Procedures to follow should any FHSU employee (faculty, staff, or student) be injured while at work:
1) Notify your supervisor immediately.
2) Go to the nearest emergency room for life-threatening or limb-threatening injuries. Contact Work Smart, (785) 623-5038, for injuries that are not a threat to life or limb.
3) Take a First Fill Letter with you to your initial contact with medical personnel.
4) Inform medical provider that the injury occurred at work.
5) Injured worker must request a written work status that provides 24 hour per day restrictions from the authorized treating physician at each and every appointment. This work status also needs to include the appointment date/time for the follow-up visit. The work status form should be given to the injured employee's supervisor and a copy sent to the Human Resource office after each appointment.
6) The injured employee's supervisor must complete a cover sheet stating if the restrictions can or cannot be accommodated and beginning what date the restrictions can or cannot be accommodated.
7) Within 24 hours of the injury, send a detailed Supervisor's Investigation Report, including the supervisor's signature, to the Physical Plant office, Brooks Building 109. This form may be faxed to the Physical Plant at (785) 628-4048.
8) If you have any questions about an injury at work, please call Roy Ibarra, Safety Officer, (785) 628-4333, the Physical Plant office, (785) 628-4424, or the Human Resource office, (785) 628-4462.
When a state employee is injured at work, the first responsibility of the employee's supervisor is to make sure that appropriate medical care is received.
Life-threatening or limb-threatening emergency situations require immediate medical attention from the closest medical facility. Injuries such as broken bones, profuse bleeding, head injuries, wounds that require stitches, chemicals in the eye(s), etc. are some examples of emergency situations. Prior authorization is not required for emergency treatment, but the Supervisor's Investigation Report form should be filled out and forwarded to the Physical Plant within 24 hours of the supervisor's awareness of the injury. Physical Plant personnel complete additional paperwork and notify the State Self Insurance Fund of the accident. Should you need to call the State Self Insurance Fund, the phone # is (785) 296-2364.
The Work Smart clinic at Hays Medical Center has been designated as the first point of contact, if an employee's injuries are not a threat to life or limb. Describe the worker's injuries to Erna Schmidtberger at Work Smart who will direct the employee to either the emergency room or to the Work Smart Clinic.
2509 Canterbury (in the Hays Family Medicine Building)
Hays, KS 67601
Phone: (785) 623-5038 (Ask for Erna Schmidtberger)
Fax: (785) 623-6278
Hours: Monday-Thursday, 8:00 a.m.-noon and 1:00 - 5:00 p.m.; Friday, 8:00 a.m.-noon, 1:00 - 4:00 p.m.
When Work Smart is Closed:
Call Hays Medical Center, 623-5000, ask to be connected to the emergency room for direction
Prescriptions All new claims are covered by a Prescription Program through MedTrak. Should medication be prescribed following an injury to a state employee, the first medication prescribed will be covered when a First Fill Letter is presented to a participating pharmacy within 24 hours of the injury.
Print off a copy of the completed First Fill Letter and give it to the employee. Selected participating pharmacies are listed on the First Fill Letter. If there is a need to search for a pharmacy, please visit: www.medtrakservices.com/workcomp. Inform the employee to give the First Fill Letter, along with the prescription, to the participating pharmacy, if the doctor prescribes medication to treat the injury. Inform the employee that the First Fill Letter is only good for 24 hours after receipt and only for the first prescription(s) following the injury. The letter can only be used for prescription medications related to this injury and cannot be used for obtaining unrelated medications. Payment for the prescription may be denied if the State Self Insurance Fund does not receive the Employer's Report of Injury form within 5 days. This form is filled out and submitted by Physical Plant personnel after receipt of the Supervisor's Investigation Report form.
As soon as the State Self Insurance Fund receives the Employer's Report of Injury, compensability will be determined. If the claim is accepted, the prescription will be approved and the injured employee will receive a MedTrak prescription drug card in 3 to 4 days. The employee should use the MedTrak Prescription Drug Card for any medication related to the injury that is prescribed by the treating physician. The employee's MedTrak Prescription Drug Card will remain valid for up to six months or until the doctor releases the employee from care. If medical treatment extends beyond a six-month period, the employee's prescriptions may be transferred to a long-term program. State Self Insurance Fund staff will handle this transfer. A MedTrak Prescription Drug Card has to be issued for each new date of injury. Employees with two injury dates requiring medications will be issued two MedTrak cards. For assistance, please contact the State Self Insurance Fund at (785) 296-2364 or MedTrak at (800) 771-4648.
If the claim is not compensable, the employee will receive a statement in the mail indicating that it has been denied and that the employee will need to submit any bills related to the denied claim to their health plan provider.
Pharmacies can contact MedTrak at (800) 771-4648 for assistance with claims processing. MedTrak hours are 8:00 AM - 9:00 PM, Monday through Friday, and 9:00 AM - 6:00 PM on Saturday.
Information follows detailing the paperwork that needs to follow the initial treatment of an injured state employee.
Fort Hays State University is subject to the Kansas Workers Compensation Law which provides compensation for job-related injuries. It is very important that all work-related injuries to faculty, staff or student employees be promptly documented and reported.
What to do if an injury occurs on the job
Notify your employer immediately. Per K.S.A. 44-520, a claim may be denied if an employee fails to notify their employer within the earliest of the following dates: (A) 20 calendar days from the date of accident or the date of injury by repetitive trauma; (B) if the employee is working for the employer against whom benefits are being sought and such employee seeks medical treatment for any injury by accident or repetitive trauma, 20 calendar days from the date such medical treatment is sought; or (C) if the employee no longer works for the employer against whom benefits are being sought, 10 calendar days after the employee's last day of actual work for the employer.
Steps to follow:
Any time an employee is injured at work, the employee's supervisor needs to fill out the Supervisor's Investigation Report and mail (or fax) it to the Physical Plant office (fax #785-628-4048). Even if the employee doesn't immediately need or seek medical help, the accident is documented if medical care becomes necessary at a later time.
Once the Physical Plant receives the Supervisor's Investigation Report, the Employer's Report of Accident form is sent to the State Self Insurance Fund office in Topeka. That office then mails a Written Claim for Compensation form (Form WC-9) to the injured employee. This Written Claim for Compensation form is the official notification that a worker is claiming compensation in accordance with the Workers Compensation Laws of Kansas.
If you have any questions about an injury at work, please call Roy Ibarra, Safety Officer (785) 628-4333, the Physical Plant office, (785) 628-4424, or the Human Resource office, (785) 628-4462.