Employer's First Report of Injury or Illness Form (Excel)

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List of Preferred Medical Health Care Providers for MISD's Workers' Comp Program

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ScripNet Prescription Services Pharmacy Flyer for MISD's Workers' Comp Program (pdf)

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PLANO

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Notice of Injured Employee Rights and Responsibilities in the Texas Workers' Compensation System

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WHAT IS WORKERS' COMPENSATION?

Workers' Compensation is a State-Regulated Insurance Program that:

         * Pays reasonable medical costs if you are injured on the job

         * May pay income benefits to replace part of the wages you lose because of an on-the-job injury  

         * Pays income benefits if you have a permanent impairment from an on-the-job injury and

         * Pays death benefits to your legal beneficiaries if you are killed on the job

Workers' compensation will replace 70% or 75% of an employee's lost wages, depending on hourly rate, if the injury or illness causes the employee to lose all of his/herincome for more than seven days. An employee becomes eligible for Temporary Income Benefits (TIB) on the eighth day that a work-related injury or illness causes the employee to lose all of his/her usual pay.

An employee, injured in the scope of his/her employment, will be allowed to use his/her state personal business days to supplement his/her workers' compensation Temporary Income Benefits until those state personal business days are exhausted.

An employee shall report an on-the-job injury to his/her supervisor by the conclusion of the work day. The affected school or department must report all on-the-job injuries and/or work-related illnesses to the MISD Risk Management Department 972-882-5561 within twenty-four (24) hours.

What to do When Injured On-the-Job:

Due to the State of Texas requirements for punctual reporting of on-the-job injuries and work-related illnesses, it is imperative that such incidents be reported promptly and accurately. Failure to report may result in substantial fines assessed against the Mesquite ISD by the Texas Workers' Compensation System.

ALL on-the-job injuries and/or work-related illnesses must be reported by the affected school or department to the MISD Risk Management Department by the conclusion of the next work day after the supervisor, principal, or department manager has knowledge of such illness or injury.

PROCEDURES:

1. Non-Life Threatening Injury:

1.1 An employee shall report an alleged on-the-job injury to his/her supervisor by the conclusion of the shift in which the injury occurred. If a supervisor is not on duty, report alleged injury to a co-worker, then to immediate supervisor by the conclusion of the next work day.

1.2 If the injured employee requires medical treatment, the supervisor shall issue an "Authorization for Medical Treatment Form" and send the affected employee to an appropriate medical provider. Call the MISD Risk Management Department when this occurs. If after normal work hours, call by the conclusion of the next work day.

1.3 By the conclusion of the next work day after the occurrence of an alleged on-the-job injury, the injured employee's supervisor, principal or department manager shall complete an "Employer's First Report of Injury or Illness Report" and forward it to the MISD Risk Management Department.

1.4 The injured employee's immediate supervisor shall call and notify the MISD Risk Management Department as soon as an employee starts losing time due to an alleged on-the-job injury. (Follow the phone call with a written confirmation memo or email.) If after normal work hours, call by the conclusion of the next work day. If during a school holiday break, see Holiday Reporting, Section 3.

1.5 Charge all absences from work due to an alleged on-the-job injury to workers' compensation leave, except for the remainder of the work shift in which the employee was injured. This time should be carried as time worked. No workers' compensation benefits will be paid without a physician's statement taking the employee off of work.

1.6 When the employee returns to work, after being off due to an alleged on-the-job injury, call and notify the MISD Risk Management Department. (Follow the phone call with a written confirmation memo or email.)

2. Life Threatening Injury:

2.1 As soon as an alleged life threatening on-the-job injury has occurred, the injured employee's co-worker or supervisor should contact the following people in the order listed below:

1st  Call: Ambulance (only if one is needed)


2nd Call: Injured employee's immediate supervisor
(if not already at the scene of the accident)


3rd Call: MISD Risk Management Department (if after normal work hours, 8 a.m. to 4:30 p.m. Monday-Thursday and 8:00 a.m. to 4:00 p.m. Friday, then call by the conclusion of the next work day.)

2.2 After the employee has been taken or sent for appropriate medical treatment, the supervisor should investigate the circumstances surrounding the accident. If there were witnesses to the accident, get their statements.

2.3 By the conclusion of the next work day after the occurrence of an alleged on-the-job injury, the injured employee's supervisor shall complete an "Employer's First Report of Injury or Illness Report" and forward it to the MISD Risk Management Department.

2.4 The injured employee's immediate supervisor shall call and notify the MISD Risk Management Department as soon as an employee starts losing time due to an alleged on-the-job injury. (Follow the phone call with a written confirmation memo or email.) If after normal work hours, call by the conclusion of the next work day.  If during a school holiday break, see Holiday Reporting, Section 3.

2.5 Charge all absences from work due to an alleged on-the-job injury to workers' compensation leave, except for the remainder of the work shift in which the employee was injured. This time should be carried as time worked. Workers' compensation benefits will not be paid without the appropriate treating physician's statement formally taking the employee off of work.

2.6 When the employee returns to work after being off due to an alleged on-the-job injury, call and notify the MISD Risk Management Department. (Follow up the phone call with a written confirmation memo or email.)

3. Holiday Reporting:

If an injured employee loses two or more work days due to an on-the-job injury, the employee's immediate supervisor should contact the MISD's Director of Risk Management.  If the Director of Risk Management is unavailable, the supervisor should contact MISD's third party administrator, TRISTAR Risk Management, and notify MISD's Claims Examiner at 214-492-5600 ext. 2825.

 
Revised: Friday, May 02, 2008 | Copyright © 2008 Mesquite Independent School District | Site Map | Privacy Policy