Your employee was injured and you know there is a process that needs to get activated quickly. The focus of this section is to put detail around this process and answer additional questions you may have.
- My staff member was injured at work. What do I do?
- Who pays for the cost of my staff member's medical care?
- How is it determined whether the injury is covered under workers' compensation?
- How long does it take to receive a determination?
- Who lets my staff member know the outcome of the review?
- Who should my staff member or I contact if we have questions about the decision or the forms?
- What do I record on my employee's timecard?
My staff member was injured at work. What do I do?
If the injury requires emergency medical care, direct your staff member to immediately seek treatment at the nearest Emergency Room. After he or she is stabilized, they will receive any necessary additional medical care within the established medical provider network. You and your staff member should complete the incident report within 24-hours of the injury.
If the injury is less severe but still requires medical treatment, please call the nearest Employee Occupational Health office to schedule an appointment (see locations and phone numbers below). Please make sure that you and your staff member complete an injury report and have your staff member bring it with them when they receive treatment. If you need assistance when Employee Occupational Health offices are closed, you may reach an occupational health nurse by calling the blood and body fluid exposure hotline at 684-8115.
Employee Occupational Health offices are located in:
Duke South (684-3136, select Option 2)
Durham Regional Hospital (470-5350), and
Duke Raleigh Hospital (954-3275).
For locations and contact information for local hospitals, urgent care centers, and Duke Employee Health offices, please click here.
If the injury does not require medical care, still complete an incident report. Knowing where and how staff injuries occur enables us to investigate, track, and take corrective action before someone else is injured - possibly more seriously next time.
Employees have the right to report any work-related injury or illness. Employers are prohibited from discharging or in any manner discriminating against employees for reporting any work-related injury or illness.
Who pays for the cost of my staff member's medical care?
The cost of your staff member's medical care is paid through workers' compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers' compensation claim. This means they would not be responsible for deductibles or copays for authorized treatment. Your staff member will need to let the provider know that the treatment is being provided for an on-the-job injury each time he or she receives medical care.
If your staff member's injury requires medicine, they will be provided a pharmacy card to cover the cost of the prescription. The card is specific to medications for the workers' compensation injury and do not require any co-pays, just prior authorization.
If the injury is later determined not to be work related, the cost of medical care and pharmaceuticals provided by Employee Health is still paid by Duke. However, the cost of medical care and medicine provided by the Emergency Department, Urgent Care, or other providers are the responsibility of the employee and/or their health plan.
The timely completion of the incident report by you and your staff member speeds the review process so that questions regarding whether the injury and the associated costs are covered can be answered as quickly as possible.
How is it determined whether the injury is covered under workers' compensation?
Each incident report is electronically forwarded to the Workers' Compensation Office. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are assigned to a Claims Specialist. Each specialist is a licensed adjuster who is experienced and knowledgeable regarding workers' compensation. The specialist will interview your staff member regarding the incident, their relevant medical history, and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers' compensation. If the circumstances are very complex, the specialist may also consult with legal counsel, and/or request to review the relevant medical records, and/or request additional information from you. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.
How long does it take to receive a determination?
Generally, first contact with your staff member to obtain additional information regarding the incident is made within two business days of receipt of the incident report within Workers' Compensation and a determination regarding compensability is made at that time. If your staff member is unavailable or additional information is needed, the process will take longer. Please encourage your staff member to respond to a request for information from the Workers' Compensation Office as soon as possible.
Who lets my staff member know the outcome of the review?
The specialist will let your staff member know the outcome of the review. The informal process is to let them know by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with Employee Health or via their family physician). There is also a formal written notification process that is required by the state, this formal process is intensely form driven. The required forms are sent to your staff member along with an explanation letter regarding the purpose of the forms.
Who should my staff member or I contact if we have questions about the decision or the forms?
You and your staff member are welcome to contact the specialist regarding the decision. You are both also welcome to request that the decision be re-reviewed by the claims manager. In addition, the Workers' Compensation Board is the state's administrative agency responsible for administering all workers' compensation claims in the state. An ombudsman at the Board is available to your staff member at no charge who can help answer questions regarding claims and to help your staff member through the process of appealing a decision if he or she does not agree with it.
What do I record on my employee's timecard?
On the day of the injury, the time spent in waiting for and receiving medical care because of the job related injury should be recorded as worked time. If your staff member is sent home before the end of their shift, he or she should be paid as if the full shift had been worked. Follow-up visits that occur while your employee is actively on duty are also considered worked time. Please see the section entitled If you are unable to work if your staff member will be out of work beyond their current shift.