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Administration

Workers' Compensation Program

 

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Employee Health Resources for Worker's Compensation

The UHD Workers’ Compensation Claims Coordinator is the Compensation and Benefits Administrator in Employment Services and Operations

Reference the EHS homepage, "General Information" section, State of Texas Worker's Compensation Health Care Network subtitle for links to:

SORM's IMO Med-Select Network

Prescription Drug Services

Helpful Resources

Workers' Compensation Program

 Always feel free to contact SORM at 877-445-0006 whenever you have network questions

 

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UHDContacts

​Claims Coordinator (Compensation & Benefits Administrator in Employment Services and Operations)713-221-8443 

S910

Fax 713-221-2751​

​Environmental Health and Safety (EHS)

​713-221-8040 or 713-221-8232

S621

​Police Department

​713-221-8065

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What is Workers’ Compensation Insurance?

Workers’ compensation laws are based on the theory that the burden of on-the-job injuries should be shifted from the worker to the employing business, and ultimately to the consuming public, as a cost of doing business. The intent of these laws is to protect and benefit the employee by providing prompt, simple, effective, and inexpensive relief without regard to the fault of the employer, the employee or third parties.

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Who is Covered?

A University of Houston-Downtown employee who sustains an injury or occupational disease in the course of employment is entitled to receive compensation under the State Workers’ Compensation System. In the case of a fatality, the deceased employee’s legal beneficiaries are entitled to benefits.

Generally speaking, a UHD employee is a person who is in the service of the University and is on its payroll. However, the following people are not considered employees for purposes of workers’ compensation:

  • Independent contractors
  • Volunteers, except during a Governor-declared State of Emergency
  • Members of the state military forces, except while on active duty
  • Persons covered by federal workers’ compensation
  • Offenders 
  • Consumers or patients of a state institution or agency
  • .Non-employed students receiving a scholarship stipend

In most cases it is easy to determine if an on-the-job injury has occurred. Some cases, however, may require further investigation. It is not the responsibility of the Claims Coordinator or the supervisor to make this determination. If the injured employee feels that the injury or illness is work-related, then it should be reported. The determination of compensability is made by the State Office of Risk Management, whose decisions may be disputed before the Texas Department of Insurance–Division of Worker’s Compensation (TDI-DWC). Supervisors may include any additional information they feel is appropriate with the injury report. 

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What Does it Pay For?

Medical Services Payments

The SORM will pay only for those services or prescriptions that are determined to be reasonable and necessary and related to the injury.

  • Medical providers should bill on the prescribed forms and according to the medical fee guidelines established by the Division of Worker’s Compensation.

Income Benefits

  • Payment of compensation for time lost from work due to an on-the-job injury is made directly to the employee on a weekly basis, unless the monthly Temporary Income Benefits election is chosen.
  • Only those employees who are physically unable to perform their usual job task for more than seven days following the date of injury are eligible to receive weekly/monthly compensation payments.
  • The first seven consecutive or cumulative days following the injury date are called the waiting period and no weekly compensation payment is due for the time lost for that period. However, if an employee is off work for more than 14 calendar days, the weekly/monthly compensation for the waiting period is paid retroactively.
  • An injured employee may elect to use sick and/or annual leave instead of receiving lost-time benefits. While sick/annual leave is being used, lost-time benefits will not be paid.
  • These benefits continue until maximum medical improvement has been reached or 104 weeks have elapsed (whichever comes first). At that time, Impairment and /or Supplemental Income Benefits may become available. Lifetime Income Benefits and Death Benefits may also be available in some cases. 

 

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Compensation Due in Fatal Cases

  • Beneficiaries of a deceased employee are due weekly compensation payments equal to a percentage of the employee’s average weekly wages subject to a maximum amount and a minimum amount established by the Texas Worker’s Compensation Act
  • Weekly payments to the surviving spouse are payable for life or until the spouse remarries

  • Weekly payments to a child shall continue until the age of 18 or beyond such age if the child is actually dependent (disabled at time of the injury), or until 25 years of age if enrolled as a full-time student in an accredited educational institution

  • All other beneficiaries (where there is neither a surviving spouse nor child) are due weekly payments for 364 weeks

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Medical Services Payments

The SORM will pay only for those services or prescriptions that are determined to be reasonable and necessary and related to the injury.

 

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Last updated 7/20/2016 11:03 AM