Workers Compensation Information

Workers Compensation Information

Workers Compensation

Claims Support Statement
LECOM Health (the “Company”) values our Team Members as our most important resource. Accordingly, the Company is dedicated to preventing injury whenever possible and when injuries do occur, the Company strives to ensure Team Members who are injured during the course and scope of their employment receive appropriate medical care and benefits so they can recover as soon as possible and return to work when appropriate. This pamphlet is a guide to help navigate the Workers’ Compensation claim process.

What is Workers’ Compensation?
Workers’ Compensation is a no-fault program that varies by state, which may provide medical and wage loss benefits for Team Members who have sustained a compensable injury that arises out of and within the course and scope of your employment. Benefits vary by state, so be sure to discuss your claim with your Claims Adjuster. Please keep in mind that Workers’ Compensation works differently than regular insurance, and timeframes can be longer than expected based on the laws of the state. Please contact your Claims Adjuster if you have any questions.

When you are injured…
It is important you report your injury right away to your supervisor (Company Policy requires reporting of all accidents/incidents – no matter how minor – within 24 hours). You want to describe your injury to a supervisor as best as you can, being as specific and detailed as you are able to. They will help you fill out the required paperwork and will submit an accident/incident report to our Claims Department who will be in contact with you with potential follow-up questions and next steps.

Who is managing my claim?
Sedgwick the Company’s Third-Party Administrator (TPA). Their role is to determine eligibility for medical expenses and wage loss benefits, and pay those benefits, if approved. If you seek medical treatment for a work-related injury, please be sure the treating physician is aware that it is a work-related injury so you will not be billed through your private insurance. Billing information:

Sedgwick
PO Box 14517
Lexington, KY 40512-4517

Your Claims Adjuster, performs a variety of duties including reviewing, examining, investigating, and analyzing Workers’ Compensation claims for compensability and benefits, in addition to providing information to Team Members regarding their claims and applicable laws in their state. Please contact your Adjuster if have questions regarding payments for treatment or lost time. They are responsible for making payments for medical bills and lost wages. They will help guide you through the claims process, so you receive the treatment you need.

Frequently Asked Questions

How do I find out who my claims adjuster is?
Contact Sedgwick at 1- 901-415-7400. You can also visit www.mysedgwick.com to look up your claim and chat with the adjuster.

I am getting personally billed for my Work Comp injury. What should I do?
Contact your Claims Adjuster and let them know. They will ensure the provider is updated with the correct billing address.

I received a referral from my doctor but haven’t heard anything regarding approval. What should I do?
Contact your Claims Adjuster.

Will I still accrue vacation and sick leave while losing time from work, for a work-related injury?
It depends. If you are placed on a leave of absence, vacation and sick accruals stop. Otherwise, vacation and sick time accrue normally.

What if my claim is denied?
If your claim is denied, your Claims Adjuster will send a denial letter to you. Initial treatment costs are handled on an individual basis for denied claims. The treatment costs may be applied to your health plan. Denial of a claim is a serious issue and is not taken lightly. There is an appeal process, and the denial letter will explain the process.

Are Workers’ Compensation payments taxed?
No.

Are payroll deductions withheld while receiving Workers’ Compensation benefits?
No. Team Members will automatically be billed and will receive instructions on how to make payments related to health insurance, 401(k), life insurance, and other employee elected benefits. For questions related to billing and payments, employees should contact the Human Resources department.