PROCEDURES FOR LEAVES DUE TO
WORK RELATED INJURY
Work Related injuries - Medical Leave
1. Supervisor completes First Report of Injury (TWCC-1) and
sends it to the Risk Manager (MS 91).
2. The Workers Compensation Carrier sends the employee a copy of
the First Report of Injury.
If more than five working days (or the equivalent) are lost from
work, the following procedures apply:
1. The Risk Manager sends a copy of the
First Report to Human Resources.
2. The employee must submit to his or her
department a physician's statement authorizing the absence and
documenting the first date of absence and expected date of return
to work or reevaluation.
3. The department attaches the physician's
statement to a Leave of Absence form and sends both to Human
4. Pay for the first five days of lost time
is drawn from Benefit Time, if available. Otherwise, the first
five days are without pay.
5. After the five working day waiting
period, the Workers Compensation Carrier begins to pay the wage
benefit on the eighth calendar day and the employee is placed on
6. If possible, the employee should make
arrangements with Human Resources to pay his or her contribution
to insurance premiums. Human Resources will bill the employee if
payment is not made in advance.
7. Employee must submit physician's
statement authorizing return to work and specifying functional
limitations, if any, to Human Resources and Risk Management.
8. To reinstate an employee to active
status, the department completes a Personnel Action Form, noting
the date of return and attaching the physician's release.
9. Note: FMLA (Family & Medical Leave
Act) leave runs concurrently with Workers' Compensation
June 21, 2000
See Policy 407-94
This page is maintained by HR ( email@example.com ).
Updated: February 2003