When Accidents Happen
Para Recibir Asistencia, usted puede hablar al (919) 684-6693 or de La Comision Industrial al (800) 688-8349.
No one intends to have an on-the-job injury. The focus of this section is to answer your questions about where to get medical care, filing an incident report, what to put on your time card, as well as other questions that may be on your mind regarding the process and resources available to assist you.
- I was injured at work. What do I do?
- What do I record on my timecard?
- Who pays for the cost of my medical care?
- How is it determined whether the injury is covered under workers' compensation?
- Where is the Workers' Compensation Office located?
- How long does it take to receive a determination?
- Who lets me know the outcome of the review?
- What forms will you be sending and what do they mean?
- Who should I contact if I have questions about the decision or the forms?
Receiving Medical Care
- My personal doctor is familiar with my medical history. Can I get treatment from him or her instead of EOHW?
- I need medical treatment for my job injury, but I am also receiving treatment for a non-work related health condition. How does that work?
- Can I request a change in physician?
- How long can I receive medical care through workers' compensation?
- I have to travel to receive medical treatment (including physical therapy). Can I receive mileage reimbursement?
- I've been told I will need to have surgery. Is that covered?
- Where are inpatient and outpatient treatment and surgeries for Duke and DUHS employees performed?
- Who performs the surgery?
- I've been told I need physical therapy. Is that covered?
If the injury requires emergency medical care, immediately seek treatment at the nearest Emergency Room. After you are stabilized, you will receive any necessary additional medical care within the established medical provider network. You should complete an incident report before the end of the shift of the day you had the injury.
If the injury is less severe but still requires medical treatment, please call the nearest Employee Occupational Health office to schedule an appointment (see locations and phone numbers below). Please make sure that you and your supervisor complete an injury report and bring it with you when you receive treatment. If you need assistance when Employee Occupational Health offices are closed, you may reach an occupational health nurse by calling the blood and body fluid exposure hotline at 684-8115.
Employee Occupational Health offices are located in:
Duke South (684-3136, select Option 2)
Durham Regional Hospital (470-5350), and
Duke Raleigh Hospital (954-3275).
For locations and contact information for local hospitals, urgent care centers, and Duke Employee Health offices, please click here.
If the injury does not require medical care, still complete an incident report. Knowing where and how injuries occur enables us to investigate, track, and take corrective action before someone else is injured - possibly more seriously next time.
On the day of your injury, the time spent in waiting for and receiving medical care before the end of your shift should be recorded as worked time. If you are sent home you will be paid as though you had worked a full shift. Your follow-up visits with Employee Occupational Health & Wellness (EOHW) are also considered work time provided they occur while you are actively at work at Duke.
Please see the section entitled "If you are unable to work" for more details on when benefit time can be used if you are placed out of work beyond your current shift.
The cost of your medical care is paid through workers' compensation when the treatment is authorized, provided by an approved provider, and the injury is accepted as a workers' compensation claim. This means you would not be responsible for deductibles or co-pays for authorized treatment. If you receive a bill from a medical provider, please contact them to let them know that they need to bill Duke's Workers' Compensation instead of you (or your insurance).
If your injury requires medicine, you will be provided with a pharmacy card to cover the cost of the prescription. The card is specific to medications for your workers' compensation injury and does not require any co-pays, just prior authorization. The name of the prescription company is "Modern Medical" and the card is accepted at most local pharmacies (ex. CVS, Walgreens, Eckerd's, Wal-Mart).
If the injury is later determined not to be work related, the cost of medical care and pharmaceuticals provided by Employee Health is still paid by Duke. However, the cost of medical care and medicine provided by the Emergency Department, Urgent Care, or other providers will be your responsibility. Contact the HR Information Center at 684-5600 if you have questions regarding whether the services will be covered under your health plan.
We understand the importance of getting medical care and knowing in advance the amount of your possible out-of-pocket costs. We will review your injury ("claim") as quickly as possible and let you know the outcome of that claim as soon as we can. Your timely completion of the incident report speeds the review process so that questions regarding whether the injury and the associated costs are covered can be answered as quickly as possible.
Each incident report is electronically forwarded to the Workers' Compensation Office. Reports that indicate that either medical care was needed or where more information is needed to determine compensability are assigned to a Claims Specialist. Each specialist is a licensed adjuster who is experienced and knowledgeable regarding workers' compensation. The specialist will interview you regarding the incident, relevant medical history, and relevant outside work activities to gather the necessary information to determine whether the injury can be covered under workers' compensation. If the circumstances are very complex, the specialist may also consult with legal and/or medical counsel, and/or request to review the relevant medical records, and/or request additional information from your supervisor. Once the review is completed, a decision is made regarding whether the injury is covered under workers' compensation.
The Workers' Compensation Office is located at 705 Broad Street, Durham NC, 27705 and the staff contact information is as follows:
|Workers' Compensation Administrationfirstname.lastname@example.org|
|Charles Kyles, Directoremail@example.com|
|Zelda Clark, Business Managerfirstname.lastname@example.org|
|Nacole Britt, Administrative Clerkemail@example.com|
|Shauna Pettiford, Claims Payment Specialistfirstname.lastname@example.org|
|Vicki Phillips, Performance & Quality Analystemail@example.com|
|Tommy Cocke, Unemployment Specialistfirstname.lastname@example.org|
|Lona Naylor, Unemployment Specialistemail@example.com|
|Delphine Goines, Associate Director, Claimsfirstname.lastname@example.org|
|Vacant, Claims Specialist, Senior||919-684-3595|
|Denise Johnson, Claims Specialist, Senioremail@example.com|
|Laurie D'Angelo, Claims Specialist, Seniorfirstname.lastname@example.org|
|Kathy Norris, Medical Claims Specialist||919-684-6764||Kathy.email@example.com|
Generally, first contact with you to obtain additional information regarding the incident is made within two business days of receipt of the incident report within Workers' Compensation and a determination regarding compensability is made at that time. If you are unavailable or if additional information is needed, the process will take longer. Please respond to a request for information from the Workers' Compensation Office as soon as possible.
The specialist will let you know the outcome of the review. The informal process is to let you know by phone so that any necessary additional care can be directed appropriately (i.e. continued treatment with Employee Health or via your family physician). There is also a formal written notification process that is required by the state, this formal process is intensely form driven. The required forms are sent to you along with an explanation letter regarding the purpose of the forms.
One of the primary forms that is used is the "Form 18" which is the official workers' compensation claim form for you to complete and file with the Industrial Commission within two years of the injury (or learning of an occupational disease). We will send a blank form to you indicating that this needs to be completed and sent by you to the Industrial Commission. Duke is not permitted to complete this form on your behalf and the Duke incident report that you completed does not substitute for this form - your completion of this form preserves your right to pursue the claim; this is especially important if your claim is not accepted and you disagree with that decision.
The statute requires that you file this form with the Industrial Commission within 30 days of the accident to give the required written notice to Duke about your injury and within two years to establish your legal claim. Click here for a more detailed explanation provided by the ombudsman section of the NC Industrial Commission.
Another form we will be sending you is the "Form 19" which is Duke's official report to the Industrial Commission of your injury. There is important information on the form regarding the injury, your average weekly wage, the length of time you have been at Duke, and more. Carefully review the information that the Workers' Compensation Office completed and sent to the Industrial Commission.
If your injury is not accepted as compensable, we will also send you a "Form 61." This form will detail the exact reason your injury (claim) is not covered under workers' compensation. If you disagree with this decision, you can always contact the specialist (see below). There is also a formal review process that you may request with the NC Industrial Commission by completing a "Form 33" and sending it to them. The Industrial Commission will review the circumstances and determine whether the claim meets the criteria to be accepted.
Below is the link to these forms as well as most of the NC Industrial Commission forms: www.comp.state.nc.us/ncic/pages/forms.htm
You are welcome to contact the specialist in Duke's Workers' Compensation Office regarding the decision. You are also welcome to request that the decision be re-reviewed by the claims manager. If you still have questions, you may also contact the director of Workers' Compensation.
In addition, the Workers' Compensation Board is the state's administrative agency responsible for administering all workers' compensation claims in the state. An ombudsman at the Board is available to you at no charge who can help answer questions regarding claims and to help you through the process of appealing a decision if you do not agree with it.
The NC Industrial Commission Ombudsman is available Monday - Friday from 8:00 a.m. to 5:00 p.m. at (919) 807-2501 or (800) 688-8349.
My personal doctor is familiar with my medical history. Can I get treatment from him or her instead of EOHW?
No. Only treatment that is authorized and provided by an approved medical provider is paid through workers' compensation. Also, Duke's health plans don't provide coverage for work injuries. This means that if you go to your own doctor, you may be responsible for the cost of the care provided.
I need medical treatment for my job injury, but I am also receiving treatment for a non-work related health condition. How does that work?
Only the treatment for the job related injury is covered under workers' compensation; the cost of medical care for non-work related injuries would continue to be your responsibility (or the responsibility of your health plan if applicable). Where possible, the physician treating your work injury will separate out care that is provided for your work injury and refer you back to your regular physician for treatment of any non-work related health condition.
Generally, one physician (or physician's assistant) in EOHW will be providing your medical care. If you wish to have an alternate EOHW physician provide your care, contact the EOHW Manager or Medical Director.
There is also a formal process established by the Industrial Commission to request a change in physician. This process requires a written request that includes the reason the change is being sought as well as copies of records supporting your request. This written request should be sent to the Executive Secretary's Office of the Industrial Commission as well as the Workers' Compensation Office.
Medical care for compensable injuries generally continues for up to two years after your last medical or indemnity compensation (for example, a weekly wage replacement). In addition, you may submit a Form 18M to the Industrial Commission to request an extension of this two year period. In the request, you would need to show "substantial risk of the necessity of future medical treatment." The form would need to be submitted to the Industrial Commission before the end of the two year period.
I have to travel to receive medical treatment (including physical therapy). Can I receive mileage reimbursement?
If you must travel at least 20 miles round trip to receive the medical treatment for your work-related injury, you can receive reimbursement for mileage at the rate established by the North Carolina Industrial Commission ($0.575 per mile in 2015). Generally, reimbursement is not available for mileage for separate trips to purchase medications or supplies. You must document the treatment dates, name of the provider, and distance traveled per visit and send this to Duke's Workers' Compensation Office using Industrial Commission Form 25T.
Inpatient treatment and inpatient or outpatient surgery are all types of medical care that are covered under workers' compensation. Unless the situation is an emergency, preauthorization from the Workers' Compensation Office may be required.
Whenever possible, these services are provided through the Duke University Health System (DUHS).
When specialist care is needed, EOHW will select a qualified physician (and/or provider) to ensure you receive optimal care. Whenever possible, the selected provider will have admitting privileges at DUHS. EOHW continues in its role as your treating physician.
Physical therapy is also a type of medical care covered under workers' compensation when ordered by your approved treating physician. Services are generally scheduled by the EOHW office and provided at Duke Clinic or other approved providers. If you live or work outside of the Durham area, an alternate therapist may be selected; discuss this need with the Workers' Compensation Office.