Accidents While on the Worksite

All employees are eligible for benefits provided by the OJI program:

a.       Full-time and part-time employees; 

b.      Temporary workers employed by the University of South Alabama General Division and USA Health; and

c.       Student employees (injury must occur in the course and scope of duties as a University  employee).

The OJI program does not provide benefits to volunteers, independent contractors, or workers employed outside of the University of South Alabama, USA HealthCare Management, LLC, and the USA Healthcare Authority.

Benefit eligibility is based on employment status and whether the injury, illness, and/or disability results from an incident arising “out of and in the course and scope of employment” with the University of South Alabama, USA HealthCare Management, LLC, or the USA Healthcare Authority. All OJI claims are investigated for compensability by the University’s Third Party Administrator, Brentwood Services Administrators. 

An Accident/Incident Report must be completed within 72 hours of the worksite accident/incident in order to be considered for OJI benefits. For this reason, a worksite accident should be reported immediately to your supervisor.

University General Division employees (Campus): the Accident/Incident Report is available online at https://www.southalabama.edu/departments/financialaffairs/riskmanagement/accidentreporting.html

USA Health employees (USA HealthCare Management, LLC, and USA Healthcare Authority): must complete an accident/incident report via RL6 located within the USA Health employee intranet. 

If you sustain a serious injury at the worksite during work hours, arrangements should be made for you to be treated at the University Hospital Emergency Room. If time is of the essence, based on the severity of the injury, the employee may be taken to the nearest emergency department. 

 

University General Division employees (Campus): If you sustain an injury that is not serious enough to warrant emergency room treatment, and you wish to be considered for OJI benefits by the University, you must report to the USA Student Health Center, for treatment. You must bring with you a completed Employee On-the-job injury Initial Medical Referral form.

For after hours and weekends medical treatment is authorized with the Greater Mobile Urgent Care - Springhill. You must bring with you a completed Employee on-the-job injury Initial Medical Referral form.

Greater Mobile Urgent Care - Springhill
4402 Old Shell Rd.
Mobile, AL 36608
251-633-0123

Additional medical treatment is authorized with the USA Industrial Medicine clinic. You must bring with you a completed Employee on-the-job injury Medical Referral form.

USA Health Industrial Medicine
1976 Michigan Avenue.
Mobile, AL 36615
251-660-5910

USA Health employees (USA HealthCare Management, LLC, and USA Healthcare Authority): If you sustain an injury that is not serious enough to warrant emergency room treatment, and you wish to be considered for OJI benefits by the University, you must report to the Employee Health Clinic, or the house supervisor (after normal business hours).

Additional medical treatment is authorized with the USA Industrial Medicine clinic:

USA Health Industrial Medicine
1976 Michigan Avenue.
Mobile, AL 36615
251-660-5910

 

 

If you are taking a leave under the OJI program, the USA Employer Group requires a fitness-for-duty certification prior to reinstatement. If your assigned physician advises that you are not able to return to work, you must report the absence to your supervisor following your department’s call-in procedures. 

The OJI program will provide Wage Replacement benefits for a maximum of 180 calendar days from the date of the incident, regardless of when medical treatment is sought. 

The OJI program will provide payment for medical care received to a Maximum Medical Improvement (MMI). 

An employee whose employment is terminated (voluntarily or otherwise), after the incident, is not eligible for the Wage Replacement benefits following the employment termination date. Payment for medical care received will continue to a Maximum Medical Improvement (MMI).  

Any time lost on the day of the injury/incident, will be paid as administrative leave. The first three days following the date of the injury/incident are considered a waiting period, and no lost wage benefit will be paid during this time. An employee may request to use available sick leave, vacation, or PTO, as applicable, during this waiting period. Accrued sick leave, vacation, or PTO used will not be reinstated. Employees may also choose to be unpaid during this time. If Brentwood determines that the injury, illness, or disability qualifies for OJI program benefits, the OJI program will compensate for lost wages beginning on day five.

Beginning with the fifth calendar day following the day of the injury incident, the OJI program will pay a wage benefit at the rate of 66 2/3% of the employee’s regular rate of pay, which shall not exceed the annually adjusted weekly maximum wage established by the Alabama Department of Industrial Relations. Part-time employees will receive prorated wage replacement benefit based of their FTE.

Employees may supplement the 66 2/3% OJI wage replacement benefit with accrued sick leave, vacation, or PTO, as applicable, to achieve 100% of the employee’s regular rate of pay. Employees must notify their supervisor, by submitting a leave of absence request form, of their desire to supplement the OJI benefit with accrued leave. In no event shall a combination of OJI benefit and supplemental time exceed 100% of an employee’s regular base rate of pay. Sick leave, vacation, or PTO used to supplement an OJI wage replacement benefit will not be reinstated. This payment is issued via the University’s Payroll Office, and normal payroll deductions, such as employee benefits premiums and federal, and state taxes will continue. 

If lost time resulting from an OJI exceeds two calendar weeks, the employee will be placed on Family Medical Leave or a personal leave of absence, if eligible and as applicable, retroactive to the date of the incident. A leave of absence and OJI program leave will run concurrently and will not “stack” one after the other.  The employee and the supervisor are responsible for submitting a new leave of absence request form to Human Resources to verify the employees’ eligibility and identify status.

University General Division Leave of Absence Request Form

USA Health PTO Leave of Absence Request Form

For University General Division employees, the Human Resources Employee Health and Wellness Office will monitor the status of employees who are unable to work as a result of an OJI. 

For USA Health employees, the Employee Health Clinic will monitor the status of employees who are unable to work as a result of an OJI. 

If the employee expects to be unable to return to work within 90 days, the employee is required to begin an application for benefits under the University’s LTD insurance program at least 45 days prior to the 90th day on leave. 

Because this benefit will be paid directly to the employee from the LTD TPA, the employee will be responsible for the direct payment of employee benefit premiums at the employee rate. Premium payments are due no later than the 25th of the month to maintain the next month's coverage.  Please make your check or money order payable to the University of South Alabama and submit your payments to the Payroll Office, TRP Bldg. III, Suite 1300.

Employees may not supplement LTD wage replacement benefits with sick leave, vacation, or PTO, as applicable.

All OJI claims are investigated for compensability by the University’s third party administrator, Brentwood Services Administrators.

Medical Providers will file medical claims ​​directly to Brentwood Services Administrators at:

Careworks
Attention: Brentwood Services
2000 Mallory Lane
Suite 130-602
Franklin, TN 37067
Fax # 877-351-3847
Phone # 615-399-8658
bwoodmbr@careworksmcs.com

Pharmacy Benefit: All employees given a prescription related to an on-the-job injury will be given a WAM's first fill pharmacy card flyer. Please note this card will not be accepted at any physician offices that dispense med​ications​ out of their medical offices. Employees are to use this card at the retail pharmacy of their choice. This card is only for first fills & good for 14 days. Once the first fill is processed WAM will issue and mail directly to the employee's home address a personal prescription card. 

Employees with evidence of payments from their personal funds may be reimbursed for qualifying expenses.​ Receipts must be submitted directly to Brentwood Services. Employees must contact their assigned claims adjuster for instructions on how to submit receipts. Once the employee is released from the care of his/her designated physician, all University payments cease unless approval for follow-up care is given from the claim adjuster.

The OJI program will provide payment for medical care received to a Maximum Medical Improvement (MMI). 

This section provides information relating to an employee’s ability to return to work after experiencing an injury, illness, or disability as a result of an OJI. Employees who are released to return to work on a regular or reduced schedule basis but with temporary job restrictions, as supported by medical evidence, may be eligible for a modified duty assignment as defined in this section. 

The department head or designee, with the concurrence of the Human Resources Department, as supported by medical evidence, may assign the employee to perform certain modified duty assignments on a temporary basis. The goal of this program is to enable employees to continue using skills and abilities temporarily limited by injury, illness, or disability when modified duty assignments are available. This shall apply to any employee who has a temporary injury, illness, or disability as a result of an OJI that prevents him/her from performing his/her full duties or meeting the minimum standards established for his/her position.

In cases where the employee is not able to return to work, the employer may rely on the information contained in the “Certification of Health Care Provider” form, if applicable and available, to determine appropriate next steps. An employee must adhere to any restrictions noted on the fit-for-duty certificate provided by his/her physician. 

Modified duty is an assignment, which is for a specified and limited period, that fulfills a necessary job function appropriate to the employee’s skills and level of experience and that the employee can perform without violating any medical restriction imposed on him/her as a result of an OJI. It is the employer’s responsibility to determine whether a modified duty assignment is appropriate for an employee.  During a modified duty assignment, the employee is compensated at his/her normal rate of pay and benefits.

Modified duty assignments are not a matter of right. The number, availability, and duration of such assignments are limited by departmental needs as defined by the department head or his/her designee. If restrictions, as noted on the fit-for-duty physician’s note or “Certification of Health Care Provider” form, are determined to be permanent, the employee is not eligible for a modified duty assignment. 

A modified duty assignment ends on the earliest of: 

1.       The date the employee is released to his/her regular schedule with no restrictions as 

           evidenced on the fit-for-duty physician’s note; 

2.      The date the physician determines the employee has permanent restrictions; or

3.      The date the employee fails to take a required medical examination, without good cause.

Assignment to a modified duty assignment does not in any way create a right for the employee to occupy that or any other position on a regular basis. At the end of the modified duty assignment, if an employee is unable to return to work without restrictions, he/she may be placed on a leave of absence, as applicable.

The University is committed to nondiscrimination and employment of qualified individuals with physical and mental disabilities in accordance with the Rehabilitation Act of 1973 (Section 504), the Americans with Disabilities Act (ADA), as amended by the Americans with Disabilities Act Amendments Act (ADAAA), and state and local laws and ordinances. The University’s attendance policy is subject to requests for reasonable accommodation under the ADA and ADAAA. 

It is the employee’s responsibility to request an accommodation. Requests for a workplace accommodation will require the employee to complete the University’s Employee Accommodation Request form and submit it to Human Resources for review. The University may require written documentation of the employee’s limitations from an appropriate health care provider. If obtaining this information is necessary, the employee will be provided with a Medical Inquiry form for the health care provider to complete. Once the required documentation is reviewed and approved, the University will engage in the interactive process with the employee in seeking the availability of a reasonable accommodation. 

If the request for a workplace accommodation is granted, implementation of the accommodation will be handled by the employee’s department with guidance provided by Human Resources. The employee who has been granted a workplace accommodation must report changes in the ongoing need for the accommodation. 

The University’s Human Resources department is responsible for implementing this policy, including the resolution of reasonable accommodation, safety/direct threat, and undue hardship issues.

If you seek to recover for lost wages, property damages, and/or medical expenses not paid by the On-The-Job Injury Program you must file a claim with the State Board of Adjustment (“BOA”).  The BOA will determine if you qualify for additional OJI compensation based upon an investigation of the incident conducted by University officials. BOA procedures and claim forms are available at:

https://finance.alabama.gov/media/l2fjim4y/on-the-job-injury-claim-form.pdf

Claims must be filed with the BOA within one year of the incident date, regardless of when you incur expenses related to the incident. If you believe you may incur incident-related expenses after the one-year deadline, you should submit a BOA Claim Form prior to the one-year deadline, noting that the expenses claimed are “to be determined.” It is not the responsibility of the University to remind you of the one-year time limit for filing a claim with the BOA.