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Frequently Asked Questions (For employees living/working in PA)

 

Yes.  Initial emergency care may be obtained at the closest emergency facility.  The Pennsylvania Workers' Compensation Act requires that employees of an employer who has posted an approved health care provider panel treat with that panel for work-related injuries for 90 days from the first day of treatment.  If you choose to treat with a non-panel provider before the 90-day period has expired, the University is not responsible for paying the non-panel provider for services.

 

Even though you may be a “student” covered through your personal/student health insurance versus an “employee” covered under Workers’ Compensation, your health is the most important and first concern.  Regardless of employment status, if you are a University of Pittsburgh individual with a potential BBP exposure you are strongly encouraged to seek immediate medical evaluation and treatment at Employee Health Services (EHS).  As noted under Environmental Health and Safety guidelines, if your exposure occurs when EHS is not open, you should immediately proceed to the UPMC Presbyterian Emergency Department (Presby).  Reports of potential BBP exposure made to Student Health Services will be referred to EHS or to Presby as appropriate.  http://www.ehs.pitt.edu/workplace/injury.html

 

Physical therapy should be scheduled before or after working hours.  If your medical provider has scheduled therapy during working hours, please call Workers’ Compensation at 412-624-1198.  They will attempt to intervene on your behalf to reschedule your appointment during non-working hours.

 

Check with your Office of Human Resources representative: http://www.hr.pitt.edu/benefits/time

 

Yes, an amended ER is always required:

  • When an employee ‘is not’ using sick/vacation to cover a WC absence, you are required to submit an amended ER to HR. At this point, completing a timecard is not necessary.
  • When an employee ‘is’ using sick/vacation time to cover a WC absence – the employee’s timecard should reflect this use and changing the ER is also required. The sick/vacation time will be listed in the paid leave section of Line 8. The first day after that time is used will be listed in the unpaid leave section.

Specific related questions should be directed to HR.

 

 

MetLife is the disability carrier that administers the Family and Medical Leave Act (FMLA) for the University.  As long as Workers' Compensation is aware that you are losing time, you do not need to contact MetLife to file a FMLA claim. The University will automatically open a corresponding FMLA claim that will run concurrently with your Workers' Compensation leave. It is not necessary for you and/or your doctor to submit any information related to the FMLA portion of the claim. You will be notified that a FMLA claim has been opened for you. Further questions may be directed to Benefits at 412-624-8160.

 

The University’s third-party claim administrator (TPA), UPMC Work Partners, adjusts University workers' compensation claims in accordance with the PA Workers’ Compensation Act which requires that a determination be made within 21 days from the first day of disability on a lost-time claim.  This assumes that proper notice of a work-related injury or illness is provided.  If your claim is accepted and lost-time disability payments are applicable, you must be disabled more than seven (7) calendar days (including weekends) before WC payments for disability are payable. Lost time wage payments are payable on the eighth (8th) day after injury. Once you have been off work fourteen (14) days, you receive retroactive payment for the first seven (7) days. Please consult with the Office of Human Resources for guidance on use of benefit days, such as sick, vacation, FMLA, etc., to cover any unpaid Workers' Compensation during this waiting period. http://www.hr.pitt.edu/benefits/time

 

UPMC Work Partners is responsible for processing all Workers’ Compensation checks.  If you have questions about your check, call UPMC Work Partners at 1-800-633-1197.  Explain that you are a University of Pittsburgh employee calling to inquire about the status of your check.

 

 

Workers’ Compensation is responsible for medical bills deemed reasonable, necessary and directly associated with your work-related injury.  Forward all bills associated with the treatment of your work-related injury to UPMC Work Partners, P.O. Box 2971, Pittsburgh, PA  15230 or fax to 412-454-7519.  If you receive a notice from a credit agency regarding unpaid bills, which are associated with your work-related injury, immediately call UPMC Work Partners at 1-800-633-1197.

 

 

Workers’ Compensation will cover the cost of your prescriptions as long as they are deemed reasonable, necessary and directly associated with your work-related injury.  Express Scripts, Inc. administers the University’s Workers’ Compensation prescription program.  You should have no out-of-pocket expense, if you choose a pharmacy from their list of Participating Retail Network Pharmacies and, on your first pharmacy visit, provide the ‘First Fill’ document - Workers’ Compensation Temporary Prescription ID Card.  Be certain to also provide your University of Pittsburgh employee ID.

 

 

Express Scripts, Inc., is the Pharmacy Benefit Manager that administers the University’s Workers’ Compensation prescription program.  If you have questions or need assistance locating a participating retail network pharmacy you may call Express Scripts Patient Care Contact Center at 1-866-759-6146. 

 

 

Workers’ Compensation does not pay for benefits such as: retirement plans, health insurance, or any other insurance plans.  Your payroll administrator should notify Payroll that you are on Workers’ Compensation leave. Workers’ Compensation will notify Benefits and they will send a letter advising you about steps that must be taken if you wish to continue participation in these plans.  If you are on Workers’ Compensation leave and have not received such a letter contact your payroll administrator or Benefits at 412-624-8160.

 

 

You should refer to University Policy & Procedure 07-06-02 @ www.cfo.pitt.edu/policies/index.

 

 

Your supervisor has been provided with the above information and should be able to clarify any questions you may have.  However, if you should have additional questions please contact

UPMC Work Partners at 1-800-633-1197 or Workers' Compensation at 412-624-1198.