Injury Occurs

1. Medical Only Claims – Remain at Work (Less than 7 calendar days off work) Injury Occurs Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room Supervisor gives employee claim filing packet. FROI* submitted to MCO by provider or employee Employee completes/signs Part A (Incident Report) Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist. BWC assigns a claim number & allows or disallows the claim MCO* contacts employee and sends FROI to BWC* Follow up by BWC certified POR* POR releases employee with or without restrictions and identifies treatment plan, including duration of restrictions. Workers’ compensation specialist provides POR with employee’s job description. POR identifies specific work duties within restrictions POR releases worker to full duty without restrictions END If modified work is not possible employee remains off work and continues treatment. Supervisor offers employee modified work whenever possible Employee reports for duty and supplies supervisor with copy of restrictions. Supervisor contacts workers’ compensation specialist for work modification assistance Supervisor forwards copy of work restrictions to workers’ compensation specialist LEGEND: FROI = First Report of Injury HSC = Health Science Campus MCO = Managed Care Organization POR = Physician of Record RTW = Return to Work Blue Text = Employee Action Red Text = Supervisor Action Green Text = Workers’ Compensation Specialist Action Employee is rechecked by POR No restrictions Full Duty

2. Lost Time Claims – Return to Work (Over 7 Calendar Days Off Work) Injury Occurs Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist. Employee completes incident report Employee completes/signs Part A (Incident Report) Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room Supervisor gives employee claim filing packet. FROI submitted to MCO by medical provider or employee FROI submitted to MCO by medical provider or employee Workers’ compensation specialist certifies/rejects the claim Supervisor forwards all Absence Reports to workers’ compensation specialist Follow up with BWC certified POR. Physician may prescribe therapy services and diagnostic testing; worker is unable to return to work. BWC assigns a claim number & allows or disallows the claim Workers’ compensation specialist faxes CWA Wage Advancement Agreement to BWC. Employee’s time card reflects sick/vacation for first 7 calendar days off work. Employee notifies supervisor of lost time work status.Supervisor notifies workers’ compensation specialist. BWC begins paying compensation unless UT approves salary continuation Test for diagnosis (health care services geared to early, safe return to work/transitional work) BWC payments are sent directly to employee Wage Advancement obligates the employee to endorse to the University payments of Worker’s Compensation to the extent of the advancement. Diagnosis determined and medical care rendered After missing work for 7 consecutive calendar days, BWC pays 72% of gross wage for the first 12 weeks of injury and 662/3% thereafter. Workers’ compensation specialist gives physician a copy of employee’s job description. Physician releases employee with restrictions, prescribes transitional work, including therapy intervention, on C-9 Form Employee is offered modified or transitional work Employee accepts modified or transitional work

3. Transitional Restrictions BWC stops payments if employee refuses modified or transitional work Transitional plan approved by BWC If modified work is not possible employee remains off work and continues treatment. Supervisor offers employee modified work whenever possible Therapist may do a functional capacity evaluation for abilities Supervisor contacts workers’ compensation specialist for work modification assistance Therapist develops transitional work plan & establishes a rehab schedule Monitoring of on-site therapy by workers’ compensation specialist & supervisor Employee reports for duty and supplies supervisor with copy of restrictions. Transitional work ends when physician has released employee without restrictions or employee has participated in the program for 90 days. Supervisor forwards copy of work restrictions to workers’ compensation specialist Employee is rechecked by POR No restrictions Full Duty