipt of a First Report of Injury by Sedgwick CMS. The card should be presented to the pharmacy filling the prescription so the pharmacist can gain online access to information regarding that employee's eligibility for workers' compensation benefits. The employee will have the right to select any pharmacy to fill his or her prescriptions; however, the letter will contain a list of participating pharmacy chains. If the employee does choose to go to a pharmacy outside of the network, he or she will have to pay for the prescription and submit the receipts to Sedgwick CMS for reimbursement Mileage and Prescription Reimbursement Form. Employees who are prescribed a prescription prior to receiving a prescription card (i.e., following an initial medical appointment) will be provided a Temporary Prescription Services Form. This form will have information for the employee to give the pharmacy and provides some of the names of participating pharmacies as well as a toll-free number (1-888-786-9640) for the pharmacy to call and receive authorization. If problems occur, please call University Human Resources ER/LR office at 515-294-8917.
11) What happens if I am unable to return to work due to being taken off work or given work restrictions?
If you are taken off work or given work restrictions by the treating physician, you must provide your supervisor with documentation immediately upon receipt. Your supervisor will then determine whether work can be made available (i.e., work restrictions). If work is not available, you will be sent home. You are encouraged to keep in regular contact with your supervisor during your absence. If work does become available, you will be notified and expected to return to work.
12) When would I be eligible for workers' compensation benefits?
If your claim is accepted and determined compensable under Iowa workers' compensation law, you may be entitled to receive WC benefits after satisfying a three-day waiting period (excluding the date of injury). Employees may choose to take sick/vacation leave to cover the three-day waiting period. The three-day waiting period is credited back only if the disability exceeds 14 calendar days; after 14 days sick leave or vacation time used during the first three days should be credited back. (Note: If the employee is supplementing, the first three days should reflect use of an adjusted rate instead of a whole day of vacation or sick leave).
13) What is a Benefit Election P-28 Questionnaire?
After an employee has missed more than three (3) calendar days, they will receive a workers’ compensation benefit election questionnaire in their Workday inbox.
University employees may wish to supplement his/her workers' compensation payment(s) (check(s) issued by Sedgwick CMS) by electing to use their personal sick, vacation, or comp time. By electing this option employees will receive a proportionate of their University pay in addition to receiving their worker’s compensation payments. This will allow for the employee to receive compensation equal to their regular base pay. Employees that are able to supplement his/her pay will receive their ISU paycheck(s) on each scheduled pay date (bi-monthly or monthly).
14) Time off for medical appointments?
If an employee is required to miss work to attend physician appointments (including physical therapy) due to a work related injury/illness and has not yet met the 3 day waiting period the employee must use vacation leave, sick leave, comp time or leave without pay. When an employee has missed a total of 24 hours of work due to physician visits (the hours do not have to be consecutive) the employee then again is paid by ISU as if they were working and personal leave is not charged. The 24 hour period is tracked within Workday based on the “reason” for the time off.
Iowa law requires the employee to take personal leave for time missed during the 3 day waiting period. If the time off exceeds 14 calendar days, the first 3 days of workers' compensation benefits will then be paid by Sedgwick CMS and personal leave taken will be credited back to the employee by ISU. When determining if the waiting period has been met, any day of full or partial incapacity from work will count as a day of waiting period; however, hours away from work cannot be added together toward the waiting period. The days missed do not have to be consecutive.
15) Are employees eligible for FMLA for time away from work due to a work-related injury/illness?
This will depend on meeting the eligibility guidelines under FMLA. If you anticipate that an employee will miss time away from work, immediately contact the UHR ER/LR office at 515-294-8917 or email email@example.com to determine FMLA eligibility.
16) Do I continue to accrue sick and vacation leave if I’m unable to work?
University benefits accrue normally for employees on modified duty or who are supplementing, but do not when an employee elects to receive Workers' Compensation benefit payments only.
17) If I am not satisfied with the medical care I’m receiving, what should I do?
Employees are encouraged to contact a Sedgwick CMS toll-free at 1-866-342-3920. Sedgwick has the sole authority in authorizing approved workers' compensation medical providers.
18) Will I be notified of the status of my workers' compensation claim?
Yes, you will receive written notification from Sedgwick CMS regarding the status of your claim. If your claim is denied, appeal rights will be detailed in this letter.
19) Who should I contact with questions about completing a First Report of Injury (FROI)?
If you have questions, please contact the UHR ER/LR office at 515-294-8917. The following instructions will guide you through the process for completing a FROI:
- Log into the ISU Incident Portal
- Complete all fields with information pertaining to the incident.
- Click “Complete Incident” in the top right-hand corner when you are finished.
- The employee will receive an email once the incident is submitted to advise regarding next steps.
- The supervisor will receive an email once the incident is submitted. The email requires a direct reply to the questions within the email within 24 hours of receipt.
- University Human Resources reviews the incident and, if necessary, forwards the incident to Sedgwick where it will become a claim. The supervisor and employee will receive an email if the incident is sent on to Sedgwick that provides additional information and next step details.