Workers Compensation

The law provides for several types of workers comp benefits. The two most common are Medical Care benefits and Payments for Lost Wages. Medical Care benefits cover the payment of related reasonable surgical and medical services. Even if you have lost no time from work, health care costs for the injury are covered, assuming a panel physician is used.

If approved for lost wages, for up to the first 13 weeks of injury, you will receive your full regular pay from the district. During this period, you will also receive checks from SDIC. It is your responsibility to sign over the SDIC checks and send them to the Benefits Office in the Spellman Building as soon as you receive each check. Failure to do so could lead to disciplinary and/or legal action. If you remain unable to return to work at the end of 13 weeks, you will no longer receive a paycheck from the district. At this time you will keep and deposit the checks from SDIC, which will cover approximately 2/3 of your pay.

The most frequent examples of an injury not covered by workers compensation are when the employee is present in a district building as a member of the general public, not as an employee; when coming to and from work and not on district property; when there is no mechanism of injury; or when on site volunteering their time (not working in an employee capacity).

Yes, claims submitted as a workers compensation claim can be denied by the workers comp insurance company, SDIC. Denied medical claims will result in the employee having to submit their claims for medical treatment to their individual medical insurance policy.

In some instances, the workers comp carrier may accept claims for medical only and not for loss of wages. SDIC has 21 days from the date the employer is notified of the injury to accept or deny the claim.

If your claim is denied for loss of wages and you are medically unable to return to work, the employee must l use accrued sick, personal and vacation days to cover the absence and will receive pay during that time.

Should you be medically unable to return to work at the end of your eligible district paid time off, your leave will be designated as unpaid FMLA, assuming you meet the FMLA guidelines of length of employment and hours worked. FMLA will hold your position and health benefits for up to 60 work days.

For any work related injury in which you are unable to return to work, those absences should be reported as Workers Comp to the appropriate absence system (Aesop and/or Time Force). The AESOP code is W069 Workers Comp

For a work related injury in which you are cleared to return to work but have follow up doctor’s appointment scheduled, employees should try to schedule those visits outside of normal work hours. If the provider cannot schedule the visit outside of normal work hours, then use the absence reason Workers Comp. If the provider can schedule outside normal work hours, but the employee chooses to make an appointment during work hours, the absence should be reported as Sick.

For an injury in which you have been scheduled for physical therapy or other tests, the employee should schedule those appointment outside of normal work hours. If the provider is not able to schedule your visits outside of normal work hours, report the absence as Workers Comp. If the provider is able to schedule visits outside of normal work hours, but the employee chooses to make an appointment during work hours, then the absence should be reported as Sick.

In an emergency, seek treatment at the nearest emergency room. You cannot seek emergency care at an urgent care facility unless it on the approved provider list.

For non-emergencies and any treatment follow up, you must seek medical treatment for your claimed injury with one of the providers listed on the district POSTED PANEL within ninety (90) days from the date of your first visit. This panel is contained in the workers comp packet available from your school nurse or the district website, under Workers Comp.

Contact One Call Care Management at 1-800-453-0574 to schedule the appointment.

Failure to follow this step can result in the service not covered by SDIC.

Use the Pharmacy Sheet contained in the Workers Comp packet to fill your prescription at your local Walgreen’s, CVS Pharmacy, Rite Aid, Wal-Mart, Giant, or Acme.

The Mitchell International Company, our workers comp pharmacy management company, will send you a personalized pharmacy card for future prescriptions related to the workers comp injury.

Please mail any medical bills you receive to SDIC, PO Box 1249, North Wales, PA 19454.

Please provide an update on your status and any doctor’s documentation to the Benefits Office.

Contact the district Benefits Office. They will need to see a copy of the doctor’s note and the restrictions.

In most cases, the Director of Human Resources will set up an Interactive Meeting and have the employee come in to meet to review the restrictions. There is no guarantee that the restrictions will be able to be met by the district. Should the district be unable to meet the restrictions, the employee will remain out of work and continue with the plan of treatment with the goal of a full duty release.

During the period you are receiving full pay from the district (up to 13 weeks) for loss of time, your standard deductions for health insurance will continue and your benefits continue. If you are unable to return to work at the end of the 13 weeks, and if you qualify for FMLA, your benefits will be covered under FMLA for up to 60 work days. During the FMLA period, the district will send an invoice to your home for the amount you would normally pay through payroll deduction for your health benefits.

If you are unable to return to work at the end of the 60-day FMLA period, a COBRA notice will be sent to you for continuation of health benefits, paying the full cost. If you do not qualify for FMLA, at the end of the 13 week period, you will be sent a COBRA notice for purchase of health benefits. Please note that failure to pay your billed amounts by the due date may result in the loss of district benefits.

Yes, you can submit for Long Term Disability benefits from the district carrier. The district’s LTD plan may provide for a small monthly benefit while you are out on workers comp, should you remain unable to work for at least 1 month.

The maximum monthly benefit is approximately $50.00 and requires you and your physician to complete the LTD forms. Please contact the Benefits Office to request these forms.

Please call our workers comp insurance carrier, SDIC, at 1-800-445-6965 if you need any assistance or have questions regarding your work-related injury.

During the period you are receiving full pay from the district (up to 13 weeks) for loss of time, your standard deductions for health insurance will continue and your benefits continue. If you are unable to return to work at the end of the 13 weeks, and if you qualify for FMLA, your benefits will be covered under FMLA for up to 60 work days. During the FMLA period, the district will send an invoice to your home for the amount you would normally pay through payroll deduction for your health benefits.

If you are unable to return to work at the end of the 60-day FMLA period, a COBRA notice will be sent to you for continuation of health benefits, paying the full cost. If you do not qualify for FMLA, at the end of the 13 week period, you will be sent a COBRA notice for purchase of health benefits. Please note that failure to pay your billed amounts by the due date may result in the loss of district benefits.

Yes, you can submit for Long Term Disability benefits from the district carrier. The district’s LTD plan may provide for a small monthly benefit while you are out on workers comp, should you remain unable to work for at least 1 month.

The maximum monthly benefit is approximately $50.00 and requires you and your physician to complete the LTD forms. Please contact the Benefits Office to request these forms.

Please call our workers comp insurance carrier, SDIC, at 1-800-445-6965 if you need any assistance or have questions regarding your work-related injury.