A reportable occupational injury or illness is one which requires the attention of a physician. The employee should report the injury or illness to the supervisor and the supervisor to the Human Resources Office as soon as possible. State law provides that the employer must be notified within 30 days of the injury or illness or Workers' Compensation benefits may be denied. The following actions shall be taken in cases of reportable occupational injuries and illnesses:

1. EMPLOYEE RESPONSIBILITY:
   When requesting Workers' Compensation Benefits:
   1. Obtain first aid and/or medical care at once from one of the State approved medical providers in the State Workers' Compensation Network.
   2. Promptly informs immediate supervisor.
   3. Completes and signs a State of Tennessee accident report. (See example, page 5).
   4. If a claim is approved by the Division of Claims Administration, receives Workers' Compensation payments and reimbursements for certain medical expenses by submitting to the UTSI Human Resources Office all out-of-pocket bills (drugs, for example) paid by the injured employee. Takes to the Human Resources Office all statements and/or bills received from hospital, physicians and any other related expenses.
   5. Promptly responds to any requests for information from the Human Resources Office. Recognizes that action taken on his/her claim depends on the employee's providing all necessary information.
   6. Excluding the day of the accident, if unable to work, chooses whether to use sick and/or annual leave or be placed on leave of absence without pay.

2. SUPERVISOR RESPONSIBILITY:
   1. Notifies his/her division director and the UTSI Human Resources Office that the employee has been injured.
   2. Completes Supervisor's Section of the Board of Claims Accident Report and signs report. (See example, page 5).
   3. Completes a Supervisor's report of accident and signs the report. (See example, page 6).
   4. Submits both to the Human Resources Office.

3. DIVISION DIRECTOR RESPONSIBILITY:
   1. Retains the injured employee on the payroll for the day of the injury or illness.
   2. If employee chooses to use sick or annual leave, reports time as outlined in the Sick and Annual Leave Policies. As long as the employee is on Sick or Annual Leave, the Bi-weekly Time Report, Salaried Employee Time Report, or a copy of the Leave Record Form - Per 12 (exempt) will be submitted to the Human Resources Office.

4. HUAM RESOURCES OFFICE RESPONSIBILITY:
   1. Reviews accident with supervisor and employee if necessary.
   2. Processes State Board of Claims Report of Accident, Supervisor's Report, and other supporting documentation.
   3. Receives Physician's statement substantiating the validity of the accident leave for the day of the accident.
   4. Receives all paid bills with receipts or cancelled checks for any out-of-pocket expenses (drugs, for example) incurred by injured employee, and any physicians statements, hospital bills and all related information and forwards to Central Workers' Compensation Office.
   5. The Central Workers' Compensation Office informs the UTSI Human Resourcs Office of the approval or disapproval by the Board of Claims of the submitted claim.
   6. If claim is approved, coordinates the disbursement of the Board of Claims checks received by the Central Workers' Compensation Office for lost pay.
   7. Receives a copy of the employee's time report that includes the day of the accident (monthly bi-weekly time report for non-exempt employees or Leave Record Form (Per 12) for exempt employees), and submits to Central Workers' Compensation Office.
   8. Notifies the Central Payroll Office in writing of the beginning and ending dates of University payment of 100 percent of health insurance premiums for injured employee on leave without compensation. University payment will not be made for any month in which the employee is in active pay status for any portion of the month either by work or approved leave.
   9. Submits a Lost Time Information form to the Central Workers' Compensation Office for each month, or portion thereof, that employee is requesting lost time pay.
   10. If applicable, prepares a Personnel Action Form, placing employee on leave of absence due to a Workers' Compensation illness or injury and returning the employee to active status.

If claimant should employ an attorney, only a Board of Claims attorney should respond to questions or comments from either the claimant or the claimant's attorney. Advice on handling these types of situations may be obtained from the Human Resources Office.