Worker’s Compensation Procedures

 

Please read this document and all attachments carefully.  This memorandum is provided to give you a general explanation of the Virginia Worker’s Compensation Act (VWCA), the benefits provided, and some of your obligations and rights under the Act. 

 

The Virginia Worker’s Compensation Act covers injuries and illnesses that arise specifically as a result of an individuals’s job duties. In order for an accident to be compensable under the VWCA, it must arise out of and in the course of employment.  This means that not all injuries that simply happen at work are compensable under the Act.  Claims that are ruled compensable allow for payment of related medical expenses and lost time over 7 calendar days resulting from that injury/illness.  NOVA does not make any claim decisions or payments.  All claim determination decisions and payments are handled by the third-party administrator for Worker’s Compensation, Managed Care Innovations, Inc. (P. O. Box 1140, Richmond, VA 23208, telephone 804/649-2288).  Claims with any lost time also need to be coordinated by the employee with the Virginia Sickness and Disability Program (VSDP) through the third party provider, UNUM at 800/652-5602.

 

Employee is Responsible for:

 

1. Comply with all the established policies and procedures;
2. Keep all parties (NOVA HR, UNUM if VSDP is involved, and your treating physician);
3. Select a physician from the list of Panel Physicians
4. Keep all parties informed of your status and any changes.

 

Work-related injuries and illnesses are not subject to the same level of doctor-patient privacy requirements that non work-related injuries and illness are.  Worker’s compensation involves you, your physician, NOVA HR, your supervisor, the workers’ compensation insurance carrier, and also UNUM when VSDP is involved.

 

 

Worker’s Compensation Procedures:

 

1. Immediately report the work-related injury/illness to your supervisor and file an Employer’s First Report of Accident (attached) with Human Resources.  Those employees needing immediate medical treatment for serious injuries may visit the Emergency Room and will need to report the injury as Workers' Compensation at the time treatment is received. All follow-up treatment must be provided by a Workers' Compensation panel physician.

§        The supervisor of the injured employee is responsible for completing and submitting to Human Resources the Supervisor’s Detailed Assessment of Employee’s Accident Form (attached).  The supervisor should also contact Campus Police and have photographs taken of the injury scene if the supervisor feels that would be useful to later assess the cause of the injury.

2. Select a physician or medical facility from the Worker’s Compensation Preferred Panel (attached) and complete a Panel Physician Selection Form (attached).  Submit the signed form to Human Resources.
3. All employees are required to use their personal sick leave (and other personal leave, as necessary) to cover time off for a claim of work-related injury or illness.  VSDP participants must notify UNUM if the injury or illness results in a physician releasing them from work for any period of time.  In situations when an employee is out of work for more than 7 calendar days on a compensable claim, the employee is entitled to benefits available under the VSDP program.  ALL time off for a work-related injury/illness must be authorized in writing by the treating health care provider.  The written release must reflect a specific time period (whether for an appointment or for a lengthier absence) along with the physician’s signature and must be submitted to Human Resources.  The treating physician must also verify the return to work status in writing to HR prior to reinstatement.  Any time missed from work will be charged to annual leave, sick leave, or leave without pay (LWOP) as necessary, pending any benefits from VSDP.
4. Continuation of full salary while a compensability decision is being made is contingent upon the amount of available personal leave balances and the establishment of a Short-Term Disability claim by UNUM under VSDP. 
5. Any bills, doctor notes, disability slips and other documents received by the employee must be forwarded to Human Resources.  During any medical appointments, it is the employee’s responsibility to request and obtain accurate written information.  All medical provider’s bills for services must be complete with medical notes and insurance codes, should reference your social security number and date of injury.  For prompt payments medical providers may invoice directly Managed Care Innovations, P. O. Box 1140, Richmond, VA 23208, telephone 804/649-2288.  Any invoices that are received by the employee and submitted to HR will simply be forwarded to Managed Care Innovations on the employee’s behalf for any payment.
6. In accordance with NOVA policy, the employee is also covered under the Family Medical Leave Act (FMLA), and is covered concurrently with all time out due to the injury and/or illness.

 

If your claim for Worker’s Compensation benefits is denied, Managed Care Innovations (MCI) will pay for the first office visit on a denied claim providing the employee has health insurance coverage, the medical service is reasonable, directly related to the injury and provided by a Workers' Compensation Panel Physician. You may contact the Virginia Workers' Compensation Commission for information on how to appeal a denied claim by calling their toll free number at 1-877-664-2566 or in writing to: Virginia Workers' Compensation Commission, 1000 DMV Drive, Richmond, VA 23220.

If at any time you have any questions about your benefits or your claim, it is appropriate for the employees to contact the claims adjuster at Managed Care Innovations (MCI) regarding specific issues associated with their claim. They may be reached by calling their toll free number at 1-888-200-9531

 

If you need further assistance and information, please contact the Human Resources Office (323-3110). Retain this memorandum for future reference.  Each division, department, and office should also retain a copy with all attachments for future use.

NORTHERN VIRGINIA COMMUNITY COLLEGE

 

PREFERRED PROVIDER PANEL

 

 

Those employees needing immediate medical treatment for serious injuries may visit the Emergency Room and will need to report the injury as Workers' Compensation at the time treatment is received.  All follow-up treatment must be provided by a Workers' Compensation panel physician.

 

 

 

The following reflects a list of general practice medical facilities:

 

Dr. Mark Davis Virginia Medical Acute Care 5501 Backlick Road Ste. 105 Springfield, VA  22151 703/642-2273	Dr. C Horton Bull Run Family Practice 8640 Sudley Road, Suite 203 Manassas, VA 20110 703/368-3161
Dr. Ditaranto Ashburn Medical Center 42882 Truro Parish Dr. Ste 201 Ashburn, VA  20148 703/729-1660	Dr. Jatinder Mann Urgent Medical Care of Lake Ridge 12449 Hedges Run Drive Lake Ridge, VA 22192 703/494-6160

 

• Prescriptions for Workers' Compensation prescriptions may be paid directly by the employee and reimbursed by our Workers' Compensation carrier in an approved claim
• The employee will need to submit to Human Resources the pharmacy receipt (usually stapled to the bag)
• A computer printout signed by the pharmacist that shows patient information, name of the medication, the prescribing doctor, the amount prescribed and the prescription cost is acceptable
• Please note that a cash register receipt will not suffice for requesting reimbursement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TO:                  All Commonwealth Employees with Work-Related Injuries

 

 

SUBJECT:            Panel Physician Selection Form

 

 

            Any Commonwealth of Virginia employee injured in a work-related accident must report to one of the physicians recommended from a list of at least three physicians provided by your supervisor.

 

            If you are an employee injured on the job and require immediate care, you should report to the nearest medical facility for treatment.  After the initial treatment, you must select a physician from the list provided by your supervisor.

 

 

Acknowledgment:

 

            I have reviewed the panel of at least three physicians provided to me by my supervisor and have selected:

 

 

 

            _____________________________ (Physician’s/Facility’s Name)

 

 

 

 

Date:            _________________            __________________________________

                                                            Employee’s Signature

 

Date:            _________________            __________________________________

                                                            Supervisor’s Signature

 

 

 

 

 

 

 

Submit completed form to Human Resources

 

 

 

Supervisor’s Detailed Assessment of Employee Accident*

 

            ___________________________________________           ____________________________

Injured Employee’s Name                                                 Date of Accident

                       

 

1 – Type of Accident:

 

 

2 – Cause – Be as specific and as much detail as possible:                                                                       

 

 

3 – Hazard Assessment of Accident/Work Area:          (Please have campus police take photographs ASAP and submit those photographs/report to HR to supplement your accident report.)

 

 

4 – Refresher Training:        

 

 

5 – Lessons Learned:

 

 

 

 

 

 

                                                                                                                           ____________________________________

                                                                               Supervisor’s Signature/Date

 

                                                                                                                           ____________________________________

                                                                     Department/Campus

 

 

*Please attach to Employers Accident Report form.  This is important to ensure that all relevant information regarding the accident can be better understood and if a safety hazard exists or something can be reasonably be done to prevent recurrence, those items can be addressed.