Workers’ Compensation (WC) provides benefits to cover specific economic loss as a result of an injury while employees are performing their jobs. These benefits, as dictated by District of Columbia laws, may include medical, cash, rehabilitation and death benefits. Employees are covered for all activities performed in the course and scope of their employment within the District of Columbia workers’ compensation statutes. They are generally not covered if performing activities that are not work-related, such as: going to and coming from work, extra-curricular activities, lunch time activities, assault or horseplay.
In the District of Columbia, there is a waiting period of three days before income benefits are payable under WC. During this waiting period the employee does not receive compensation for lost wages; however, employees may use available sick leave. On the 14th day of absence due to a compensable workers’ compensation injury, District of Columbia law provides that the first three days of sick leave used by the injured worker retroactively becomes compensable. The employee will receive workers’ compensation income benefits for the entire 14 days including the first three days that was originally classified as sick leave. The university will credit the employee’s sick leave hours and the employee will return any sick leave compensation to the university, since employees cannot be compensated twice; once by American University’s payroll office and once again by the workers’ compensation insurance program for missed days. Employees may use vacation time should they not have adequate sick leave during the three day waiting period, although the same reimbursement policy will apply as described above.
Vacation Days and Sick Leave
Once a workers’ compensation claim has been filed and accepted as a compensable injury, employees are required to accept WC income benefits and may not use their own sick leave or vacation time in lieu of these payments. In some circumstances an employee may use sick leave or vacation time owed as compensation while the compensability of their claim is determined. However, once the claim has been deemed compensable, the employee must return any income benefit received and accept the workers’ compensation payments. The university will then credit the injured employee’s account for the vacation days or sick leave. Reimbursement options should be discussed with the employee’s human resources service delivery team member.
There are four classifications of income benefits, depending on the nature of the injury. These disability classifications are: temporary total, permanent total, temporary partial, and permanent partial. Most cases are classified as temporary total disability (TTD). In these cases, an employee is totally disabled for a period of time but is expected to recover and return to work. In the District of Columbia, benefits are determined by taking 66 2/3% of the injured workers average weekly wage over the previous 26 week period, subject to a minimum and maximum payment as established by the District of Columbia. Once the injury classification has been determined, more specific questions regarding an individuals income benefits can be answered by the risk management office or the university's claim representative.
When appropriate, rehabilitation benefits are provided by WC for injured employees. As these injuries are specific in nature, information will be provided as needed.
American University pays medical costs directly to the treating medical provider of the injured worker. The medical provider, in addition to providing medical care, evaluates the extent of the injury to the employee and his or her ability to return to work, and also determines the kind of work the employee can do upon returning to the university.
When an injury is covered by workers’ compensation, and American University's insurance company has made payments to the treating physician on behalf of the injured employee, the employee should not pay any differences requested by the physician. In the event that an employee receives a bill for additional payments, the employee should bring the physician’s bill to the risk management office.
In order to prevent receiving unnecessary billings from treating physicians for compensable injuries, injured employees should clearly state that they are employed by American University and that the insurance is provided by Travelers Insurance Company before receiving any treatment. If the physician has any questions, please have them call the risk management office.
After an Accident
After any accident, supervisors should report injuries immediately to St. Paul Travelers insurance company, the university’s WC insurance provider. St. Paul Travelers has established a toll-free, 24 hours/7 days a week reporting number: 1-800-238-6225
It is crucial to use the toll-free reporting system on the same day of the injury to ensure compliance with DC workers’ compensation regulations. The university’s WC system comes into play from the earliest possible moment to assist the injured worker and supervisors receive valuable support. Examples of assistance are:
if questions of compensability, fraud, or other unusual circumstances arise, supervisors have the immediate support of experts
all legally required reports are filed in a timely manner
a preferred medical provider list can be offered to the injured employee if necessary.
Once an employee is absent due to an injury, it is important that the employee return to work as soon as possible. Economic and emotional hardships that an employee faces after an occupational injury are reduced. The university benefits by reducing lost-time and indirect costs of an injury such as training, overtime, and temporary labor as well as the direct costs associated with the injury.
Not all injured employees are able to return to their regular jobs immediately; however, many are able to return to a transitional job based on medical restrictions which may limit certain job activities. Transitional duty enables employees with temporary medical restrictions resulting from occupational injuries to return to campus and perform value-added tasks consistent with medically documented capabilities. Job tasks and assignments are designed to assist in the employee’s smooth return to his or her permanent assignments.
Medical restrictions may limit certain activities such as typing, lifting, bending or twisting or may limit the number of hours that an employee can work. If possible, supervisors should attempt to accommodate the employee’s restrictions within the employee’s pre-injury job or develop temporary job tasks that accommodate the employee’s restrictions. The risk management office will work with supervisors to determine if an injured employee can be accommodated with transitional duty on a case by case situation.