EIU Office of Internal Auditing

#24 - Workers' Compensation

Approved: April 11, 1988

Nomenclature changes: April 22, 2024

Monitor: Vice President for Business Affairs

In order to insure employee benefits under the Illinois Workers' Compensation and Occupational Diseases Acts, the following procedure shall be followed when an employee suffers an accidental injury or occupational disease arising out of and in the course of employment, regardless of the severity of the injury or disease:

Incident Only

This report is to be filed for incidents where no medical treatment is necessary:

• Once an employee has been injured on the job or suffers from a work-related illness/disease that does not require medical treatment, he or she should notify his or her immediate supervisor immediate supervisor.
• The supervisor completes and submits an online form to document the incident.
• No further action is required unless treatment is later deemed necessary.  If treatment is necessary, employee should proceed in filing a claim.

Filing a Claim

1. Notify the supervisor immediately.
2. The employee injured at work must report the injury to the State of Illinois Workers Compensation Administrator at 855-495-1554 as soon as possible to report the injury and initiate a claim.  If the employee is unable to make this call, the supervisor may place the call.  If the injury requires immediate medical attention, the employee should seek medical attention before informing the supervisor or the Illinois Workers Compensation Administrator.
3. Human Resources should be contacted to initiate a Family Medical Leave (FML).  Family Medical Leave (FML) runs concurrent with Workers’ Compensation Leave.  If the medical provider determines the employee is unable to return to work and the injury/illness/disease involves loss of work for five or more days and is expected to continue for fourteen or more days, a statement from the attending physician should include the estimated length of disability. It is very important that employees follow these procedures when experiencing an on-the-job injury or identifying a job-related illness.  An outside agency will determine eligibility for Workers’ Compensation benefits.
4. When an employee has a work-related accident, illness or injury, the following reports must be completed within 24 hours of the accident and returned to Human Resources:

·         Employee Notice of Injury/Illness

·         Authorization to Use or Disclose Information Form

·         Initial Workers’ Compensation Medical Report (employee gives to medical provider)

·         Witness Report(s) – if applicable

·         Supervisor’s Report of Injury/Illness

Claims are processed and sent to Tristar Risk Enterprise Management, Inc. for review by a claims examiner, who will determine if the claim is compensable or non-compensable.  Please note that this decision is NOT made at Eastern Illinois University by the Workers’ Compensation Coordinator.  If deemed compensable, all medical costs relating to the injury/illness/disease will be paid by the State of Illinois.  It is very important that employees follow these procedures when experiencing an on-the-job injury/illness/disease.  Failure to complete any necessary actions could delay the processing of the claim and payment of bills.  Failure to inform the medical provider that the injury/illness/disease is work-related will result in the employee or his or her insurance plan being billed directly for the services.

5. Employee will be required to pass a drug test immediately after the injury/illness/disease.  This will occur when the employee seeks treatment.  If the employee does not require medical attention, the supervisor will contact the Department of Human Resources to arrange for a post-accident drug test.

A copy of the Employee's Notice of Injury/Illness is also given to the Safety Officer for follow-up of any safety hazard or violation. Violation of safety regulations could impair claims for Worker's Compensation.

Temporary Total Disability (TTD) benefits are paid to the injured employee who must lose time from work to recover from a work-related injury/illness/disease.  The employee is entitled to collect TTD benefits until able to return to work that is reasonably available to him or her.  The following rules apply to Total Temporary Disability (TTD):

·         A written request must be submitted by the employee in order for the benefit to begin paying.  A begin date must be specified.

·         An employee may not utilize EIU paid time off AND collect TTD.

·         To qualify for TTD, employee must be off work due to work related injury/illness/disease greater than 3 consecutive days.

·         If employee is not off work greater than 3 consecutive days then time missed should be paid utilizing employee’s own sick leave time.

·         If employee is off 4-13 consecutive days, then TTD can be paid and effective day 4 or the first day the employee chooses to not use benefits.

·         If employee is off greater than 14 consecutive days, TTD benefits can be retro-active back to day 1 if the employee did not use their own benefits.  If employee chose to use their own benefits to remain in 100% pay status, then TTD begins on either the request date or the first day that benefits were not used.

·         TTD pays 7 days a week (Saturdays and Sundays included).

·         TTD pays 66.67% of base wages.

·         TTD benefits are not normally considered taxable income at the state or federal level.  Exceptions arise when an employee also receives disability benefits through Social Security disability insurance (SSDI) or Supplemental Security Income (SSI).

·         An employee collecting TTD must pay active member insurance premiums directly to CMS.

·         An employee collecting TTD cannot contribute to SURS, however, service credit is still earned.

When released to return to work, employees are required to provide authorization from their treating physician that should be forwarded to the Department of Human Resources prior to physically returning to work.  The authorization should include any restrictions, if applicable.  Review of the authorization will be conducted, and the employee notified of final return to work status.