Wage Payment Information
Workers' compensation provides benefit payments for medical care with an authorized provider and disability benefits. The first appointment for a work-related injury at the authorized medical provider is paid by ISU at 100%. Continued treatment and associated costs will be reviewed by Sedgwick CMS and if accepted as compensable and authorized, will also be paid at 100%. All other workers' compensation benefits (mileage, medical bills, etc.) are paid directly to the employee or medical provider through the state's third-party administrator (Sedgwick CMS).
Payment of unauthorized care may be denied by the workers’ compensation insurer (Sedgwick), so it is important that treatment is authorized by Sedgwick CMS
Pay for Missed Work Time
Payment of lost wages begins when these conditions have been met:
- The employee's claim has been accepted by Sedgwick CMS as work-related.
- The injury results in more than three (3) calendar days missed.
- The time missed is for one of the following:
- The employee has a work status form from an occupational medicine physician placing the employee off work. Note: this means that the employee would have been incapacitated from any work.
- The employee has a work status form from an occupational medicine physician with work restrictions and the employer is unable to accommodate the restrictions resulting in lost time for the employee.
Lost time benefits begin on the fourth calendar day of disability following the injury. (The actual date of injury is not counted as a part of the three-day waiting period.) However, the three-day waiting period is payable if the disability exceeds 14 calendar days. Iowa law requires the employee to take personal leave the first three days. However, if the time off exceeds 14 days, the first three days of workers' compensation benefits will then be paid.
Definition of three-day waiting period: Three (3) calendar days of full or partial incapacity (Iowa Code 85.27). Days missed do not have to be consecutive. To qualify as a waiting-period day, the time missed must be physician-directed for the employee and meet one of the conditions above under number 3. Time missed.
The actual date of injury is not counted as a part of the three-day waiting period nor is time missed exclusively for physician appointments.
Iowa Statutes specifically allow an employee to be paid for a full day of work on the date of injury regardless of what time the employee leaves work. Thus, an employee would not be required to use sick time off or vacation time off when seeking medical care on the actual date of injury.
Receipt of your first missed time wage replacement benefits check from the workers’ compensation insurance company is dependent on the completion of the Sedgwick CMS investigation. Once a claim is approved, missed time is paid weekly. The check is sent directly from Sedgwick to the employee's home address.
Injured employees who are unable to work in any capacity (full or partial days of work), are entitled to approximately 2/3 of their normal gross salary based on rates set forth by the workers' compensation commission. However, employees may elect to "supplement" with their previously earned university benefits (sick time off, vacation time off, compensatory time) in order to receive a full paycheck. Payment for the waiting period (employee's first three calendar days away from work) is not paid unless the employee is off 14 or more calendar days.
Workers’ compensation benefits are not taxed by the Federal or State government. At the end of the year, the employee will be responsible for paying taxes on reported income from Iowa State University. This income does not include any workers’ compensation payments.
Supplementing Personal Leave
Workers’ compensation benefits provide employees with a percentage of their normal wages while on approved medical leave. If approved for workers’ compensation, employees may elect to supplement their workers’ compensation benefits with their own vacation or sick time off in order to continue receiving full wages. However, employees can elect not to supplement the workers’ compensation benefit and go on medical leave without pay. Employees choosing not to supplement receive no payment from the university. A P-28 form must be completed indicating which choice the employee wants to utilize.
Supplementing is using accrued personal time off to add to the workers’ compensation missed time benefits to bring the employee's income during the healing period up to as close to his/her normal salary as possible.
If the injured employee chooses to supplement personal leave, they must supplement until benefits that were elected to use are exhausted. If an employee elects workers’ compensation pay/benefits only, they may choose to supplement later. Employees choosing not to supplement personal time off will be placed in leave without pay status.
When an employee elects to supplement, workers' compensation will calculate the adjusted rate of vacation or sick time off to be used per day. The adjusted rate for vacation and sick time off for employees supplementing may change as their rate of pay from the institution is changed (e.g., each FY, merit increases)
A P-28 questionnaire must be completed by the employee and submitted to the supervisor when the employee incurs lost time.
Use of Personal Leave to Attend Physician Appointments
Iowa law requires the employee to take personal leave for time missed during the three-day waiting period. If the time off exceeds 14 calendar days, the first three 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.
Once an employee satisfies the three calendar day waiting period for workers’ compensation pay benefits, any time missed for physician appointments after the employee returns to work (with or without restrictions) must be paid by ISU at full pay (as if the employee worked) and personal leave will not be charged. Work time missed due to physician restrictions will be reimbursed by our workers’ compensation insurance carrier as per Iowa regulations.
If an injured employee has not satisfied the three-day waiting period: Any time missed for physician appointments the employee must use vacation time off, sick time off, 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.
Physical therapy appointments are considered medical treatment appointments.
Length of Workers’ Compensation Benefits
Benefits will end when:
- the employee has returned to work, or
- the occupational medicine physician releases the employee from treatment, or
- the physician determines the employee to be medically capable of returning to substantially similar employment.