Workers' Comp / Work-Related Injury Information and Forms
Environmental Health and Safety
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 Environmental Health and Safety (EH&S) Department is responsible for coordinating the UT Tyler Workers' Compensation Program. The UT Tyler EH&S Office serves as the facilitator between UT Tyler injured employees and all UT System W/C Insurance entities by submitting appropriate forms in a timely manner and making every effort to negotiate modified duty assignments. Chris Kinsey is the UT Tyler campus W/C representative and can be reached at 903.565.6504 or 903.521.6162.
- 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 EH&S Office of the injury at 903-566-7011 or email email@example.com 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 firstname.lastname@example.org.
- 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 EH&S at 903-566-7011 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. Click here to find a provider: https://injurymanagement.com/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 EH&S Office immediately, email to WCI@uttyler.edu. All medical related expenses are subject to fee guidelines established by Texas Department of Insurance, Division of Workers' Compensation.
- Chris Kinsey, 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.
- 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)
Other Forms & Resources
Telemed Services Information