Workers' Compensation

Introduction

The Workers’ Compensation Reference has been compiled to assist you in your duties involving workers’ compensation injuries and claims.

Workers' Compensation is an insurance program that pays medical and disability benefits for work-related injuries and diseases. Under the State of New Hampshire Workers' Compensation Law RSA 281-A, every employee is covered, including faculty, staff, student employees, temporary employees and casual workers.

It is sometimes difficult to know whether a person’s injuries/illness will be covered by Workers’ Compensation. Although the university does not make the decisions as to whether a person’s injuries/illness is covered, we can give you the general guidelines which are used by our third party administrator in making these decisions. Please realize that while we can give you the general guidelines, claims still fall into many “gray areas.” If you have questions regarding a specific case, please feel free to call the HR Benefits Team at HR.Benefits@usnh.edu or at (603) 862-0504 so we can discuss it with you in more detail.

The Employee Guide to Workers’ Compensation - A one page fact sheet describing the benefits concerning Workers’ Compensation.

Department managers and supervisors need to be familiar with this information. As a manager or supervisor you will be responsible for following the University policy on Workers Compensation in accordance with NH Department of Labor Regulations.

We recommend you don’t wait until an employee has an injury before you read this. We hope this reference will be a useful tool and we welcome any comments or suggestions.

What is Workers’ Compensation?

Workers’ Compensation is a "no fault" system that protects employees from loss of salary and pays medical expenses in the event of an injury or occupational illness arising out of and in the course of employment. The University contracts with MEMIC (effective 4/1/19) to administer the claims.

The benefit structure defines what injured workers are entitled to receive when they sustain an injury arising out of and in the course of employment. Benefits available depend on the nature and severity of the worker’s injury. Potential benefits are:

• Medical Care – You are entitled to receive all medical and hospital treatment reasonably required to cure or relieve your work related injury. The insurance carrier pays these fees directly to the physician.
• Disability Payments - Temporary Disability - These payments will be made according to state law and University policy. If you are unable to work more than three days you are eligible to receive income based on 60 percent of the employee’s average weekly wage. The average weekly wage is determined using the average of earnings for the 26 weeks prior to the injury.
• Mileage Reimbursement Form - The injured employee may be reimbursed for mileage accumulated for all doctor and PT appointments.

Reporting an Injury

If injured while working a report of injury or illness must be reported within 24 hours of occurrence to your supervisor no matter how minor the job related injury or illness may seem.
UNH Accident / Injury / Illness Report

Failure to file a report or injury after five (5) days may subject the employing department to a late filing penalty fine from the NH Department of Labor up to $2,500.00.

Payment or Denial of Claims

Medical Only Claims:  Pay/Deny deadline for medical bills in the state of NH is 30 days from the date the bill is received by the workers compensation insurance company.  You will receive written notification if a medical bill is denied. A copy of the denial will also be sent to the medical provider. After medical claims are denied it is the employee's responsibility to provide the medical provider with their private insurance information or make arrangements for payment of services.

Lost Time (Indemnity) Claims: Pay/Deny deadline for lost time claims is 21 days from the date the workers compensation insurance company is first notified of any lost time. Once they are notified of any lost time, they then have 21 days to conduct a thorough investigation and make a decision to either pay or deny the claim. If you are unable to work, you will have to use your accrued leave until a decision has been made. On all lost time claims you will be notified of  decision in writing.

Appealing a Denial: After receiving a denial on a claim, you may request a hearing at the Department of Labor in order to dispute the denial. Hearings are before administrative officers at the Department of Labor building in Concord, NH. You have up to 18 months from the date of denial to request a hearing.

Timeframes for Filing a Claim

The university requires injuries be reported within 24 hours of occurrence. The New Hampshire law states: RSA 281-A:19 "The injured worker has two (2) years from the date of injury to notify the employer of his/her injury in order to make a claim for benefits. In cases where an occupational illness develops gradually and an injury is not immediately recognized by the claimant, the claimant must provide a date he/she knows, or by reasonable diligence should have known, the nature of the injury and its possible relationship to the employment."

Please remember, the insurance carrier has a responsibility to investigate each claim thoroughly to determine whether a claim is legitimately compensable. Therefore, to avoid any question of a claim later on, do not delay in filing a report when an injury occurs.

Medical Treatment

If you have an employee who is injured/ill from a work related accident you will first need to send them for medical treatment if it deemed necessary. If the injury/illness appears life threatening, call 911.

Employees who require immediate medical attention for work related injury/illness during regular office hours, but are not in a life threatening situation may elect to seek medical treatment with a provider of their choice.

Recommended medical providers in the area include:

UNH Health & Wellness - Hours and location

Employees who are injured or become ill after regular hours and on weekends should determine if they can wait until regular office hours to be seen by a provider of their choice or to go to the nearest hospital emergency room. 

Medical Benefits

All reasonable and appropriate medical expenses for treatment of your work related injury will be paid. These expenses include, but are not limited to, visits with doctors, therapists, diagnostic testing, prescription and medical related Mileage Reimbursement Form. Please forward all bills related to your injury to MEMIC, the Workers Compensation Carrier using the claim information provided to you from HR Benefits at the time reporting.

Weekly Compensation Benefits

Under NH law you must satisfy a three day wait period before you are eligible to receive weekly compensation benefits for loss of earnings and will be required to use their accrued leave balances. You will be compensated for the first three days of disability if you remain out of work for more than 14 days.

Under NH law an injured worker is to be paid 60% of their pre-injury average weekly wage while they are out of work due to a work related injury. These benefit payments are issued by the insurance company on a weekly basis and are tax free.

Supplemental Benefits

The University allows employees to use accrued leave to supplement the 40% portion that workers compensation does not cover. The injured employee is required to fill out the Workers Compensation Accrued Time/Overpayment Agreement form and submit the completed form to the Workers Compensation Coordinator.  Once your accrued leave balance is exhausted the injured worker will be on a leave without pay from the university as long as they are out of work.

Instructions - Responsibility of Supervisor

• If immediate medical attention is necessary, assist employee. For more information refer to Medical Treatment
• Instruct the employee to complete the UNH Accident / Injury / Illness Report within 24 hours
• Advise employee about disability payments (loss wages). See Workers’ Compensation Benefits
• Advise employee regarding the Family and Medical Leave Act (FMLA) if out for more than five days
• Keep the HR Workers’ Compensation Coordinator informed such as:
  a) Verify if employee is working, or last day of work if out
  b) Verify employees normal work schedule
  c) Following any physician visit(s)
  d) If there are any concerns or the condition worsens
• Investigate the accident, obtaining all details possible. If an accident results in a serious injury, contact Environmental Health and Safety (EH&S) immediately
• Stay in touch weekly, with the injured employee to ensure a smooth transitive back to pre-injury status
• Correct the unsafe conditions immediately
• Identify return-to-work options to find light or alternative duties that will get the employee back to work

Instructions - Responsibility of Employee

• Inform supervisor of injuries or illness immediately
• Fill out employee section of the UNH Accident / Injury / Illness Report
• Seek appropriate medical attention
• Inform your doctor that modified duty will be provided if released with restrictions
• Provide your supervisor and Workers Compensation Coordinator with NH Workers Compensation Medical Form each and every time following doctor visit
• Notify supervisor in advance of doctor or therapy appointments
• Maintain communication with supervisor
• Report any unsafe working conditions or hazards  

Temporary Alternative Work Program 

The University of New Hampshire has developed a Workers' Compensation Temporary Alternative Work Program (TAWP). This program is designed to develop temporary alternate work opportunities for injured employees. The TAWP prefers to establish work in the injured employee's home department. The primary case management team in conjunction with Human Resources will screen requests for employment and other unfilled positions that the University may have for a satisfactory temporary fit. It temporary work is established outside of the employing department, the salary of the employee will be split equally between the home and outside departments. When absolutely necessary, alternative methods of funding will be investigated. If you have any questions about this program, please contact HR.Benefits@usnh.edu or (603) 862-0504.

Temporary Alternative Work Program Information
Temporary Alternative Work Forms and Procedures