3.1.11 Workers' Compensation Leave & Benefits

Policy Section: Leaves of Absence

Policy Number and Title: 3.1.11 Workers' Compensation Leave & Benefits
Applicable to: All Employees
Effective Date: July 1, 2013

Description of Benefits

Medical Treatment & Costs
When a work-related injury or illness has been accepted by the University’s independent workers’ compensation claims administrator, all necessary medical, surgical, hospital and rehabilitation costs, if any, are paid under the University’s workers’ compensation insurance coverage.
 
The University has the right under law to designate physicians or other medical care providers for an employee who has a work-related injury or illness.
 
Employees should not seek medical treatment for a work-related injury without approval or authorization from the Office of Employee Health, except in emergency situations.
 
Failure to do so may result in denial of payment for medical services.
 
An employee may be taken to the University Medical Center at Princeton or a like facility due to an accident occurring off hours or on a weekend.
Authorization for Time Off
The Office of Employee Health must authorize and/or concur with the need for time out of the workplace due to a work-related injury.
 
Employees must notify the Office of Employee Health by the next working day as the University Medical Center at Princeton or other hospital facility cannot authorize time out of the workplace.
End of Medical Benefits
Medical benefits cease when the authorized treating physician certifies that the employee has reached maximum medical improvement, that is, no further benefit from medical treatment can be expected.
Re-aggravation of Original Injury
If the employee reaggravates the original injury within two years of the last medical treatment or wage payment, the employee can request, through the Office of Employee Health, that the University reopen the workers’ compensation claim.
 
The University’s independent workers’ compensation administrator makes all decisions regarding entitlement of benefits, including whether a claim can be reopened.

Wage Replacement

Waiting Period
Under the New Jersey workers’ compensation program, employees are compensated for absences due to work-related injuries or illnesses only after the time lost from the workplace is more than seven calendar days. This is the seven calendar day waiting period and is applicable to any one injury or illness.
The seven calendar day waiting period of disability does not need to follow the accident immediately or be consecutive.
Start of Workers’ Compensation  Pay
When the waiting period has been fulfilled, workers’ compensation pay is at once payable retroactively to the first day of absence from the workplace.
Work-Related Absences Prior to Fulfilling the Seven-Day Waiting Period
Prior to fulfilling the seven-day waiting period to qualify for workers’ compensation wage replacement, employees who are absent from work due to work-related injuries or illnesses may use paid leave benefits to compensate them, including but not limited to sporadic absence time, vacation, paid time off, optional holidays, etc., or may use leave without pay.
 
Compensation paid during this period is treated as taxable wages. All work–related absences must be authorized and approved by the Office of Employee Health.
 
Under no circumstances will employees be compensated twice for the seven–day waiting period. Employees will be required to reimburse the University for any duplicate payments.
 
Individuals who must schedule doctor appointments and physical therapy sessions authorized by the Office of Employee Health may be required to schedule these appointments or sessions during nonwork hours, based on the needs of the department and/or the availability of the health care provider.
Benefit Rate
 
The base benefit for eligible employees, as established by the State of New Jersey, is 70 percent of an employee’s gross weekly wages in effect at the time of the injury, up to a maximum determined by the New Jersey Commissioner of Labor.
 
Union employees should refer to their collective bargaining agreement.
Impact of Benefits on Taxes
The 70 percent base benefit is exempt from, or not subject to, federal income tax.
Probationary & Casual Employees
Probationary employees and casual hourly employees are paid at the benefit rate for the New Jersey Workers’ Compensation Law.
Compensation Paid When Disability Exceeds 26 Weeks
Compensation benefits will be paid directly by the University’ workers’ compensation claims administrator for all employees, whether or not their position has been held, should the disability exceed 26 weeks, at the lesser of:
  • 70 percent of regular base salary received at the time of injury or
  • the New Jersey workers’ compensation maximum weekly rate.
Permanent Partial & Permanent Total Disability Benefits
When a job-related injury results in a permanent partial or permanent total disability, employees are eligible for benefits as defined under New Jersey Workers’ Compensation Law, or in the case of an occupational disease or condition, within two years of the date when the employee learned about the condition and its connection to the University.
 
These benefits vary depending upon the extent of disability and are paid separately from wage replacement and medical benefits.
 
A formal claim petition must be filed within two years of the date of the injury or the last payment of compensation or payment of medical expenses, whichever is later. To obtain these benefits, the employee may seek the services of outside legal counsel.
Retirement Benefits A full retirement plan contribution based on base pay compensation before going out on workers' compensation leave will be made by the University each pay period.
Death Benefits 
A sum prescribed by law is payable to the dependent(s) of an employee who suffers death as the result of a work-related injury or illness, while in the course of employment.
Vacation Accrual During a Workers’ Compensation Disability Period
Employees who have been continuously disabled and are returned to work by their health care provider within the 26-week period will accrue vacation days for the first three months only that they are on workers’ compensation leave.
 
No vacation will accrue after three months of disability and absence or if the employees are not returned to work.
 
It is expected that vacation time accrued in one fiscal year will be taken before the end of the next fiscal year. However, there may be circumstances when employees are unable to use their accrued vacation time due to absence from the work place as a result of a workers’ compensation leave. At the discretion of the supervisor and Human Resources, vacation time earned during the period of disability may be carried over into the next fiscal year. However, the supervisor may require that the carried time is used by a specific date or it will be lost (see 3.1.8 Vacation).
Holding an Employee’s Position 
In general, supervisors will hold a position for up to 26 weeks for a regular benefits-eligible employee who is absent from the workplace because of a work-related injury or illness. (Positions are not held for probationary or casual employees.)
 
Supervisors may apply a variety of strategies such as the hiring of temporary replacements or casual employees and temporary reassignment of duties to other staff members to insure that the department can continue to operate effectively while the employee is absent.
 
On a case-by-case basis, employees who have a prolonged absence due to work-related injury may be replaced if: 
  1. medical prognosis, by an authorizing health care provider, documents that the employee’s condition will not improve sufficiently within the 26-week period to allow the person to return to work and be able to assume the essential duties of the position, or
  2. it can be clearly demonstrated that the continuing absence seriously interferes with the effective operation of the workplace.
Supervisors who believe that circumstances justify a replacement prior to the expiration of the 26-week period must submit a written request for authorization detailing the reasons for the request to Human Resources. A senior Human Resources manager will review the request with the supervisor and explore alternative options for meeting the department’s needs.
 
If there are no feasible alternatives, the request is submitted to the executive director for Human Resources for review and approval. Requests for replacement that are denied may be appealed to the vice president for Human Resources.