Franklin Pierce University
Human Resources Department
First report of
What you need to know if you are injured at work:
If you have an injury at work you need to complete an Incident/ Accident Report, whether you seek medical care or not. This provides a record in case there are problems later and enables the University to track the type of injury; where it occurred; and what, if any, corrective action(s) that needs to be taken to prevent further injury.
If you have an injury that requires medical attention, please follow our usual reporting protocol:
Our Workers Compensation insurance carrier is:
1750 Elm Street, Suite 500
Manchester, NH 03104
Ph: (603) 695-6601
Fax: (603) 314-0630
Claim Reporting: 1-800-MEMIC WC (1-800-636-4292)
Franklin Pierce University is responsible for payment of medical treatment for all accepted claims through the workers’ compensation carrier, MEMIC, as long as the treatment is reasonable and necessary and related to the accepted claim.
Helpful information for an employee that has filed a Workmen’s Compensation claim:
· Insurance carrier has 21 days upon receipt of the First Report of Injury to investigate the claim to determine if the claim will be accepted or denied.
· There is a 3-day waiting period for payment of wages lost due to an injury. First 3 days of disability are not covered unless an employee is out for more than 14 days OR returns to work within the first 5 days of disability to light duty.
· If an injured employee seeks medical treatment, he/she will need to provide the New Hampshire Workers’ Compensation Medical Form filled out by the physician to employer after each visit.
· If an injured employee is totally disabled as a result of the injury or placed on restriction by a physician a Case Manager Nurse and/or a Claim’s Adjustor may become involved.
· Wages for an employee who has an approved claim is calculated based upon 60% of the employees Average Weekly Wage - wages taken from 26 weeks prior to date of injury. Wages for the approved claim are paid through the MEMIC.
· Mileage reimbursement to and from medical, hospital or physical therapy appointments are paid by MEMIC at the ‘per mile’ business rate established by Federal/State guidelines. The employee is responsible for filing a claim for such mileage with MEMIC.
· Employees who need to fill a prescription for a work-related injury will need to pay for the prescription out-of-pocket and submit for a reimbursement from the MEMIC using the prescription RX receipt.
If you have any questions regarding your workers’ compensation medical care contact:
· Franklin Pierce University - Human Resources Department at 603-899-4075
· MEMIC – Workers Compensation Dept. at (603) 695-6601