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UNCG <br /> Center <br /> New North Carolinians <br /> 2. The ACCESS Director will then submit Form 19 (Employer's Report for Injury or <br /> Occupational Disease to the Industrial Commission), Form 18 (Notice of Accident to <br /> Employer), HRS 301, and EE Statement form to the UNCG Department of Human <br /> Resource Services and the Office of Safety within 48 hours after the occurrence or <br /> knowledge of an injured member(GS 97-92). <br /> 3. Forms may be obtained by contacting the Office of Safety, the UNCG Department of <br /> Human Resource Services, or you may go to the UNCG Human Resource Services web <br /> site at www.uncg.edu/hrs and select Workers' Compensation Program. <br /> The Workers' Compensation Act requires that a member give written notice to the <br /> ACCESS Director and Site Supervisor within 30 days of an accident or within 30 days of <br /> being diagnosed as having a disease associated with employment. After 30 days no <br /> compensation is payable without a ruling by the Industrial Commission. <br /> Obtaining Medical Care <br /> A member who is injured on the job or who contracts an occupational disease must go to the <br /> University's Student Health Center for medical care. For additional information, see the UNCG <br /> staff policy manual, which can be found at: <br /> http://web.uncg.edu/hrs/PolicyManuals/Staffmanual/section8/workers comp/ <br /> Return to Service (Same Day) <br /> After treatment by a physician following a work-related accident,the member is expected to <br /> return to service unless the treating physician indicates the member must go home for the day. <br /> The member is responsible for obtaining from the treating physician a written statement <br /> certifying the need to go home instead of returning to service. <br /> Return to Service (After Workers'Compensation Leave) <br /> A member who has been released by the treating physician to return to service has the obligation <br /> to accept any suitable service assignment provided by the site supervisor that is in keeping with <br /> the member's capability. Refusal to accept suitable service assignment will result in termination <br /> of compensation and may result in dismissal. <br /> ACCEPTANCE OR DENIAL OF CLAIM FOR WORKERS' COMPENSATION <br /> • The CorVel Corporation(University Third Party Administrator)has responsibility for <br /> determining whether or not the University is liable for the claim for workers' compensation <br /> benefits. The decision is made on the basis of all the facts presented on the member's notice and <br /> the discussions with the site supervisor, ACCESS Director and the University Compliance and <br /> Safety Officers. Payment of medical bills by the University is not an indication of the <br /> University's acceptance of liability for the claim. <br /> • If the claim is denied, the member will be notified as soon as possible,pending receipt of <br /> medical documentation if necessary. To petition further, the member must file a written notice of <br /> A <br /> C <br /> C <br /> 8 <br /> Qd <br /> A .- <br /> A nity, <br /> 915 W.Lee St. Suite A,Greensboro,NC 27403 Phone(336)256-1060 Fax(336)334-5413 ""'s°;-=;"' <br />