Skip to main content

Administration

Filing A Claim For Workers' Compensation

On This Page:

 

Back to Risk Management               Back to Driving and Safety Home Page 

 

Filing a Claim

k.

File a claim for compensation with the Texas Department of Insurance-Division of Workers’ Compensation (TDI-DWC), no later than one year after the date of injury. If the injury is an occupational disease, filing must take place not later than one year after the employee knew (or should have known) that the disease was related to the employment. Forms are sent to the employee directly by TDI-DWC.

l.

To qualify for workers’ compensation benefits, the law requires that an employee who claims work-related exposure to HIV infection must provide a written statement of the date and circumstances of the exposure. According to 25 Texas Administrative Code 97.17 (b), by reference to 25 Texas Administrative Code 97.10 (a) (2), the following conditions constitute a possible exposure to HIV:

  • A needle stick or other penetrating puncture of the skin with a used needle or other contaminated item; or
  • Either a splatter of aerosol into the eye, nose, or mouth or any significant contaminated item; or
  • either a splatter of aerosol into the body or body fluids.

The law also requires the employee to document that, within 10 days after the exposure; the employee had a test result that indicated an absence of HIV infection (Section 85.116(c) Health and Safety Code).

Back to Top              Back to Risk Management               Back to Driving and Safety Home Page

 

Family and Medical Leave

m.

Family and Medical Leave is an additional option available to eligible employees for continuing insurance benefits (except disability insurance plans) and receiving the premium sharing from the state or the university toward the cost of health insurance. In the event of lost time resulting from an on the job injury or illness, the Claims Coordinator will provide the employee with information and forms necessary to apply for Family and Medical Leave, if the employee is eligible for leave benefits.

The injured employee must be employed in a position that accrues sick leave to be eligible to apply for Family and Medical Leave. Student and temporary employees who are injured on the job or have a work related illness are not covered under Family and Medical Leave. Employees should advise their supervisor of their intent to use Family and Medical Leave

Back to Top              Back to Risk Management               Back to Driving and Safety Home Page

 

The Claims Coordinator is Required to:

  • Work with the supervisor to complete and process the first report of injury,
  • Notify EHS of an employee’s work-related injury, illness or occupational exposure,
  • Maintain frequent contact with the employee on workers’ compensation leave,
  • Serve as the liaison between an injured employee and SORM,
  • Submit the required injury reports and notices to SORM,
  • Maintain all workers’ compensation claims filed by UHD employees for at least two years after the claims become inactive,
  • Prepare personnel actions for paid/unpaid leave and return from leave,
  • Coordinate Worker’s Compensation with FMLA leave, unpaid leave, and other leave programs available to the employee,
  • Advise ERS (Employees Retirement System of Texas) of the employee’s leave status,
  • Coordinate the reporting of leave on timesheets for payroll purposes,
  • Provide administration of the group insurance including, premium billing, filing of disability claims, and death claims if the employee dies.
  • Clear the employee to return to work with the supervisor and approve the return to work date.
  • Provide EHS with any additional information on the injury or illness that is received in ESO.

 

Back to Top             Back to Risk Management               Back to Driving and Safety Home Page

 

 

Prompt Reporting

Once an injury occurs, it is important the injury be promptly reported to the Claims Coordinator. The Claims Coordinator works with the supervisor to remind them that early reporting of injuries is crucial to investigate the accident, evaluate the claim and manage the employee’s medical care appropriately. Promptness ensures that proper medical care starts quickly and allows the claims adjuster to start benefits in a timely manner. It is equally important that the Claims Coordinator reports to the SORM in, a timely manner, when an injured employee returns to work. Supervisors must relay this information promptly to prevent overpayment of income benefits. Early personal contact may also help to determine the possibility of third-party liability. 

Back to Top              Back to Risk Management               Back to Driving and Safety Home Page

 

Liaison

The Claims Coordinator is the primary point of contact between the SORM claims adjuster and UHD. Upon receiving the first report of injury, the adjuster will contact the Claims Coordinator to verify the information provided and investigate the claim.

Back to Top             Back to Risk Management               Back to Driving and Safety Home Page

 

Claims Processing

The Claims Coordinator is responsible for supplying SORM with the appropriate information and forms so that their adjusters can properly process claims. There are various forms that the Claims Coordinator must file with SORM to ensure that the adjuster can manage the claim appropriately and remain in compliance with TDI-DWC rules. There are important time guidelines that must be adhered to when filing these forms.

Form

Review for Completeness and Submit to the SORM no later than:

Supervisor's Report of Accident (PDF)

(Forwarded from Supervisor within twenty-four (24) hours of the injury)

For Injury – No later than the fifth calendar day after the date of injury.

For Occupational Disease – No later than the fifth calendar day after the employee knew or should have known that the disease was related to the employment.

(Forward to Claims Coordinator and EH&S Office Representative immediately upon completion)

Employee’s Report of Injury (SORM-29) (PDF)

(Forwarded from Employee within 24 hours of the injury)

Forms are sent by Claims Coordinator to SORM within 24 hours of receipt.

(Forward to Claims Coordinator and EH&S Representative immediately upon completion)

Employer’s First Report of Injury or Illness (DWC-1S) (PDF)

The Claims Coordinator submits the First Report of Injury or Illness on-line to the SORM immediately upon receipt of the report from the supervisor. Information for the on-line submission is taken from the Supervisor Report of Accident and/or the Employee’s First Report of Injury or Illness.

Authorization for Release of Information (SORM 16) (PDF)

(Signed by and forwarded from Employee within 24 hours of the injury)

Employee Signed Form – No later than the 5th calendar day after the injury.

Witness Statement(s) (SORM-74) (PDF)

No later than the fifth calendar day after the injury, and a copy to EHS Representative.

(Forward to Claims Coordinator and EH&S Office Representative immediately upon receipt)

Employer’s Wage Statement (DWC-3) 

SORM Online Report - No later than the fifth calendar day after the injury.

Completed by the Claims Coordinator upon request by the SORM.

Employee’s Election Regarding Utilization of Sick and Annual Leave (SORM-80) (PDF)

(Inform the employee of their options to use or not sick and annual leave)

No later than the fifth calendar day after the first full day of lost time

(Forward to Claims Coordinator immediately upon receipt)

 Supplemental Report of Injury (DWC Form 6)

Claims Coordinator completes and files online no later than the third calendar day after the event occurred, and as requested by the SORM

 

Back to Top               Back to Risk Management               Back to Driving and Safety Home Page

 

Environmental Health and Safety's Responsibility

Once notified of an accident, the EHS Representative will secure the site, if possible, and begin the investigation to determine cause and other factors that contributed to the incident/accident. This will include:

  • An interview of all witnesses and if available, the injured person
  • Pictures taken of the scene and diagrams drawn as required
  • A report of the investigation findings submitted to the Claims Coordinator and to the SORM if requested

Based on the investigation findings, recommendations should be made to correct or eliminate contributing factors. A follow-up investigation should be conducted to ensure contributing factors have been corrected.

Back to Top               Back to Risk Management               Back to Driving and Safety Home Page

 

Re​ferences

Laws and Regulations

State Office of Risk Management

University of Houston System Administrative Memorandum: 

University of Houston-Downtown Policy Statement: 

Workers' Compensation Forms: 

 

Back to Top             Back to Risk Management               Back to Driving and Safety Home Page


Last updated 7/21/2016 11:16 AM