You may need to complete the following forms:

• Return to Work Offer
• Benefit Election Form
• Mileage Reimbursement Form

Continued authorized medical care is care received at these same locations. UI Occupational Health or Sedgwick CMS may direct you to additional providers. If you claim is approved by Sedgewick CMS, authorized medical treatment will be paid at 100%. There are no co-payments or deductibles.

Payment for unauthorized care may be denied by both your private health insurance carrier and workers' compensation. It is important that treatment for all workers' compensation injuries is authorized by Sedgwick CMS. This is consistent with Iowa law.

With authorized care, you may receive a statement indicating the charges have been filed with your private health insurance provider as well as workers' compensation. You may also receive a statement from your private health insurance provider stating that payment has been denied because this is a workers' compensation claim. This is normal procedure for many insurance companies and is not in the control of the University of Iowa.

UIHC and other providers normally bill the workers' compensation provider and your private health insurance carrier.

If your health insurance Explanation of Benefits (EOB) indicates that these charges are pending, you should assume the payment between the two companies will be resolved. If the statement indicates you owe money for services related to your claim, contact your medical provider and inform them this is a workers' compensation matter.

If you receive a "past due" notice or collect letter, please contact University Benefits at 319-335-2676.

If your claim is not approved, contact your private insurance carrier. Notify them that your workers' compensation claim was denied and provide them with any additional information they require. Your personal insurance should pay any bills according to the terms of your insurance policy.

Visit our Workers' Compensation Resources webpage.

No. Workers' compensation benefits are not taxed by the federal or state government.

The department uses the Patient Status Report in order to determine restrictions, authorization to return to work, etc. You should not request completion of a DOL medical certification form.

No. Employees with approved workers' compensation claims do not need to use accrued leave for authorized medical appointments.

Routine medical appointments, including physical therapy appointments and follow-ups with UI Occupational Health, should not exceed two hours (30 minutes round-trip to the clinic and one hour for the appointment). 

Time required for appointments with the UI Work Injury Recovery Center, or similar specialist clinics, are reviewed on a case-by-case basis.

Yes. Information shared with Workers' Compensation staff is confidential. Only restrictions are shared with the employing department, unless the employee signs a Release of Information form permitting the sharing of medical information.

Yes. You must complete follow-up appointments as directed. Failure to attend appointments may result in discontinuation of your workers' compensation benefits. Your employing department should not allow you to work until an updated Patient Status Report (PSR) or other relevant communication is provided.

Please visit our website for a list of treatment locations.

If you think you are unable to perform the work your employing department has offered due to injury-related limitations or restrictions, contact your doctor for an appointment to discuss the restrictions they have imposed.

Please respond to your department's offer within 24 hours. If you say you are unable to perform the temporary restricted-duty work, you must provide specific reasons. Refusal of a temporary restricted-duty assignment may jeopardize your workers' compensation benefits and may result in discipline according to attendance policies.

• Report your injury to your supervisor or local HR representative within 24 hours. This person will ask you several important questions to gather information for the First Report of Injury form in Employee Self-Service.
• Complete the First Report of Injury form and submit it to University Benefits within 24 hours.

To find your HR representative and fill out the form in Self-Service you need to know your HawkID and password. If you don't know your HawkID or password, please refer to the HawkID Tools webpage.

Yes. Sedgwick CMS must approve the treatment. Please contact University Benefits at 319-335-2676 to begin the process.

You can call Sedgwick CMS toll-free at 866-342-3920. You may also contact an HR representative: Bethany Kaplan, Sonja Galligan, or Kyra Harrison.

Maximum Medical Improvement (MMI) means you are not expected to improve beyond your present status.

When you attain MMI, your physician will determine the extent of any permanent injury and inform Sedgwick CMS. Your benefit status will change to Partial Permanent Impairment or "Permanency" benefits. You are entitled to a certain number of weeks of workers' compensation benefits based on the Impairment Rating, if any, provided by your physician.

Depending on the impairment rating, it's possible you will receive zero weeks of workers' compensation benefits.

• Report work-related injuries or conditions to your supervisor or HR representative within 24 hours.
• Obtain medical care from an approved facility.
• Provide your supervisor with the Patient Status Report (PSR), completed, and signed by an authorized medical provider within 24 hours (or one business day) following a medical appointment. The PSR provides specific information regarding the medical diagnosis, treatment plan, recommended physical restrictions and their duration, and the date and time of the next medical appointment.
• Do not return to work until the PSR is reviewed by your supervisor. Failure to provide the PSR to your supervisor may result in disciplinary action.
• Attend all scheduled appointments related to your workers' compensation claim. If you fail to attend a scheduled appointment, you will not be allowed to work until an updated PSR is provided and reviewed.
• Follow recommended restrictions at work and in all non-work activities. Restrictions will remain unchanged until the next scheduled appointment with an authorized provider. However, the medical provider may alter the recommended limitations and provide updated restrictions as appropriate. Failure to comply with restrictions may jeopardize your workers' compensation benefits.
• Review your PSR with your supervisor to confirm restrictions and capabilities and discuss availability of temporary work. Restricted work assignments may change with your restrictions, or based on available duties, and may be scheduled outside your normal work hours.
• Respond to departmental restricted work offers in writing and within 24 hours of receipt. If you are unable to perform the temporary restricted duty work, you must provide specific reasons. Refusal of a temporary restricted duty assignment may affect your workers' compensation benefits.
• Immediately contact your supervisor with questions or concerns related to temporary restricted-duty work assignments. Temporary restricted-duty work assignments should not exceed six months.

The provisions of the Family and Medical Leave Act (FMLA) may apply in situations where a work-related injury bars an employee from working. Please contact your local HR representative if you have questions.

Missed time benefits begin after three calendar days of absence. If you miss work for more than 14 calendar days, missed time benefits will also be paid for the waiting period.

Workers' compensation missed time benefits typically represent about two-thirds of an employee's regularly weekly salary, depending on their income. Missed time benefits have a maximum payment, so the income replacement percentage will be lower for higher income employees. You receive missed time benefits during the healing period when you're unable to work or when your department is unable to provide you with a temporary work assignment. 

Please note that you may elect to supplement workers' compensation benefits with accrued leave. The combination of your workers' compensation benefits and accrued leave should approximate your weekly salary.

If you are able to work restricted duty during the healing period, you will receive your full salary instead of missed time benefits.

Receipt of your missed time benefits check is dependent on the completion of an investigation by Sedgwick CMS. Once a claim is approved, missed time is paid weekly. The checks are sent directly from Sedgwick CMS to your home address.

You should stay in contact with the workers' compensation specialist to determine what effect missed time benefits may have on your financial situation. Notify the workers' compensation specialist in University Benefits at 319-335-2676 when you receive your first missed time benefits check.

Yes. You can use the Catastrophic Leave Program for absence due to a work-related injury after you have exhausted your accrued sick leave and vacation.

Please visit the Catastrophic Leave webpage for more information.

Mileage reimbursement

Mileage reimbursement is provided for individuals using their personal vehicle to travel to and from treatment for a work-related injury. You can request the Travel Reimbursement form from University Benefits. A receipt for parking is required if you include it in the reimbursement request.

Taxi reimbursement

Reimbursement of a taxi fee is provided for individuals traveling to and from their university work location to UI Occupational Health in Coralville. A receipt for taxi fare is required.

Taxi use

The university has established an account with Yellow Cab of Iowa City to provide taxi service to and from an individual's university work location to UI Occupational Health. 

Please call Yellow Cab of Iowa City at 319-338-9777 to request cab service. At the time of pick up, you will be required to show a university ID to the cab driver. When you are dropped off, schedule a pick-up time with the cab driver. The taxi will not wait at the clinic during the appointment.

Use of a university vehicle

A university vehicle may be used for transportation to UI Occupational Health as approved by your employing department.

Use of a personal vehicle to transport a colleague

It is not recommended that individuals use their personal vehicles to transport a colleague to UI Occupational Health for medical treatment. Mileage reimbursement will not be provided in this case.

*It is important to note that travel outside of your university work location to UI Occupational Health is not a covered expense and is the individual's responsibility.

Please reference the Workers' Compensation Glossary.

An employee is eligible to transfer to another department or position while on temporary restricted work duty due to a work-related injury if the following applies:

• The employee must be responsible for informing the hiring department of any temporary restrictions in place related to a work injury.
• The hiring department must be able to accommodate any temporary work restrictions in place at the time of the transfer.