1. Worker’s Compensation
Any work-related injury should be immediately reported to the employee’s supervisor. The proper paperwork must be submitted to the contacts listed at the bottom of the Employee Injury Report: a) within seven days of the occurrence of the injury or death, or b) within seven days of the employer’s knowledge of the injury or death.
When a work-related injury or illness happens, the following forms must be completed by the employee: 1) Employee Injury Report, 3) Medical Authorization, 4) and the HIPAA Authorization form. The completed forms should be forwarded to the regional Human Resources department for processing. The regional Human Resource department is responsible for completing the Chubb First paperwork and submitting the claim to insurance.
These forms, along with instructions for completion, can be found on Infonet (http://infonet.ivytech.edu/college/forms.html) under Worker’s Compensation - Employee Forms, Worker’s Compensation – Employer Forms. The forms are also located on Campus Connect (http://cc.ivytech.edu/cp/home/loginf) and in the regional Human Resources department.
2. Student Accident – College Provided
Student accidents should be reported immediately to the student’s instructor. The College should NEVER guarantee medical coverage for any student accident. The College maintains this coverage as a service to its students for injuries that arise out of the College’s negligence. If the accident or injury involves a student needle stick, student exposure to blood borne pathogens or body fluids, or student exposure to an air borne pathogen (i.e. tuberculosis), the claim falls under the College’s general liability policy, which is discussed in part 3.
When a student accident occurs, the student must complete the following forms: 1) Student Accident Report, 2) Release of Information form, and 3) HIPAA Authorization form. These forms should be faxed to the contacts listed at the bottom of the Student Accident Report. If a student accident exceeds the $2,000 maximum benefit payable under the student accident policy, the claim is transferred to the College’s general liability carrier for payment. The appropriate regional contact is notified when this happens.
These forms, along with instructions for completion, can be found in the forms section of Infonet (http://infonet.ivytech.edu/college/forms.html) under “Student Injury Report”. Students can access the forms in the Campus Life section of Campus Connect (http://cc.ivytech.edu/cp/home/loginf). Forms can also be obtained through the regional Human Resources department.
3. General Liability/Property Damage
A General Liability/Property Incident claim form must be completed when one of the following occurs: 1) theft of College-owned property, 2) damage to College property, 3) a visitor to the campus is injured, 4) student needle stick, 5) student exposure to blood borne pathogens or body fluid, or 5) student exposure to an airborne pathogen (i.e. tuberculosis).
When a general liability claim occurs, a General Liability/Property Damage claim form and the appropriate supporting documentation must be sent to the contacts listed at the bottom of the claim form. Claim forms, along with instructions for completion, can be found on Infonet (http://infonet.ivytech.edu/college/forms.html) under “General Liability/Property Incident Claim form”, or by contacting your regional Human Resources department.
4. Automobile Claims
Whenever a College-owned, leased, or rented vehicle is involved in an accident, the local police or state troopers should be contacted immediately. It is extremely important that the employee secures names, phone numbers, and addresses of drivers, witnesses, or injured persons. In addition, the employee must get the make, model, and license number of all cars involved. Failure to get this information may jeopardize the claim.
Most College vehicles have the Automobile Incident Report and Indiana Operator’s Proof of Insurance Crash/Report located inside the vehicle along with the College’s insurance information. If the appropriate forms are not located in the vehicle, they can be obtained in the forms section of Infonet under “Auto Incident Claim form” and “Indiana Operator’s Proof of Insurance/Crash Report” or in the regional Human Resources department.