Emergency Medical Treatment If you receive a work place injury that needs immediate advanced care, call 911 to summon an ambulance and emergency response personnel for care and transportation to the Cooley Dickenson Hospital’s Emergency Department. If your injury is less than an emergency but still in need of timely medical treatment, you may seek medical attention at the Urgent Care Center at University Health Services. (Ambulance services cannot transport people to the Health Center).
Reporting a Work-Related Injury or Illness If you are injured on the job or suffer a work-related illness, your supervisor or department personnel officer should be notified immediately. Every injury or work-related illness must be reported, regardless of whether it might seem relatively minor or insignificant. You should report the nature of the injury and the circumstances surrounding the incident.
Seeking Medical Treatment If you need medical attention for a work-related injury or illness, you may seek treatment from your own health care provider or receive initial treatment from the University Health Services (UHS). UHS refers employees to the Cooley Dickinson Hospital in Northampton in cases where additional/immediate care is needed. The University’s workers compensation insurance carrier will be billed for any costs associated with your approved workers compensation claim. You or your medical provider must call the state insurer’s Utilization-Review Agent for pre-approval of treatment or within 24 hours after seeking emergency treatment. The phone number is:1-800-266-7991
Notice of Injury Report Your supervisor or department personnel officer is responsible for filing a Notice of Injury Report within 48 hours of the time when an incident occurs. The report establishes an official record of your injury/illness and is submitted to the Workers Compensation section of Human Resources, Room 325, Whitmore Administration Building.
Authorizing the Release of Medical Records Your department will ask you to sign an Authorization for Release of Medical Records form. This form authorizes hospitals and medical providers to release any and all information relating to your injury, to persons and/or institutions involved in the Workers Compensation process. The state’s Workers’ Compensation Unit will not pay medical bills related to the injury unless it has received this authorization form. If you are seriously injured and/or not immediately available to sign the form, your department will mail the Authorization to your home. Return the completed Authorization for Release of Medical Records form to: Human Resources, Attn: Workers Compensation Section, 325 Whitmore Administration Building, University of Massachusetts, Amherst, MA 01003.
Absence from Work for 5 Days or More If you become disabled and are unable to work for a period of five or more calendar days, the following forms must be completed and submitted to Workers Compensation section of Human Resources, Room 325, Whitmore Administration Building, University of Massachusetts, Amherst, MA 01003 as soon as possible. If you are disabled and unable to earn full wages for a period of five or more calendar days, your department will fill out a Form 101-First Report of Injury. Form 101 must be submitted to the Workers Compensation section of Human Resources within seven (7) business days after the 5th calendar day of disability. Human Resources fills in University wage information, and forwards the form directly to the state Workers’ Compensation (WC) Unit. Within 14 days of receiving Form 101, the state WC Unit must begin paying you for lost wages or send a denial letter explaining why the claim was not accepted. Upon receiving the First Report of Injury - Form 101 from your department, the Workers Compensation section of Human Resources will send you a Physician’s Report and a Concurrent Earnings Report . Have your doctor fill out the Physician's Report form and return it to Human Resources as soon as possible. The second form is in the event that you have a second job that you are loosing earnings from because of your work-related injury. Human Resources will forward the completed form to the state Workers’ Compensation Unit in Boston on your behalf. Since the state has a limited amount of time to reach a decision on your claim, it’s important for your doctor to complete this form in a few days, or your claim may be denied due to lack of information.
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