4.23.2 Workers' Compensation Insurance Program

A. Purpose

The purpose of this policy is to give guidelines for the self-insured Workers’ Compensation Insurance Program at The University of Texas at Tyler.

B. Persons Affected

All employees that sustain an injury while in the course and scope of employment.

C. Definitions

N/A

D. Policy and Procedures

It is the policy of The University of Texas at Tyler that a self-insured Workers’ Compensation Insurance Program will provide certain benefits for injuries sustained in the course and scope of employment.

  1. ELIGIBILITY WAIVER, REVOCATION, AND NOTIFICATION OF COVERAGE
    1. All employees of The University of Texas at Tyler whose names appear on the payroll are eligible for Workers' Compensation Insurance as of January 1, 1991, as provided by the Texas Workers' Compensation Act and Chapter 503, Texas Labor Code.
    2. Employees who do not wish coverage may waive rights to all benefits prior to employment.
    3. The waiver may be revoked at any time during continuous employment and will be effective immediately.
    4. The institution shall give notice to all employees that Workers' Compensation Insurance has been provided.
  2. MEDICAL BENEFITS
    1. If an employee's injury is found to be compensable under The University of Texas System Workers' Compensation Insurance program, the employee is entitled to all health care reasonably required by the nature of the compensable injury.
    2. The injured employee is entitled to the employee's initial choice of doctor. This choice of doctor should be documented on the "Employer's First Report of Injury" form (TWCC-1). The employee may not change treating doctors without authorization from the Texas Workers' Compensation Commission (TWCC). If the employee changes treating doctors without authorization from TWCC, the employee may become personally responsible for any medical treatment rendered by the unauthorized physician.
    3. When purchasing prescription drugs for treatment of the work-related injury, the employee should not use his or her group health plan card. Most pharmacies will bill the U.T. System WCI Office directly upon verification of coverage. Personal and non-prescription items are generally not covered by the workers' compensation program.
    4. Unless the injured employee has received medical treatment from an unauthorized physician, he or she should not be billed directly for health care which is required to treat his or her work-related injury. If the employee does receive a bill from a health care provider, the employee should immediately send the bill to the U.T. System WCI Office for payment. All expenses for medical treatment are subject to fee guidelines established by TWCC.
  3. INCOME BENEFITS
    1. Workers' Compensation Insurance income benefit payments for the injured employee are generally expressed in terms of "weeks of compensation." Currently, one week's benefit is equal to seventy percent (70%) of the employee's average weekly wage. The benefits will be equal to seventy-five percent (75%) of the employee's average weekly wage for the first twenty-six (26) weeks of disability if the employee earns less than $8.50 per hour. The average weekly wage is calculated from the "Employer's Wage Statement" using a formula defined in the law. The weekly benefit is subject to a statutory maximum and minimum payment.
    2. No compensation accrues during the first seven days of absence from work due to the injury. During this "elimination" period, the employee must utilize accrued sick leave, accrued vacation leave, or be placed on "leave without pay" status. If the disability continues for four weeks, the elimination period then becomes payable provided the employee was not in a paid leave status for that time.
    3. If absence extends beyond seven days, the employee has the choice of continuing to receive full wages under accrued sick leave or vacation leave, if available, or applying for weekly compensation benefits. If weekly compensation benefits are paid, the employee must be placed on "leave without pay" until he or she returns to work. It is the employee's responsibility to inform his or her department of this choice and the department must keep the U.T. System WCI Office advised of current leave status. The employee may also be responsible for maintaining his or her other insurance coverages while on leave without pay.
    4. Payment of weekly compensation benefits for a job-related injury or occupational disease will not extend beyond 401 weeks from the date of injury except in very limited circumstances.
  4. DEATH AND SURVIVOR BENEFITS
    1. If the injury or occupational disease results in the death of the employee, the current statute provides for a lump sum funeral expense benefit. In addition, the surviving spouse is eligible for a weekly benefit payable until the spouse's death or re-marriage. In the event of re-marriage, a lump sum payment equal in amount to the benefits due for a period of two years will be paid to the surviving spouse. Surviving children may be eligible to share a portion of weekly death benefits.
    2. Any beneficiary claiming entitlement to receive death benefits must first file a "Statement of Beneficiary" form with both the U.T. System WCI Office and the Texas Workers' Compensation Commission. More detailed instructions regarding claims for death benefits may be obtained by calling the U.T. System WCI Office.
  5. NONDISCRIMINATION AGAINST CLAIMANTS
    1. The University of Texas at Tyler shall not discharge or in any other manner discriminate against any employee because the employee has filed a claim; instituted, or caused to be instituted, any proceeding under the Texas Workers' Compensation Act; or has testified or is about to testify in any such proceeding.
    2. An employee discharged in violation of this policy shall be entitled to be reinstated to his former position, upon appropriate adjudication.
    3. Nothing contained in this policy shall prevent discipline or discharge of any employee for just cause, in accordance with established discipline and discharge policy. Discipline and discharge actions must be pursuant to established policy and may be due to repeated violation of established safety regulations.
    4. This policy does not prohibit discipline and discharge for reasons other than retaliation.
    5. The University of Texas at Tyler shall cooperate with the Texas Workers' Compensation Commission and Texas Rehabilitation Commission in seeking to provide rehabilitation to disabled employees.

E. Responsibilities

See Policy and Procedures section.

F. Review

This policy shall be reviewed by Human Resources every five years or as legislation changes.

ORIGINALLY APPROVED:  12/01/2001

LAST AMENDED:  04/22/2009

REVIEWED:  AY 2014-15