Workers' Comp / Work-Related Injury Information and Forms

Office of Human Resources

Work-Related Injuries

Workers' Compensation Insurance (WCI) provided by The University of Texas at Tyler (UT Tyler) is funded by The University of Texas System (UT System) through a self-insured Workers' Compensation (W/C) program. Cannon Cochran Management Services Inc. (CCMSI) administers this program.  Administering the program includes receiving, investigating, and making liability determinations on W/C claims; determining the reasonableness and necessity of medical treatment and services; generating income benefit payments to injured employees and medical payments to health care providers.  All employees of UT Tyler whose names appear on the payroll are eligible for Workers' Compensation Insurance benefits.

The Office of Human Resources is responsible for coordinating the University of Texas at Tyler (UT Tyler) Tyler Workers' Compensation Program. The Office of Human Resources serves as the facilitator between UT Tyler injured employees and all UT System Workers' Compensation Insurance entities by submitting appropriate forms in a timely manner and making every effort to negotiate modified duty assignments.  Marcus Ray, Human Resources Compliance Specialist, is the UT Tyler campus Workers' Compensation program representative and can be reached via phone. 903.877.7743 or email, wci@uttyler.edu.

• Employees who experience a work-related injury are required to communicate the incident immediately to their supervisor.
• The injured employee, supervisor or designee is advised to notify the UT Tyler Risk Management office regarding the injury at 903.877.7743 or email wci@uttyler.edu about the incident.
• Employees are required to report all injuries/illnesses within twenty-four (24) hours, even if they do not need medical attention.

Injury Reporting Forms: email completed forms to wci@uttyler.edu.

• Employee’s Report of a Work-Related Injury or Occupational Disease form – Must be completed as soon as possible after the injury.
• WCI Network Acknowledgement form – Must be completed as soon as possible after the injury. This form provides awareness of the Health Care Network.
• Notification of Work-Related Injury or Occupational Illness – Presented to the Injured employee’s medical provider. It notifies the medical provider that a work-related injury has been reported and gives the provider the W/C insurance information needed to process the medical bills.
• Please notify Marcus Ray at 903.877.7743 of any follow-up appointments or lost work days related to the injury.

Employees who choose to receive medical attention, please be advised:

• UT System has contracted with Injury Management Organization Med Select, a certified workers' compensation health care network, to provide medical care for employees who experience a work-related injury. Find a provider.
• In an emergency situation, employees should seek care from the nearest urgent care facility or hospital ER. However, follow-up care must be received from a network provider. Your treating doctor will coordinate all medical care and make referrals for diagnostic testing or to be seen by a specialist.
• Unless the injured employee has received medical treatment from an unauthorized physician, the employee should not be billed directly for health care intended to treat a work-related injury. Should a bill from a health care provider be received, the employee is advised to send the invoice to the Risk Management office immediately via email to WCI@uttyler.edu.  All medical related expenses are subject to fee guidelines established by Texas Department of Insurance, Division of Workers' Compensation.
• Marcus Ray, the UT Tyler WCI campus representative, may provide the description of the circumstances and nature of the injury, including any information related to the incident location, with a safety representative from the University of Texas at Tyler Environmental Health and Safety and Risk Management offices for the purpose of accident and injury prevention and as part of ongoing workplace safety programs. 

   

Manuals

• Workers’ Compensation Injury Process & Procedure

• Notice of Network Requirements for UT System (English)
• Notice of Network Requirements for UT System (Spanish)

• Healthcare Network Employee Handbook for UT System (English)
• Healthcare Network Employee Handbook for UT System (Spanish)

Required Employer Notices

• Notice 6: Workers’ Compensation in Texas (English)
• Notice 6: Workers’ Compensation in Texas (Spanish)

• Notice 9: Work-Related Communicable Diseases & WCI Eligibility (English)
• Notice 9: Work-Related Communicable Diseases & WCI Eligibility (Spanish)

• Notice of Injured Employee Rights and Responsibilities in the Texas Workers’ Compensation System

Other Forms & Resources

Form 23 – Request for Paid Leave

Form 23P – Injury Leave for Peace Officers

RxBridge First Fill Form - for payment of prescriptions related to the injury

UT System Health Care Network Information

Texas Department of Insurance

W/C Network Opt-in form - if you live out-of-network you may opt in to receiving treatment from an in-network provider

Telemed Services Information

Telemed for Injured Employees 

Telemed Process for Supervisors

Telemed FAQs