HCC District Administrative Office

HILLSBOROUGH COMMUNITY COLLEGE
Workers’ Compensation Employee Information

Hillsborough Community College is self-insured for Workers’ Compensation insurance coverage through the Consortium known as the Florida Community College Risk Management Consortium. This program is administered by Gallagher Bassett Services and coordinated by the College’s Employee Relations Office. Gallagher Bassett is the insurance carrier, which pays the benefits thereby, fulfilling the College’s obligation under the provisions of Florida Statutes to provide Workers’ Compensation to its employees.

The law requires that the College be responsible for all accidental injuries and occupational diseases arising out of and in the course of employment. Generally, no compensation is payable if the injury was caused primarily by the employee’s intoxication, by the influence of non-prescribed drugs, or willful intention to injure himself/herself or another person. The law also provides that where the injury is caused by the knowing refusal of the employee to use a safety device or observe a safety rule, compensation may be reduced by 25%. Claims may be investigated where it is not obvious that the injury is job-related or arose out of and in the course of employment.

An employee injury may or may not be covered by Workers’ Compensation. Injuries are compensable only if the injury arose out of and in the course of his/her employment while actively engaged in the duties of the job. This is an issue that is determined by Gallagher Bassett since it requires knowledge of the Workers’ Compensation law and investigation of the facts surrounding the injury. If the injury is covered, Hillsborough Community College is responsible for payment of all reasonable and necessary medical care, including surgical, hospital, and dental (within limits of various fee schedules). Also included are items such as drugs, braces, crutches and other medical supplies when ordered by the doctor treating the injured employee. Rehabilitation services for injured workers who need help to return to employment are also available if prescribed by the assigned physician. Gallagher Bassett will pay these costs for Hillsborough Community College.

The program also provides payment to the employee for 66-2/3% of the wages he/she might lose, if the injury disables the employee for more than the 45 illness-in-line of duty hours the College awards. The remaining 33-1/3% of wages is utilized from accrued sick, personal, vacation leave and/or compensatory time.

NOTE: Employees sustaining work-related injuries that qualify under the Family Medical Leave Act (Administrative Procedure 2.045), are required to utilize their compensatory, vacation and sick leave prior to being placed on any approved leave of absence without pay

WHAT IS A MANAGED CARE ARRANGEMENT?

A Managed Care Arrangement is defined as a health care delivery system which provides quality medical care while ensuring treatment and containing medical costs.

Florida is one of the few states that have undergone a major reform in Workers’ Compensation legislation. The three primary reasons for the reform are as follows:

1. To establish systems whereby high quality cost effective care is delivered.

2. To establish a self-executing, return-to-work system versus a litigation driven system.

3. To retain significant cost savings.

WHAT TO DO WHEN INJURED

An injured employee must immediately notify Security (7911) of the incident and the immediate supervisor. The Safety and Security Officer notifies the Office of Employee Relations. The Safety and Security Office then completes several forms to document the incident. If there were witnesses to the incident, their observations must be documented. The injured worker must sign the reports even if it is after the fact.

NOTE: Immediate medical attention, remedial treatment, and medical benefits are available to all injured employees. In addition, specific expenses incurred as a result of your Workers’ Compensation injury/illness may be reimbursed.

The Office of Employee Relations and Safety and Security Personnel are the only persons who can authorize medical treatment.

In case of an emergency, the injured employee may be transported by local emergency personnel to the nearest hospital emergency room/trauma center.

At the time of your injury, HCC will refer you to one of Gallagher Bassett's adjusters for treatment. You will also be given an Identification Form to present to the medical facility at the time of treatment. HCC will report the injury and the Managed Care process will begin.

Treatment received outside of your Workers’ Compensation Managed Care Arrangement may not be paid unless authorized by Gallagher Bassett prior to the treatment date, except for emergencies.

Any time it becomes necessary to receive additional health care services from a provider, the adjuster will authorize the appropriate qualified specialist. Referrals must be made to a participating network provider unless the referral is for emergency treatment not available within the network.

You are allowed to change to another provider one time within the provider network. You should call or write your current adjuster with your request to change to another provider. The adjuster will review your request within two (2) business days and will identify another provider, within the network and of the same specialty. Any special request (i.e., provider closer to home, work, etc.) will be considered and every attempt will be made to meet any request.

You are encouraged to express to the College’s Employee Relations Office (ext. 7187) any dissatisfaction with the Workers’ Compensation Managed Care Arrangement or with any medical care provided for you.

If the injured employee is unable to perform his/her duties, the injured employee must notify his/her immediate supervisor AND Employee Relations. The employee should keep the Office of Employee Relations informed of his/her progress. The employee must notify the Office of Employee Relations the day he/she returns to work. All forms given to the employee by doctors, therapists, etc., MUST be forwarded to the Office of Employee Relations with a copy to the employee’s supervisor.

Sometimes the employee is returned to work with certain limitations. It is important that the employee’s supervisor abides by the restrictions placed on the duties of the injured employee and makes certain that the employee does not perform beyond the restrictions. The Office of Employee Relations must be kept informed of all limitations and the length of time of the limitations.

The Payroll Office, which is the custodian of leave records, will be responsible for maintaining the official absence records for an injured employee. The employee’s administrative supervisor in conjunction with the Payroll Office will ensure that the employee’s absences are properly recorded.

If an employee qualifies for disability payments, the Office of Employee Relations, the Payroll Office, and the injured employee shall coordinate disability payments from Gallagher Bassett to make certain that the amount received complies with the law.

IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO CONTACT THE OFFICE OF EMPLOYEE RELATIONS AT EXTENSION 7187.