Workers Compensation
Workers compensation provides protection for all university employees, including student workers, who acquire a work-related injury or illness. Employees are protected while carrying out assigned job duties both on the premises and while traveling on university business. Coverage is provided, with certain limitations, for medical expenses, time an employee is unable to work and any permanent impairment.
If you are injured on the job:
- Seek medical Assistance
- Notify supervisor if possible
If you are the supervisor for an employee injured on the job:
- Send employee for treatment, if necessary
- Complete an injury report form
- Call the Liberty Mutual claims service center
- Process leave form, if required
- Follow-up
Medical Assistance
For injuries not requiring immediate treatment, call campus police at 260-481-6827 for first aid.
For situations requiring immediate treatment, the supervisor should send the employee to one of the following IPFW preferred providers.
- IPFW/Parkview Health & Wellness Clinic
Walb Union, Room 228
260-481-5748 - Parkview Corporate Health Clinic
3103 E. State St., 260-373-9300 - Any local office of RediMed or StatCare
The supervisor should call ahead to let the provider know that the employee will be arriving. Payment for medical costs should be billed to:
Indiana University—Purdue University Fort Wayne
Human Resources
2101 E. Coliseum Blvd.
Fort Wayne, IN 46805-1499
Cost of prescription medications will be reimbursed by sending prescription receipts to Human Resources. Also check with Human Resources about reimbursement for other items recommended by the doctor.
First Report of Injury Form
With assistance from the employee, the supervisor should complete the First Report of Injury form. Forms are available online, from Human Resources, or from campus police (after 5:00 p.m.). Information provided on the report form will be helpful in answering questions from the customer service representative when calling in the claim.
Call the Liberty Mutual claims service center immediately at 1-800-362-0000 to report any work-related claim that involves medical treatment or time off work. The center is open 24 hours a day, 365 days a year.
Send the report form to Human Resources. Send the completed First Report of Injury form to Tina Sullivan in Human Resources immediately following the incident. Note: The form must be filed with the Workers' Compensation Board within seven days to ensure proper payment.
The supervisor should contact Liberty Mutual if the injury or illness causes the employee to miss additional work. Also, the supervisor should contact Liberty Mutual when an employee returns to work. In addition, the supervisor should contact Tina Sullivan at sullivat@ipfw.edu, 260-481-6683 or Tina Chin at chint@ipfw.edu, 260-481-6684 in Human Resources to ensure necessary benefit-related actions are taken in a timely manner.
If the situation does not require medical treatment or time off work, a claim need not be filed. However, the information should be kept on file in case treatment or time off work is required at a later time. Due to the nature of the information, these records should be maintained separately from departmental personnel files.
Process Leave
Workers' compensation pays for the first seven calendar days an employee is unable to work, but only if the disability exceeds twenty-one calendar days. After seven calendar days, compensation is paid at a rate of about two-thirds of an employee's normal pay, subject to a maximum amount.
Available sick/vacation leave can be used to pay for the first seven days and/or to supplement compensation payments. Clerical and service staff who miss 10 days or more should file a Form 33C/S leave report. Monthly paid staff should file a Form 33A for all days missed.
260-481-IPFW
Contact
Maps