The Workers Compensation Claims Process

1. The Workers Compensation Claims Process START (Click Here)

2. The Workers Compensation Claims Process START (Click Here)

3. Ouch! A workers compensation claim begins when an employee suffers an occupational injury or illness. Occupational injuries result from work accidents or exposures involving the work environment (e.g., cuts, fractures, and sprains). Occupational illnesses include, but are not limited to, skin diseases, respiratory disorders, and poisoning. After an incident, the employee and administration both have responsibilities. Consistency and awareness of the process are necessary to handle claims. Click the appropriate box below to follow the flow of the claim. Injured Employee Administration Key Players Home Page

4. Ouch! A workers compensation claim begins when an employee suffers an occupational injury or illness. Occupational injuries result from work accidents or exposures involving the work environment (e.g., cuts, fractures, and sprains). Occupational illnesses include, but are not limited to, skin diseases, respiratory disorders, and poisoning. After an incident, the employee and administration both have responsibilities. Consistency and awareness of the process are necessary to handle claims. Click the appropriate box below to follow the flow of the claim. Injured Employee Administration Key Players Home Page

5. Ouch! A workers compensation claim begins when an employee suffers an occupational injury or illness. Occupational injuries result from work accidents or exposures involving the work environment (e.g., cuts, fractures, and sprains). Occupational illnesses include, but are not limited to, skin diseases, respiratory disorders, and poisoning. After an incident, the employee and administration both have responsibilities. Consistency and awareness of the process are necessary to handle claims. Click the appropriate box below to follow the flow of the claim. Injured Employee Administration Key Players Home Page

6. Employee’s Perspective During normal work hours, the employee should receive care at the Graham Health Center (GHC) or Crittenton Hospital’s Occupational Medicine Department (Crittenton Occ. Med.). Receiving prompt and proper care is the focus of our response. The employee’s supervisor completes an Authorization to Seek Treatment form for the employee to bring to the initial visit with the health provider. If an emergency situation prevents the supervisor from immediately completing this OU form, the supervisor should submit it to University Human Resources (UHR) within 24 hours of the incident. Potential Issues Next Home

7. Employee’s Perspective During normal work hours, the employee should receive care at the Graham Health Center (GHC) or Crittenton Hospital’s Occupational Medicine Department (Crittenton Occ. Med.). Receiving prompt and proper care is the focus of our response. The employee’s supervisor completes an Authorization to Seek Treatment form for the employee to bring to the initial visit with the health provider. If an emergency situation prevents the supervisor from immediately completing this OU form, the supervisor should submit it to University Human Resources (UHR) within 24 hours of the incident. Potential Issues Next Home

8. Employee’s Perspective During normal work hours, the employee should receive care at the Graham Health Center (GHC) or Crittenton Hospital’s Occupational Medicine Department (Crittenton Occ. Med.). Receiving prompt and proper care is the focus of our response. The employee’s supervisor completes an Authorization to Seek Treatment form for the employee to bring to the initial visit with the health provider. If an emergency situation prevents the supervisor from immediately completing this OU form, the supervisor should submit it to University Human Resources (UHR) within 24 hours of the incident. Potential Issues Next Home

9. Employee’s Perspective During normal work hours, the employee should receive care at the Graham Health Center (GHC) or Crittenton Hospital’s Occupational Medicine Department (Crittenton Occ. Med.). Receiving prompt and proper care is the focus of our response. The employee’s supervisor completes an Authorization to Seek Treatment form for the employee to bring to the initial visit with the health provider. If an emergency situation prevents the supervisor from immediately completing this OU form, the supervisor should submit it to University Human Resources (UHR) within 24 hours of the incident. Potential Issues Next Home

10. Potential Issues Preparing the Authorization to Seek Treatment form in a timely manner ensures the correct billing to workers compensation rather than to the employee’s personal health insurance. When an employee receives treatment at facilities other than the GHC or Crittenton Occ. Med. without supplying our OU Authorization to Seek Treatment form, improper medical procedure coding and billing can occur. This impacts both the employee’s personal health insurance and the University’s workers compensation claims experience. Should an employee incur personal healthcare costs for occupational injuries/illnesses, an explanation of benefits (EOB) should be submitted to UHR for corrections. Back Home

11. Potential Issues Preparing the Authorization to Seek Treatment form in a timely manner ensures the correct billing to workers compensation rather than to the employee’s personal health insurance. When an employee receives treatment at facilities other than the GHC or Crittenton Occ. Med. without supplying our OU Authorization to Seek Treatment form, improper medical procedure coding and billing can occur. This impacts both the employee’s personal health insurance and the University’s workers compensation claims experience. Should an employee incur personal healthcare costs for occupational injuries/illnesses, an explanation of benefits (EOB) should be submitted to UHR for corrections. Back Home

12. Potential Issues Preparing the Authorization to Seek Treatment form in a timely manner ensures the correct billing to workers compensation rather than to the employee’s personal health insurance. When an employee receives treatment at facilities other than the GHC or Crittenton Occ. Med. without supplying our OU Authorization to Seek Treatment form, improper medical procedure coding and billing can occur. This impacts both the employee’s personal health insurance and the University’s workers compensation claims experience. Should an employee incur personal healthcare costs for occupational injuries/illnesses, an explanation of benefits (EOB) should be submitted to UHR for corrections. Back Home

13. Employee’s Perspective (Continued) Once the employee receives treatment, s/he returns to work (if possible). The employee must furnish a note from the health provider that specifically identifies work restrictions (if any). If the supervisor cannot accommodate specific work restrictions, the employee may be excused from work and return only when the employee’s health provider determines that the tasks can be adequately performed. Key Points Back Home

14. Employee’s Perspective (Continued) Once the employee receives treatment, s/he returns to work (if possible). The employee must furnish a note from the health provider that specifically identifies work restrictions (if any). If the supervisor cannot accommodate specific work restrictions, the employee may be excused from work and return only when the employee’s health provider determines that the tasks can be adequately performed. Key Points Back Home

15. Employee’s Perspective (Continued) Once the employee receives treatment, s/he returns to work (if possible). The employee must furnish a note from the health provider that specifically identifies work restrictions (if any). If the supervisor cannot accommodate specific work restrictions, the employee may be excused from work and return only when the employee’s health provider determines that the tasks can be adequately performed. Key Points Back Home

16. Employee’s Perspective (Continued) Once the employee receives treatment, s/he returns to work (if possible). The employee must furnish a note from the health provider that specifically identifies work restrictions (if any). If the supervisor cannot accommodate specific work restrictions, the employee may be excused from work and return only when the employee’s health provider determines that the tasks can be adequately performed. Key Points Back Home

17. Key Points Work limitations are updated each time the employee visits the health provider and receives follow-up care. Directly after these visits, the employee must provide updates to both the supervisor and UHR. UHR relays this information to the third party claims administrator (TPA). The TPA continues to monitor the employee’s medical improvement. Back Home

18. Key Points Work limitations are updated each time the employee visits the health provider and receives follow-up care. Directly after these visits, the employee must provide updates to both the supervisor and UHR. UHR relays this information to the third party claims administrator (TPA). The TPA continues to monitor the employee’s medical improvement. Back Home

19. Key Points Work limitations are updated each time the employee visits the health provider and receives follow-up care. Directly after these visits, the employee must provide updates to both the supervisor and UHR. UHR relays this information to the third party claims administrator (TPA). The TPA continues to monitor the employee’s medical improvement. Back Home

20. Administration’s Perspective (Supervisor) Receiving the proper care is primary. If time allows, the employee’s supervisor completes the Authorization to Seek Treatmentform for the injured employee to provide to the healthcare provider. The supervisor determines how the employee will be transported (e.g., self, supervisor, or ambulance). Within 24 hours, the supervisor must complete an Occupational Accident Report and forward it to UHR. The supervisor monitors the employee’s attendance status via leave reports and direct communication. The supervisor is required to complete both forms. Potential Issues Next Home

21. Administration’s Perspective (Supervisor) Receiving the proper care is primary. If time allows, the employee’s supervisor completes the Authorization to Seek Treatmentform for the injured employee to provide to the healthcare provider. The supervisor determines how the employee will be transported (e.g., self, supervisor, or ambulance). Within 24 hours, the supervisor must complete an Occupational Accident Report and forward it to UHR. The supervisor monitors the employee’s attendance status via leave reports and direct communication. The supervisor is required to complete both forms. Potential Issues Next Home

22. Administration’s Perspective (Supervisor) Receiving the proper care is primary. If time allows, the employee’s supervisor completes the Authorization to Seek Treatmentform for the injured employee to provide to the healthcare provider. The supervisor determines how the employee will be transported (e.g., self, supervisor, or ambulance). Within 24 hours, the supervisor must complete an Occupational Accident Report and forward it to UHR. The supervisor monitors the employee’s attendance status via leave reports and direct communication. The supervisor is required to complete both forms. Potential Issues Next Home

23. Administration’s Perspective (Supervisor) Receiving the proper care is primary. If time allows, the employee’s supervisor completes the Authorization to Seek Treatmentform for the injured employee to provide to the healthcare provider. The supervisor determines how the employee will be transported (e.g., self, supervisor, or ambulance). Within 24 hours, the supervisor must complete an Occupational Accident Report and forward it to UHR. The supervisor monitors the employee’s attendance status via leave reports and direct communication. The supervisor is required to complete both forms. Potential Issues Next Home

24. Potential Issues (Supervisor) When supervisors fail to complete required forms such as the Authorization to Seek Treatment, improper billing for workers compensation costs can occur. Similarly, when the supervisor neglects to complete and forward the Occupational Accident Report to UHR, Environmental Health & Safety (EH&S) cannot address potential health and safety concerns. This also jeopardizes the University’s MIOSHA compliance requirements. Back Home

25. Potential Issues (Supervisor) When supervisors fail to complete required forms such as the Authorization to Seek Treatment, improper billing for workers compensation costs can occur. Similarly, when the supervisor neglects to complete and forward the Occupational Accident Report to UHR, Environmental Health & Safety (EH&S) cannot address potential health and safety concerns. This also jeopardizes the University’s MIOSHA compliance requirements. Back Home

26. Potential Issues (Supervisor) When supervisors fail to complete required forms such as the Authorization to Seek Treatment, improper billing for workers compensation costs can occur. Similarly, when the supervisor neglects to complete and forward the Occupational Accident Report to UHR, Environmental Health & Safety (EH&S) cannot address potential health and safety concerns. This also jeopardizes the University’s MIOSHA compliance requirements. Back Home

27. Administration’s Perspective (UHR) Once UHR receives the Occupational Accident Report, it is forwarded to the manager of EH&S. If the employee sought treatment, UHR completes an “F100” form. This “F100” form, required by the State of Michigan, initiates the necessary documentation for a workers compensation claim. UHR also submits this form to the University’s TPA. The TPA subsequently coordinates and processes all payments to medical providers, hospitals, pharmacies, and the injured employee. Back Next Home

28. Administration’s Perspective (UHR) Once UHR receives the Occupational Accident Report, it is forwarded to the manager of EH&S. If the employee sought treatment, UHR completes an “F100” form. This “F100” form, required by the State of Michigan, initiates the necessary documentation for a workers compensation claim. UHR also submits this form to the University’s TPA. The TPA subsequently coordinates and processes all payments to medical providers, hospitals, pharmacies, and the injured employee. Back Next Home

29. Administration’s Perspective (UHR) Once UHR receives the Occupational Accident Report, it is forwarded to the manager of EH&S. If the employee sought treatment, UHR completes an “F100” form. This “F100” form, required by the State of Michigan, initiates the necessary documentation for a workers compensation claim. UHR also submits this form to the University’s TPA. The TPA subsequently coordinates and processes all payments to medical providers, hospitals, pharmacies, and the injured employee. Back Next Home

30. Administration’s Perspective (UHR) Once UHR receives the Occupational Accident Report, it is forwarded to the manager of EH&S. If the employee sought treatment, UHR completes an “F100” form. This “F100” form, required by the State of Michigan, initiates the necessary documentation for a workers compensation claim. UHR also submits this form to the University’s TPA. The TPA subsequently coordinates and processes all payments to medical providers, hospitals, pharmacies, and the injured employee. Back Next Home

31. Administration’s Perspective (TPA) The TPA coordinates with UHR to ensure that relevant federal and state reporting requirements for medical costs have been properly filed. The TPA also recommends to UHR appropriate future budget amounts to assign to individual claims. Potential Issues Back Home

32. Administration’s Perspective (TPA) The TPA coordinates with UHR to ensure that relevant federal and state reporting requirements for medical costs have been properly filed. The TPA also recommends to UHR appropriate future budget amounts to assign to individual claims. Potential Issues Back Home

33. Administration’s Perspective (TPA) The TPA coordinates with UHR to ensure that relevant federal and state reporting requirements for medical costs have been properly filed. The TPA also recommends to UHR appropriate future budget amounts to assign to individual claims. Potential Issues Back Home

34. Administration’s Perspective (TPA) The TPA coordinates with UHR to ensure that relevant federal and state reporting requirements for medical costs have been properly filed. The TPA also recommends to UHR appropriate future budget amounts to assign to individual claims. Potential Issues Back Home

35. Potential Issues (TPA) Since the TPA provides administrative services for workers compensation claims, payments to health providers are only made when bills are reviewed and approved. The TPA has discretionary authority to reject a payments for a variety of reasons. Typically, if the TPA does not receive any bills (generally because claim processing referenced personal health insurance rather than workers compensation insurance), the TPA closes the claim after 90 days. Back Home

36. Potential Issues (TPA) Since the TPA provides administrative services for workers compensation claims, payments to health providers are only made when bills are reviewed and approved. The TPA has discretionary authority to reject a payments for a variety of reasons. Typically, if the TPA does not receive any bills (generally because claim processing referenced personal health insurance rather than workers compensation insurance), the TPA closes the claim after 90 days. Back Home

37. Potential Issues (TPA) Since the TPA provides administrative services for workers compensation claims, payments to health providers are only made when bills are reviewed and approved. The TPA has discretionary authority to reject a payments for a variety of reasons. Typically, if the TPA does not receive any bills (generally because claim processing referenced personal health insurance rather than workers compensation insurance), the TPA closes the claim after 90 days. Back Home

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44. Ouch! A workers compensation claim begins when an employee suffers an occupational injury or illness. Occupational injuries result from work accidents or exposures involving the work environment (e.g., cuts, fractures, and sprains). Occupational illnesses include, but are not limited to, skin diseases, respiratory disorders, and poisoning. After an incident, the employee and administration both have responsibilities. Consistency and awareness of the process are necessary to handle claims. Click the appropriate box below to follow the flow of the claim. Injured Employee Administration Key Players Home Page

45. Key Players • Injured Employee ……………………………………………………………………………….. GHC (248)370-2341 • …………………………………………. Crittenton’s Occ. Med. Dept. (248)652-5000 • Injured Employee’s Supervisor • If possible, fill out Authorization to Seek Medical Treatment and send it with employee. • Immediately report unsafe situations or conditions to EH&S. • Complete Occupational Accident Report within 24 hours of the reported injury and forward it to HR at 401 Wilson Hall. • Cora Hanson, EH&S Manager ……………………………………................................... (248)370-4427 • Address unsafe work environment issues. • Oversee OSHA compliance. • Corey Brittingham, Benefit & Compensation Analyst ….................................. (248)370-3484 • Initiate Claim with ASU • Kirby Lau, ASU Workers’ Compensation Adjuster ……………………………………….. (248)960-1242 Back

46. Key Players • Injured Employee ……………………………………………………………………………….. GHC (248)370-2341 • …………………………………………. Crittenton’s Occ. Med. Dept. (248)652-5000 • Injured Employee’s Supervisor • If possible, fill out Authorization to Seek Medical Treatment and send it with employee. • Immediately report unsafe situations or conditions to EH&S. • Complete Occupational Accident Report within 24 hours of the reported injury and forward it to HR at 401 Wilson Hall. • Cora Hanson, EH&S Manager ……………………………………................................... (248)370-4427 • Address unsafe work environment issues. • Oversee OSHA compliance. • Corey Brittingham, Benefit & Compensation Analyst ….................................. (248)370-3484 • Initiate Claim with ASU • Kirby Lau, ASU Workers’ Compensation Adjuster ……………………………………….. (248)960-1242 Back

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