Workers’ Compensation Program
What You Need to Know…
Florida Statute, Chapter 440.105: "Any person who, knowingly and with intent to injure,
defraud, or deceive any employer or employee, insurance company, or self-insured
program, files a statement of claim containing any false or misleading information commits
insurance fraud, punishable as provided in s. 817.234."
Content Overview
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Purpose
•
Eligibility
•
When an Injury Occurs
Medical Emergency
Non-Medical Emergency
•
Benefits:
Medical Treatment
Lost Time Wages
Pharmacy/Prescriptions
•
Return-To-Work Program
•
Assistance Directory
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What Is the Purpose of The FIU Workers’
Compensation Program?

To provide legally mandated benefits to workers who are injured at work, or who
develop a job-related illness as a result of their employment.

Benefits may include payment of medical bills, mileage, lost wages and vocational
rehabilitation.

The State of Florida, Division of Risk Management determines eligibility for
coverage based on the circumstances reported. Eligibility is not determined by
Florida International University.
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Am I Eligible for Workers’ Compensation benefits?

All FIU employees are covered under the State of Florida Workers' Compensation
Program from their first day on the job.

Coverage is available for full-time, part-time, and temporary employees, whether
they are Faculty, Administrative & Professional (A & P), University Support
Personnel System (USPS), Graduate Assistants, Student Assistants or College
Work Study. (Conditions apply for temporary employees)

Registered volunteer workers are also covered.

Coverage is not available for independent contractors or vendors who provide
services to state agencies.
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What To Do When Injured on the Job?
Actions Required of the Injured Worker and/or Supervisor:
1.
MEDICAL EMERGENCY
GO! REPORT! FILE!
2.
NON-MEDICAL EMERGENCY
REPORT! REQUEST! FILE!
Supervisors must assure injuries are reported promptly!!!
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FILE REPORT
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MEDICAL EMERGENCY
REPORT! FILE! GO!
GO to the nearest emergency medical facility
Closest Emergency Medical Facility:
Modesto M. Maidique Campus
Kendall Regional Medical Center
11750 Bird Road
(305) 223-3000
Biscayne Bay Campus
Parkway Regional Medical Center
160 NW 170th Street
(305) 651-1100
OFF-CAMPUS emergency transportation CALL 911
BE SURE TO INFORM THE EMERGENCY MEDICAL FACILITY AND RESPONDING
PERSONNEL THAT THE INJURY IS WORK-RELATED
MEDICAL EMERGENCY (2)
GO! REPORT! FILE!
REPORT! (by injured employee or supervisor)
• To AmeriSys at (800) 455-2079, available 24 hours a day 7 days a week
•
To FIU Worker’s Compensation Coordinator at (305) 348-7960
FILE Workers’ Compensation claim report
• Online at http://hr.fiu.edu/Injury
•
By phone to FIU Worker’s Compensation Coordinator at (305) 348-7960
•
Participate in Accident/Injury Investigation, as required
NON-MEDICAL EMERGENCY
REPORT! REQUEST! FILE!
REPORT!
• To (or by) Supervisor
• To FIU Workers’ Compensation Coordinator at (305) 348-7960
REQUEST!
• Medical appointment, if required.
During Business Hours: FIU Workers’ Compensation Coordinator will coordinate
the initial treatment with an approved Managed Care Network Provider. Medical
treatment from an unauthorized Managed Care Network Provider may
jeopardize your eligibility for Workers' Compensation benefits.
Non-Business Hours: Call AmeriSys at (800) 455-2079
FILE!
• Workers’ Compensation claim report
Online at http://hr.fiu.edu/Injury
By phone to FIU Workers’ Compensation Coordinator at (305) 348-7960
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BENEFITS: MEDICAL TREATMENT
What to expect?
 Injured employees will be referred to an approved participating network healthcare
provider. Failure to properly report or schedule non-emergency injuries will jeopardize
all workers' compensation benefits.
 If you have questions regarding medical treatment, benefits or a Managed Care
Network Provider, please contact the Workers' Compensation Program Coordinator for
further information at 305-348-7960 or email at cruzma@fiu.edu.
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BENEFITS: MEDICAL TREATMENT
The Procedure:
1. Injured worker or injured worker’s supervisor completes the online Workers’ Comp
Injury/Accident Report.
2. Workers’ Comp Coordinator files claim to the Managed Care Network AmeriSys.
3. AmeriSys’ Case Manager and Workers’ Compensation Coordinator coordinates the first
medical appointment for the injured worker.
4. Employee contacts Workers’ Compensation Coordinator after each medical
appointment to provide a copy of the medical report and/or work status.
5. Workers’ Compensation Coordinator provides a copy of the medical report to case
manager and adjuster to authorize further medical treatment as prescribed by the
authorized physician.
6. Workers’ Compensation Coordinator emails the WC Notification Letter to supervisor,
Payroll and Benefits Department.
7. Office of Employee Assistance is also available to provide assistance, if needed.
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BENEFITS: LOST TIME & WAGES
Injured FIU employees may be eligible for workers’ compensation wage benefits while
away from work (for more than 7 days) as a result of a work-related injury.
Eligibility begins on the eighth day (8) of partial or total disability:
IF:
Documentation from an approved Managed Care Network Physician or medical
facility is submitted to the Workers’ Compensation Coordinator, WHICH substantiates
the employee's inability to return to work as a result of the injury.
OR
The employee is certified to return to work on full or modified duty with restrictions,
but the supervisor and/or department is unable to provide reasonable
accommodation.
SUPERVISORS ARE STRONGLY ENCOURAGED TO IDENTIFY APPROPRIATE MODIFIED
DUTIES FOR EMPLOYEES WHO HAVE BEEN RELEASED TO WORK WITH
RESTRICTIONS.
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BENEFITS: LOST TIME & WAGES
 The first forty (40) hours of missed work will be paid under Administrative Disability
Leave/WC, code WCH, in Panthersoft. This includes intermittent visits to an
authorized Managed Care Network Physician.
 After the first forty (40) hours, two-thirds of the injured employee’s wages are paid by
the State’s Workers' Compensation Program, while the remaining one-third may be
paid by applying available accrued personal leave (sick, annual and compensatory).
This allows the injured employee to receive their standard paycheck by making up the
differences between Workers' Compensation wage benefit and injured worker normal
bi-weekly wage.
 Workers’ Compensation Coordinator completes injured worker time in Panthersoft
after injured worker has exhausted the first forty (40) hours of administrative leave.
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BENEFITS: LOST TIME & WAGES
 Temporary Employees DO NOT receive disability leave or payments, unless they have
been medically disabled for a minimum of twenty-one (21) consecutive days. After
this time, temporary employees will be eligible to receive retroactive pay for the first
seven (7) days after the incident occurred.
 The injured worker is responsible to provide the Workers’ Compensation Coordinator
a copy of the medical report, DWC-25 (Florida Workers’ Compensation Uniform
Medical Treatment Status Reporting Form) provided by the physician’s office after
each medical visit.
 Workers’ Compensation Coordinator is responsible for maintaining communication
with the injured worker and supervisor regarding the work status, follow-up
appointments, and physical therapy.
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BENEFITS: PHARMACY
 The cost of medically necessary prescriptions for treatment and or recovery from
work-related injuries is covered under the Workers' Compensation Program. The
“Progressive Card” is a prescription card which will be provided to the injured worker
on the first doctor’s appointment.
 Any pharmacy within the State of Florida may be used to fill a prescription.
 In most cases, pharmacies will charge AmeriSys directly with no charge to the injured
employee. However, some pharmacies may require the injured employee to pay for
medications out-of-pocket. To obtain reimbursement for these charges you must
make a copy for your records and submit the original receipt to:
Florida Department of Financial Services
Division of Risk Management
Bureau of State Employees WC Claims
P.O. Box 8020
Tallahassee, FL 32399-0314
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RETURN-TO-WORK PROGRAM
 STATEMENT OF POLICY:
The Return-To-Work Program is promoted in order to bring back to work injured
employees who are able to perform on modified duty or alternate duty within
the limitations established by the authorized treating physician, and will bring
the employee back to work as quickly as medically possible.
 PURPOSE AND SCOPE:
To establish procedures to facilitate the re-integration of eligible injured
employees into the workplace by providing accommodation within the
limitation as determined by the authorized treating physician.
 DEFINITIONS:
Medical documentation: The DWC-25, which is the Florida Workers’
Compensation Uniform Medical Treatment Status Reporting Form, is a written
report from the authorized treating physician providing information on
management/medical treatment, referrals, functional limitations and
restrictions, maximum medical improvement/permanent impairment rating and
follow up appointments.
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RETURN-TO-WORK PROGRAM
 DEFINITIONS: Continuation
Functional Limitations and Restrictions: Identification of the employee’s ability
or lack of ability to perform stated activities and the degree to which these
activities may be performed. Functional limitations and restrictions are
identified on the DWC-25 provided to the employee by the authorized treating
physician after each doctor’s appointment.
Alternate Duty: Temporary duties established away from employee’s regular
work area/responsibilities and within the “functional limitations and
restrictions”
Modified Duty: Duties established within the employee’s regular position and
within the functional limitations and restrictions as reflected on the DWC-25.
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RETURN-TO-WORK PROGRAM
DEFINITIONS: Continuation
Workers’ Compensation Notification Letter: An acknowledgement between
the employee, supervisor and Workers’ Compensation Assistant that
provides the specific standard alternate/modified duty task with the
limitations and restrictions established on the DWC-25 form by the
authorized treating physician.
Maximum Medical Improvement (MMI): The medical condition at which
the injured worker is no longer in the process of recovery and will not
medically improve any further. In other words, an injured worker is
medically as well as they are going to be.
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ASSISTANT DIRECTORY
FIU DIVISION OF HUMAN RESOURCES
11200 SW 8th Street, PC 224
Miami, FL 33199
Phone : (305) 348-7960
Fax: (305) 348-6462
http://hr.fiu.edu
DIVISION OF RISK MANAGEMENT
Bureau of State Employee's WC Claims
P.O. Box 8020
Tallahassee, FL 32399-0314
AmeriSys
P. O. Box 160729
Altamonte Springs, Fl. 32716
1-800-455-2079
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