Instructions for All Employees

Work Life Event: 
Applies To: 
All Employees

Employees who are ill/injured due to a work-related situation/incident may be entitled to income security (beyond use of sick, vacation and personal leave accruals) and employer-paid medical care for that illness/injury. The University's Division of Human Resources and the Commonwealth's Division of Industrial Accidents can assist you with questions about Workers' Compensation benefits.

Critical initial steps:

1.     Secure any required emergency medical care

                     This may entail providing first aid on the job, the employee seeking care at
                     University Health Services or calling 9-1-1 for emergency care.

                    The employee or his health care provider must contact the Commonwealth’s Utilization
                     Review department for pre-approval of medical treatment (or within 24 hours after
                   seeking emergency medical care):
                   
                          Telephone: 800.266.7991
                          Facsimile: 617.727.7816

Medical invoices and treatment notes should be sent to the University’s Workers’
Compensation insurer (HRD/WC):
                                  Commonwealth of Massachusetts
                                  Human Resources Division, Workers’ Compensation Unit
                                  1 Ashburton Place
                                  Boston, MA 02108
                                  Telephone: 617.727.3437

Note: after emergency care is secured, all subsequent medical care and related prescriptions must be obtained by a provider that accepts the Commonwealth of Massachusetts Workers’ Compensation insurance. Medical expenses otherwise incurred will not be paid.

2.     The employee & his/her supervisor must complete and submit a Notice of Injury form for receipt
         in UMass Amherst Human Resources within 48 hours of the illness/injury.

3.     If the employee is (or will be) out of work for five-or-more calendar days:

a.     The employing department must submit a Form 101 to Human Resources to request income benefits on behalf of
         the employee and provide the employee:

         1. The Employee Leave application process
         2. copy of his/her job description
         3. completed FMLA Notice of Eligibility and Rights & Responsibilities form.
 

         The department should retain copies of all documents sent to the employee
        for submission to Human Resources once the employee returns to work.

                                 Upon receipt of the 101 Human Resources will submit a Personnel Action
                                  Form to Payroll placing the employee on a Leave of Absence for
                                 Workers' Compensation and provide a copyof the form to
                                  the employee's department.

b.     Employee must submit a:

                                1. Physician’s Report and Concurrent Employment Review to Human
                                   Resources. The timing of these is critical – late submission may result in
                                   denial of the claim and elimination of both WC income and medical benefits!

                                2. leave request to his/her department with a Certification of Health Care Provider                                     form completed by his/her health care provider

The department should respond to the leave request using the standard Employer Leave response process including but not limited to providing the FMLA-eligible employee a completed FMLA Designation Notice. The department should retain copies of all documents sent to the employee for submission to Human Resources once the employee returns to work.

Securing income:

Until HRD/WC makes a determination on the claim, a benefited employee’s department should submit time/labor using the employee’s accrued time (sick, vacation, personal, compensatory) if he or she is unable to work and unless the employee requests to be on an unpaid leave or has no accrued time to submit. Unless working, non-benefited employees are not paid by the University during this time.

If approved, Workers Compensation income benefits begin effective the 6th calendar day of absence and replace 60% of the average of your earnings over the 12 months preceding your illness/injury (within certain minimum and maximum benefits).  If you are disabled for more than 21 days, these benefits will become retroactive to the first day of your absence.

If you have received income from the University during a period later covered by Workers' Compensation (eg, by using sick, vacation, personal or compensatory time to secure income) you may not retain both payments in full (which would total more than 100% of your normal salary). Human Resources will work with you to restore the duplicate payment to the University, restoring the accrued time paid for your future use.

If Workers' Copensation benefits are:

Approved – Human Resources will provide the department instructions on how to submit time/labor. Typically an employee stops receiving income from the University at this juncture (T/L code: IAI). Reference impact of unpaid leave on benefits (below).

Denied – the employee may appeal this denial. In the interim Human Resources will:

            1.     Reverse the Personnel Action Form placing the employee on leave

            2.     Notify the department that the employee is not on a WC leave & that the leave (time/labor) should be
                    fully managed by the supervisor/department

            3.     Instruct the department to submit time/labor as determined by the employee & department

Reference medical leave for income options and impact on benefits.

 

Impact of an Approved Workers’ Compensation Leave on Benefits

Workers’ Compensation Leave Paid via University Paycheck (using accrued time)

Typically this occurs only during the period during which HRD/WC is reviewing your claim. Normal payroll deductions will continue while you are on paid leave and there is no impact on benefits during this period.

University Sick Leave Banks and AFSCME Extension of Sick Leave cannot replace or supplement income for an employee who is on leave due to a work-related illness/injury.

Workers’ Compensation Leave Not Paid via University Paycheck

  • Health & Basic Life Insurances: an employee who has health insurance through the MA Group Insurance Commission must be on an approved leave and submit a completed Application for Continuation of Part Cost Premium (“Form 11”) to UMass Amherst Human Resources in order to continue coverage at the normal contribution rate (without this the GIC will invoice you at 100% of premium). The GIC bills the employee at home for insurance premium(s). Return payment directly to the GIC to keep coverage(s) intact. Non-payment and late payment of premium will result in cancellation of coverage & the employee will be unable to re-establish coverage until the next GIC open enrollment period.
  • SERS and ORP creditable service:

                - WC Section 34 (totally disabled) – you will earn full creditable service toward retirement while on leave

                - WC Section 35 (partially disabled) – you earn no creditable service toward retirement unless you are also
                   working part-time in your University position (which will then yield full-time service toward retirement).

  • GIC Optional Life insurance: Employee will be billed by GIC at home for premium. If not paid timely coverage may be cancelled with no option to re-enroll without passing medical evidence of insurability.
  • GIC Long-Term Disability insurance: Employee will be billed by GIC at home for premium unless he/she has an approved LTD claim, which would result in: reduced LTD monthly payment, waiver of LTD premiums. If GIC premium payments not paid timely coverage may be cancelled with no option to re-enroll without passing medical evidence of insurability.
  • HCSA: An Employee may not incur eligible expenses during an unpaid leave & bi-weekly deductions upon return to University payroll will be increased to meet his/her annual election amount.

                 Alternatively participants may have:

                        1.    a pre-tax deduction lump sum taken from their last check before the unpaid leave starts.
                               The deduction must cover the period of leave during which no payroll deductions are
                                being taken. With this option, the flex debit card remains active and participants are able
                                to continue using their HCSA funds and submit claims;

                      2.   their flex benefit premiums and administration fees directly billed by Benefit Strategies
                            while on leave. This process must be requested directly of Benefit Strategies via e-mail to
                            flexgic@benstrat.com before the unpaid leave starts. The employee will be invoiced every
                            two weeks. Premiums may be paid by check or money order no later than the pay date on  
                            which the employee would’ve received a paycheck had they been active. If payments are
                            made timely the flex debit card remains active and participants may continue to incur eligible
                            expenses. Direct bill payments are post-tax.

  • DCAP: IRS regulations state that you must be at work or a full time student in order to be able to use the benefit. Payroll deductions will resume upon return to work at an increased level in order to meet the annual election amount.  Payroll deductions will resume upon return to work at an increased level in order to meet the annual election amount.
  • Paid leave accruals: you continue to accrue vacation and sick time as normal.
  • Voluntary 403(b) and 457/SMART Plan contributions: 403(b) and 457 deductions discontinue and resume when UNIV earnings/payments great enough to cover your elected contribution.
  • Union dues: please contact your union.
  • Met Home/Auto/Legal: You must to contact Met Life to arrange for payment of home, auto and/or legal insurance premium if you normally pay premium via payroll deduction (800.438.6388).
  • College Savings Program (529 plan): direct deposit of contributions discontinue while on unpaid leave and resume when your University earnings/payments great enough to cover your elected deduction.

Where this information departs from Massachusetts or federal law or relevant bargaining contract, the law or contract will prevail.