If you have a work related injury or illness (a condition that develops over time, such as carpal tunnel syndrome or tendonitis) you must do the following:

1. Get necessary medical care! Advise the treating physician that you are there due to a work related injury/illness. Medical bills, receipts for out-of-pocket expenses, such as prescription medication and equipment, should be sent to UVM Risk Management & Safety (RM&S) for reimbursement under WC (NOT your health insurance plan). Notify your supervisor as soon as possible and provide information to assist supervisor with completion of the Employer First Report of Injury Form (PDF) (FROI). Your supervisor must send the completed form to RM&S to be forwarded to the Vermont Department of Labor and Industry within 72 hours of the date of injury (subject to penalty for non-compliance).
2. If you are unable to work as a result of your injury/illness, you MUST obtain a WRITTEN doctor’s note stating your absence from work is due to the work related injury/illness and provide copies to your supervisor and RM&S. Keep your supervisor informed of your progress and anticipated return to work date.
3. If you are able to work part time or can work with temporary job modification, please notify your supervisor and RM&S. A temporary modified duty work agreement must be completed. This agreement specifies your doctor's stated restrictions and temporary work assignment as well as the time period the restrictions should remain in place.

Please note, when a FROI is received by RM&S, a copy is distributed to Cannon Cochran Management Services, Inc. (CCMSI), UVM’s third party claims administrator/adjuster (TPA). CCMSI submits an electronic copy to the Department of Labor and Industry as required by law. CCMSI’s claim adjuster investigates all claims, determines compensability and processes payments for medical expenses and disability payments for lost wages. According to VT state statute, UVM’s claim adjuster has 21 days from the date that UVM received notice of injury/illness to investigate and determine compensability under WC. Additional forms and contact with the CCMSI claims adjuster and RM&S may be necessary. Complete all requested forms and return them to RM&S or CCMSI as soon as possible.

Please note, UVM must report UVM-related job injury/illness resulting in medical care and/or absence from work to the Vermont Department of Labor within 72 hours of receiving notice. It is the supervisor’s responsibility to report the injury/illness to RM&S.

1. Complete the Employer FROI Form (PDF) and send it to RM&S as soon as possible. Provide a copy to the employee. If the employee is unable to assist with completion of the form, complete it to the best of your ability.

Employees who need non-emergency medical attention should report to one of two UVM occupational health services providers:

• Concentra Medical Center: located at 7 Fayette Road in South Burlington, 802-658-5756, or
  Employee needs to complete and bring the appropriate authorization form (PDF)
• Champlain Medical Urgent Care: located at 150 Kennedy Drive, South Burlington, 802-448-9370
  Employee needs to complete and bring the appropriate autorization form (PDF)

2. Communicate with RM&S. Notify the RM&S Claims Specialist if you have information relative to the investigation of a WC claim, if your employee is unable to work and when they return to work.
3. Communicate with your employee. The employee’s return to work is a logical and desirable goal in workers’ compensation for both the employer and the employee. Keeping in touch with employees regarding their progress and what is happening at work helps reassure and encourage efforts in recovery and return to the workplace.
4. Consider providing temporary modified duty which will allow your employee to return to work. Often, an employee who is unable to perform their usual work tasks can work in some capacity. View the necessary work tasks with a creative eye or identify special projects the employee may be able to do. Consider allowing your employee to return to work on a part time basis.

Employee should advise all medical providers to forward bills to: CCMSI, 1750 Elm Street, Suite 404, Manchester, NH 03104.

The absence must be authorized in writing by the employee's treating medical professional.

If an employee loses time from work due to a job-related injury/ illness and it is determined to be compensable, the employee will receive disability payments at a rate equal to two-thirds of the employee’s average weekly wage. This is calculated by using an average of the 26-week period before the date of disability. In addition to any temporary disability benefits, a small supplement will be provided for each dependent child, defined by law. A three-day “waiting period” is applied to WC disability payments. If an employee is disabled for four to ten consecutive days, payment is calculated starting from the fourth day of disability. If disability extends beyond ten days, payment is calculated from the first day of disability. If the waiting period applies, accrued medical leave is used for those three days. All WC payments are subject to minimum and maximum amounts according to VT state statute.

• Additional information from the Vermont Department of Labor

There are two options for compensation during absences caused by a work related accident/illness. You may choose to be compensated by receiving WC disability payments directly from the insurer or by using your accrued leave balances.  Only one option may be chosen.

If you opt to receive WC payments directly from the insurer, you will be considered on unpaid status and will not accrue additional vacation or medical leave from UVM during your period of absence. Nor will you receive UVM contributions to your retirement plan, if enrolled. You will be responsible for paying your normal benefit cost-share.

If you decide to be paid using your accrued medical leave balance, you will receive full pay for the period of available medical/vacation leave. WC disability checks issued to you under this option must be endorsed to UVM and will be deposited in the appropriate departmental account. After deposit of the check, your leave balances will be credited for 2/3 of the leave time that you used (this is because WC reimburses 2/3 of your wages). If you do not have accrued leave available, WC disability checks will be sent directly to you from the insurer and you will be considered on UVM’s unpaid status (as in the first option).

No payment will be made until the claim has been investigated and deemed compensable under VT state statutes. If an employee has no accrued leave available, please advise RM&S so efforts can be made to expedite investigation and processing of the claim.

The employee must obtain a written note from the treating physician stating the employee is able to return to work.

If an employee is only able to return to work on a part time basis, WC insurance will pay wages for the time they are unable to work and the department will pay wages for the time the employee is at work. The total shall not exceed 2/3 of the employee’s gross pay.

Once an employee has returned to work following a disabling injury/illness that was covered by WC, related follow-up visits to medical professionals are not charged to the employee’s UVM medical leave.  It is the employee’s responsibility to notify their supervisor of any medical appointments as far in advance as possible. If necessary, the supervisor can request written verification of the appointment from the employee.

Why is completion of an Employer First Report of Injury (FROI) necessary? Do I need to report minor injuries?

Employers are required by law to report work related injuries to the Department of Labor and Industry via the FROI Form (PDF). Whenever a UVM employee suffers a job-related injury or illness, regardless of its severity, the employee should report the injury or illness to their supervisor as soon as possible.

Who is responsible for completing the Employer First Report of Injury (FROI)? When should it be completed?

The law considers notification to a supervisor sufficient notice to the employer. THE SUPERVISOR IS THE EMPLOYER. The employee has a responsibility to report the injury and assist the supervisor in completing the First Report of Injury (PDF) (FROI). This must be done as soon as possible after discovery of a work related injury or illness. Labor and Industry guidelines state that the injury must be reported within 72 hours, subject to a penalty for late notification.

Why do I have to reveal confidential information such as my wages, social security number and physician's name and address? Is it necessary to sign a medical authorization form in order to file a workers’ compensation claim?

Some of this information is necessary for identification and statistical purposes. If your injury is serious enough to warrant medical attention, this needs to be communicated on lines 34 and/or 35 of the FROI, enabling your claim to be set up for payment of expenses related to your injury prior to the receipt of bills. This helps to facilitate prompt payment to your medical provider. If you did not seek medical attention, indicate this on line 34. The FROI is maintained for recording purposes. Signing the medical authorization form is necessary to verify with your treating physician that your injury and related charges are the result of the on-the-job injury/illness. Medical records cannot be released without your authorization.  All medical records are considered confidential. No payments will be made for medical costs and/or lost work time without a signed medical authorization. Refusal to sign the medical authorization is grounds for denial of your claim under Vermont state law.