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Workers' Compensation Definition
The Workers' 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 of the employee against the employer. Benefits are administered according to Iowa law.
The law provides for the payment of all reasonable and necessary medical care incurred to treat the injury and weekly compensation due to incapacity to work or permanent impairment. The employer has the right to choose the medical provider. Reasonable and necessary transportation expenses are also provided. Mileage for use of a private auto is reimbursed at a rate set forth in 876 IAC, 8.1(2).
Claim Services Responsibilities
The Department of Administration Services (DAS) has contracted with Sedgwick Claims Management Services (CMS) 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 ISU contact for workers' compensation issues. UHR will answer workers' compensation questions, assist departments with appropriate and timely return to work for employees with physician restrictions and assist with questions concerning payroll reporting for employee's receiving workers’ compensation benefits. They can be reached at 515-294-8917 or firstname.lastname@example.org.
Reporting a work related accident, injury or illness
All accidents and injuries occurring at work or in the course of employment must be reported to the employee's supervisor, even if no medical attention is required. The supervisor and/or employee are responsible for electronically completing a First Report of Injury (FROI) via the ISU Incident Portal. Incidents that are not reported may cause an employee to be ineligible for future benefits related to this injury or illness. The filing of an incident report is not an admission of liability. Each report will be evaluated by the state's third party administrator to determine whether the claim meets the criteria to be classified as workers' compensation. The supervisor should make no representation to the employee that the claim will be accepted or denied.
Work-related injuries or illnesses must also be documented for Occupational Safety and Health Administration (OSHA) reporting purposes if an event or exposure that occurred in the work environment caused, contributed to a condition or significantly aggravated a pre-existing condition. This potentially includes injuries while the employee is on break, in the restroom, traveling on business or engaged in work activities such as training required by the employer.
Supervisors or the injured employee will need to log into the ISU Incident Portal to complete a FROI. If the employee completes the FROI, the supervisor will receive an email notifying them of the incident.
When an employee believes he/she has experienced an occupational illness or injury that was acquired gradually (i.e. repetitive motion condition) he/she should use the date the employee first sought medical treatment for the condition or the date the employee first became aware of the symptoms as their date of injury.
The email received by supervisors upon submission of the FROI for one of their employees will include information relating to the Accident Investigation as part of the FROI process. We ask that they reply directly to the email with the answers to the questions asked within 24 hours of receiving the email. Supervisors who do not have accident investigation experience can contact Environmental Health & Safety (EH&S) (515-294-5359) for guidance and assistance in accident investigations, especially when a serious injury or major loss occurs. This information will automatically be saved into the system once the email reply is sent.
The status of a workers' compensation claim (whether or not it is compensable) is determined by Sedgwick CMS. Sedgwick representatives are available by calling (866) 342-3920 (toll-free phone number) for inquiries concerning whether a claim has been accepted or denied.
Injuries that occur while going or coming to work are considered on a case-by-case basis. In Iowa, the general rule is that the course of employment commences after the employee reaches the work premises where her/his actual work begins and is carried on and ceases when he/she leaves.
Sedgwick CMS will notify the employee in writing if a claim is denied. The employee should then submit this information to their personal insurance carrier. Appeal rights/processes will be detailed in this letter.
Medical Bill Reimbursement
When an employee receives a medical bill for work-related injury or illness treatment, forward a copy of the bill to Sedgwick CMS, PO Box 14628, Lexington, KT 40512 or contact the University Human Resources at 515-294-8917 or email email@example.com with questions or concerns regarding payment