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

Roles, Responsibilities & Procedures

Introduction
Timely and accurate reporting of work-related injuries and illnesses is essential to ensure payment for medical treatment and time lost from the workplace. The supervisor and employee jointly share responsibility for prompt reporting of work-related injuries and illnesses.
Employees
Notification
Employees must notify their supervisors immediately following a work-related injury and no later than the next scheduled work day.
 
Employees must also contact the Office of Employee Health to:
  1. schedule an appointment following the injury and by no later than the next scheduled work day and
  2. enable the Office of Employee Health to complete the required State of New Jersey form, “Employer’s First Report of Accident, Injury or Occupational Illness.”
For serious injuries, employees, or their coworkers or supervisors, should call 9-1-1 for assistance. Public safety officers will evaluate and determine the appropriate course of action.
Absences Exceeding Seven Calendar Days
When absences exceed seven calendar days, employees must2:
  1. complete the application provided by the Office of Employee Health;
  2. have their authorized physician or the Office of Employee Health complete the medical certificate;
  3. ensure that both forms are returned promptly to the Office of Employee Health and by no later than two weeks from the onset of the work-related illness or injury; and
  4. attend all regularly scheduled follow-up visits with or as directed by the Office of Employee Health and, if applicable, the outside treating physician.
Follow-up Care
Employees must attend all subsequent follow-up visits with or as directed by the Office of Employee Health and/or, if applicable, the outside approved treating physician, including all physical therapy or other approved medical appointments.
Return to Work
Employees must meet with the Office of Employee Health for a return-to-work evaluation prior to returning to work.
Proper Claim Reporting and Billing Instructions
The University’s third party claims administrator will pay for all medical treatment as prescribed and authorized by the Office of Employee Health.
 
Employees should have their providers contact the Office of Risk Management about questions or information about procedures for proper claim reporting and reimbursement because physicians or hospitals may not have proper billing instructions for emergency care provided for a workers’ compensation claims.
Procedures for Filing Claims for Out-of-Pocket Medical Expenses
If employees have authorized out-of-pocket medical expenses, such as prescription drugs, they should provide receipts to the Office of Employee Health or the Office of Risk Management in order to obtain reimbursement.
 
Employees who have questions about their out-of-pocket expenses should contact the Office of Risk Management.
Supervisors
Notification
Supervisors should notify, or ensure that the employee has notified, the Office of Employee Health to schedule an appointment for the injured worker immediately following the injury and no later than the next scheduled work day.
 
In the event of a serious injury, supervisors should call 9-1-1 for assistance. Public safety officers will evaluate and determine the appropriate course of action.
Notification When Injuries Involve Hazardous or Toxic Substances
For injuries involving hazardous or toxic substances, supervisors should make every effort to notify the Office of Environmental Health and Safety on the day the injury occurs.
Follow-up Care
Supervisors must permit employees to return to the Office of Employee Health for all subsequent follow-up visits.
 
Supervisors should remain in contact with the Office of Employee Health and/or the Office of Human Resources to:
 
  1. ensure that the employee is providing the required medical certification and
  2. plan if the employee is unable to be at work or perform the essential functions of the job.
Office of Employee Health
Approval of Benefits
The Office of Employee Health evaluates the medical nature of the work-related illness or injury to determine whether time out of the workplace is necessary.
Medical Oversight
The Office of Employee Health has responsibility to treat and/or refer the injured employee to an authorized physician and
  1. coordinate care between the employee and the authorized physician, including the review of medical certificates;
  2. approve any sporadic work-related absences and/or a leave of absence;
  3. determine whether the employee can perform the essential functions of the job with or without reasonable accommodations due to limitations in consultation with the supervisor and Human Resources, as needed; and
  4. review and approve out-of-pocket medical expenses incurred.
Communication
The Office of Employee Health has responsibility to communicate and/or coordinate with the supervisor, the Office of Risk Management, and/or the Office of Human Resources regarding:
 
  1. time out of the workplace;
  2. return to work plans;
  3. temporary or permanent work restrictions; and
  4. any other circumstance related to the employee’s injury or illness, including but not limited to medical care, time out of the workplace, medical expenses, hazardous or toxic substances.
Confidentiality
All medical information will be maintained by the Office of Employee Health and is confidential.
 
In all cases, the offices of employee health, risk management and human resources work with the supervisor and the employee to ensure that appropriate procedures are followed while maintaining the confidentiality of the employee's medical information.
 
Under no circumstance should the supervisor or Human Resources inquire about the employee’s underlying medical condition or diagnosis and should communicate only with the employee about the employee’s ability to perform the job duties or plans to return to work.
 
The employee is required to discuss the anticipated period of absence and plans to return to work with the supervisor or Human Resources.

Limitations

Underlying or Pre-Existing Medical Conditions
There are no workers’ compensation benefits for underlying or pre-existing medical conditions.
Reopening a Claim
If treatment ceases, the employee may request to reopen the claim within two years after the last date of medical treatment; the previously completed waiting period remains in effect.
Maximum Medical Recovery and Long Term Disability
If the authorized treating physician certifies that maximum medical recovery has been reached in the treatment of a workers’ compensation disability (that is, no further medical improvement can be expected), no further workers’ compensation benefits (including medical treatment) will be paid.
 
The University will make reasonable efforts to determine if the employee can perform the essential functions of the former position, with or without modifications and to consider transfer to another available position within the department for which the employee is qualified.
 
Employees who cannot return to the workplace will be placed on a short-term leave of absence without pay pending review and possible certification under the University’s Long Term Disability Insurance Plan.
 
Employees who are not certified for long term disability benefits and who cannot perform the essential job functions of their former position or another available position for which they are qualified will have their employment terminated or may choose to retire, if eligible.
Workers’ Compensation  Leave & the Family & Medical Leave Act
Time absent from the workplace because of a workers’ compensation injury or illness that has been approved by the Office of Employee Health is also counted as time taken under the Family and Medical Leave Act (FMLA) for eligible employees.
 
The FMLA covers regular full–time and part–time employees who have at least one year of service. The law provides that an employee may take an unpaid leave of up to 12 weeks within a 12-month period for a personal serious illness. It also guarantees that the employee be allowed to return to the same or comparable position within the 12-week period (see 3.2.1 Family and Medical Leave).
Graduate & Undergraduate Students
Students who perform work and are paid wages by the University are covered for workers’ compensation benefits as long as the injury occurs within the course and scope of employment.
 
All eligible employed students who have satisfied the seven-day waiting period and who receive authorized medical care are eligible for a benefit amount of 70 percent of gross weekly wages received at the time of injury, up to a maximum rate established by the New Jersey Commissioner of Labor.
Senior Visiting Fellow, Visiting Fellows & Visiting Research Fellows
Senior visiting fellow or visiting fellows are employees of their home institution and not considered to be Princeton University employees. Therefore, they are not eligible to receive workers’ compensation benefits from Princeton University. They must apply to their home institution or university for those benefits.
 
Visiting research fellows are not Princeton University employees and, therefore, are not eligible to receive workers’ compensation benefits.
Others
Individuals hired through an outside temporary employment agency or outside contractor must apply directly to their agency or employer for benefits.
 
Employees while on jury duty are not covered by workers’ compensation.
 
Volunteers and independent contractors are not considered to be employees and, therefore, are not covered by workers’ compensation while performing volunteer work for Princeton University.


2 Employees who do not follow the prescribed treatment and/or procedures will likely have their workers’ compensation benefits terminated and/or may be subject to disciplinary procedures up to and including termination.