1. What is workers' compensation?
The Workers' Disability Compensation Act establishes the system used to provide wage replacement, medical, and rehabilitation benefits to workers who suffer a work-related injury. If you are injured or become ill because of your job, you may be entitled to worker’s compensation benefits.The State of Michigan Workers' Compensation Program is administered by the Office of the State Employer through its Third Party Administrator (TPA), York Risk Services Group.
2. How do I report a work related injury or illness?
To file a workers' compensation claim, you should immediately notify your supervisor or the designated personnel in your department, who will instruct you on what paperwork you must complete to file a claim.
3. Can I seek medical care from my primary care physician for a work related injury?
The Workers' Disability Compensation Act entitles you to all reasonable and necessary medical treatment for injuries arising out of and in the course of employment. During the first 28 days when care begins, the State of Michigan’s Workers' Compensation Third Party Administrator, York Risk Services Group, has the right to select the medical care providers. After that 28 day period, you are free to change doctors if you wish. In order to change, you will need to notify York and the DMO of your desire to change and provide the name of the physician you select.
A list of clinics and hospitals can be found on the DMO website at www.michigan.gov/dmo under the “Resources” heading. The list is provided to assist you in identifying medical facilities in your geographic area and is not intended as a source of referral.
4. What if I seek medical treatment before a claim is filed?
If you seek medical treatment before your claim is filed, tell the health care provider that you suspect your injury or illness is work-related. Your health insurance carrier should not be billed for reasonable and necessary medical treatment resulting from an approved claim for injuries and illnesses that arise out of and in the course of employment. If the treating provider requires authorization to evaluate you, they should contact the DMO at (877) 766-6447 and select option #2.
5. How long does it take to process my workers' compensation claim?
For claims that result in 7 or more days of disability, the State of Michigan’s Workers' Compensation Program Third Party Administrator, York, will notify you of the disposition of your claim within 14 calendar days from the date your claim is filed.
For claims that result in less than 7 days of disability, medical bills are processed within 30 days from the date that they are received by York.
You may be asked, at any time, to provide further information in order to ensure that your claim meets all of the criteria for compensability as set forth in the Workers' Disability Compensation Act.
6. Will I be paid if I cannot return to work?
If your work-related disability is 7 calendar days or less, your worker’s compensation benefit is limited to the payment of reasonable and necessary medical treatment for your work related injury or illness. No wage loss payment will be made. You may use sick or annual leave credits to cover these days in accordance with departmental policy or your collective bargaining agreement.
If your work-related injury or illness lasts more than 7 calendar days, but less than 14, your worker’s compensation benefit includes reasonable and necessary medical treatment related to the injury or illness and wage-loss benefits beginning on the 8th day of disability.
If your work-related disability is 14 calendar days or longer, your worker’s compensation benefit includes reasonable and necessary medical treatment related to the injury or illness and wage loss benefits from the first day of disability.
Leave credits may be used during the waiting periods while the disposition of your claim is being determined. Your first worker’s compensation check will be sent to the State of Michigan in order to credit up to two-thirds of the leave credits used prior to your first worker’s compensation check. The State of Michigan will send you the balance. Future checks will be mailed directly to you from York, the State of Michigan’s Workers' Compensation Third Party Administrator.
7. What workers' compensation wage loss benefits may be available and how much can they be?
State employees with disabling injuries or illnesses arising out of and in the course of employment may qualify for wage loss benefits under the state Workers' Disability Compensation Act, civil service rules, and collective bargaining agreements. Eligibility for and the amount of these various benefits can depend on the amount of other qualifying benefits. The terms of the act, rules, or agreements are dispositive and should be consulted.
Basic statutory benefits: Under the Workers' Disability Compensation Act, if disability extends beyond 7 consecutive days, employees may receive a benefit equal to 80% of the after-tax value of their average weekly net wage based upon their highest-paid 39 weeks of gross wages (including overtime) of the 52 weeks immediately prior to the illness or injury. Many factors are included in this calculation including the tax filing status, the number of dependents, and the state and federal tax rates. Statutory benefits, however, are subject to limits established by the state Workers' Compensation Agency. Basic statutory benefits continue for the duration of the disability.
2/3 supplement benefits: If basic statutory benefits are less than two-thirds of regular weekly net wage (i.e., two-thirds of base hourly salary multiplied by 40 hours), state employees may qualify for a 2/3 supplement benefit based on the civil service rules or collective bargaining agreements. The 2/3 supplement equals the difference between the basic statutory benefit and two-thirds of regular weekly net wages. The general supplement is normally limited to 50 weeks, subject to eligibility. The rules or collective bargaining agreements may contain additional terms affecting this calculation.
100% assault pay supplement: If disability resulted from an assault from a client in specified agencies, employees may qualify under state law, the civil service rules, or collective bargaining agreements for a 100% assault supplement instead of the 2/3 supplement. The 100% assault supplement equals the difference between basic statutory benefits and regular net wages. The 100% assault supplement is normally limited to 100 weeks, subject to eligibility.
Again, this is a basic summary of benefits available and cannot cover every aspect of the complex system used to determine the exact amount of qualifying benefits. Please consult relevant statutes, rules, or agreements for all dispositive terms and conditions that will govern benefit calculation.
8. What if I cannot return to work?
If you cannot return to work, the State of Michigan’s Workers' Compensation Third Party Administrator, York, will continue to pay for reasonable and necessary medical treatment related to your work related injury. They will also continue to pay your statutory wage-loss benefits, as long as you continue to be disabled.
Depending on your medical leave rights under Civil Service Rules and Regulations, or collective bargaining agreements, you may be placed on a medical leave of absence, medical layoff, or separated from employment.
9. Can York require an independent medical examination (IME)?
Yes. The Workers' Disability Compensation Act provides that, from time to time, you must present yourself for an IME if requested by York. If you do not participate in the scheduled IME you will risk having your worker’s compensation benefits suspended. If the scheduled appointment conflicts with a previously scheduled medical appointment, you should contact your claim adjuster to work out a better date and time.
10. What is needed before I return to work?
If it is determined that you can return to work, it is your responsibility to submit supporting medical documentation to the State of Michigan Workers' Compensation Program’s Third Party Administrator, York, and the DMO.
If your doctor determines that restrictions are needed for you to return to work, they must be submitted to York and the DMO. The DMO will work with your department and Human Resources to evaluate the restrictions and determine if suitable work is available. If your department can accommodate the restrictions, you will be notified when to report to work.
11. Who administers workers' compensation for the State of Michigan and how do I contact them if I have questions?
The State of Michigan’s Workers' Compensation Program is administered by the Office of the State Employer through its Third Party Administrator, York Risk Services Group.
|Fax :||(866) 229-4474|
|Address:||PO BOX 620, Howell, Michigan 48844-062|
12. Can I appeal a workers' compensation determination?
You should attempt to resolve any disagreements regarding your claim with your claim adjuster. If you are unable to resolve your disagreement, you may contact the Workers' Compensation Agency (WCA) directly at (888) 396-5041. Additional information may also be found online at www.michigan.gov/WCA.