We have an employee who sustained a minor injury at work. We would like to pay for his medical. Do we still have to file the DWC-1, First Report of Injury?
Yes. Per Rule 120.2 an employer must file the report no later than the eighth day after receipt of notice of an injury. TDI has the right to apply fines to employers who fail to do this.
If we believe an injury being reported by one of our employees is fraudulent, can we file a negative DWC-1?
Yes. You can write that language at the top of the DWC-1 that you submit to us, and you can file it with TDI.
If our injured employee is missing time from work, can we continue to pay his/her full wages while they are off?
Yes. You will need to let your adjuster know you are going to do this and file a Supplemental form (DWC-6) showing that the employee’s salary has been continued. You can find this form under the forms section of TDI’s website.
Will Service Lloyds make up the difference in our injured employee’s wages if he/she is working light duty at reduced earnings?
Yes. Your adjuster will need a Wage Statement (DWC-3) and Supplemental form (DWC-6) showing the date the light duty started and the amount you are paying the employee in reduced earnings. The DWC-3 is needed to show what the average weekly wage was for the employee prior to the injury.
When does Service Lloyds start paying my injured employee?
Per Rule 124.7 benefits begin to accrue on the eighth day of disability. By law the first payment of Temporary Income Benefits shall be initiated no later than the seventh day after the accrual date (eighth day of disability).
When will my employee receive payment for the first seven days he/she missed work?
The first seven days of disability is called the “wait week.” It is not paid to the employee until they have been off work for 14 days. If your employee returns to work on the 14th day, the wait week will not be owed.
If my injured employee returns to work before the wait week is due, are we obligated to reimburse him/her for that week?
It is not mandatory. This would be based upon your company’s policies and how they apply to this particular individual and the situation.
Why is it important that I call the adjuster on my injured employee’s claim when he/she returns to work?
It is very important that you call the adjuster immediately whenever an injured employee returns to work so that benefits can be stopped. The longer you delay getting this information to the adjuster the more room there is for an overpayment on the claim. Keeping in good contact with your adjuster in such matters will help contain the cost of your claims and ultimately keep your premiums from rising.
Do I have to file a form when my injured employee returns to work? And, if so, when is it due?
Yes. You will need to file the Supplemental Report (DWC-6) showing the return to work date and at what type of work and pay (box 18 of the form). The DWC-6 is due 3 days after the injured employee returns to work.
I have an injured employee who just started losing time from work. Are there any forms I need to send the adjuster?
Yes. You will need to fax/mail the Supplemental form (DWC-6) no later than the third day of lost time. If you are not going to continue your employee’s salary during the lost time period, you will need to send the Wage Statement (DWC-3) as well.
Why do I have to put 13 weeks of wages prior to the date of injury on the DWC-3 Wage Statement form?
The form requires that the wages submitted are prior to and do not include the date of injury. If the wages you submit do include the date of injury, then the form will be invalid. It is very important to complete the form correctly so that your adjuster can adjust your employee’s wages accordingly. This will alleviate the problem of over or under paying your employee. TDI can and will fine employers who do not submit valid wage statements in a timely manner. The wage statement is due within 30 days of the earliest of: employee’s eighth day of disability; or the date the employer is notified that the employee is entitled to income benefits; or the date of the employee’s death as a result of a compensable injury.
Do I have to file the wage statement with the Division (TDI)?
Only when requested. If requested, then it must be filed within seven days of receiving the request.
We have an employee with a pre-existing bad back. He has filed a claim with us stating he was lifting a refrigerator and now his back is hurting. Why would this be compensable if he already has a bad back?
Per the law, if an employee exacerbates an existing condition it is deemed as a “new injury.” In such cases you will need to make sure you give all the facts to the adjuster so that he/she can fully investigate the accident and contain treatment to what this incident caused. Your adjuster will work to keep the past and present conditions separated.
We have an injured employee who is currently not working and receiving benefits. Several of our employees saw her mowing her yard and washing her car. Per her doctor she can’t do anything…what can we do about this?
Whenever you receive information like this you need to immediately contact your adjuster so that they can investigate the situation. Such information is valuable in successfully handling fraudulent claims. It needs to be reported to the adjuster as soon as possible with as many details as you can gather on the situation.