Navigating workplace injuries, medical leaves, or disability claims can be complex. At Upmc Work Partners, we are dedicated to supporting our partners through every step of these processes. This guide provides answers to frequently asked questions to help you understand workers’ compensation, leave options like FMLA, and disability benefits. We aim to make these processes as straightforward and stress-free as possible, ensuring you receive the support you need when you need it most.
Frequently Asked Questions About UPMC Work Partners Services
Connecting with a Real Person
Can I speak with a real person to answer my questions about my claim or leave?
Yes, absolutely. At UPMC Work Partners, we believe in personalized support. Each workers’ compensation claim or leave of absence case is assigned to a dedicated specialist. For workers’ compensation, you will be assigned a claims adjuster, and for leave or disability, you will have a leave/disability specialist. These professionals are your direct contacts, guiding you through the entire process, assisting with paperwork, and supporting your return to work. You won’t be alone navigating this process; your assigned specialist is there to provide clear, helpful guidance.
Initiating a Claim with UPMC Work Partners
How do I file a claim with UPMC Work Partners?
The process for filing a claim depends on whether it’s a workers’ compensation claim or a leave/disability claim.
For workers’ compensation: The first and most crucial step is to immediately report your workplace injury or illness. Inform your immediate supervisor or manager as soon as possible. Timely reporting is essential for a smooth claim process. You can also contact your state workers’ compensation agency for guidance on filing your claim.
For leave and disability claims: Many employers who partner with UPMC Work Partners offer online claim submission. Check your company’s intranet site for information on online filing. This is often the quickest and most efficient method. If you have any questions about online filing or need to file via phone, please call us directly at 1-800-633-1197. Our representatives are ready to assist you.
What Happens After Filing a Claim?
Once I file a claim with UPMC Work Partners, what happens next?
For workers’ compensation claims: After you file a workers’ compensation claim, a claims examiner from UPMC Work Partners will conduct a thorough claim analysis and investigation. This process ensures that all aspects of your claim are reviewed fairly and accurately. A decision regarding the compensability of your claim will be made promptly. Throughout this period, your assigned claims examiner is available to answer any questions you may have and provide updates on your claim’s progress.
Understanding the Workers’ Compensation Process with UPMC Work Partners
What should I do immediately if I am injured on the job?
If you experience an injury at work, follow these critical steps:
- Report the Injury Immediately: Your first action should be to immediately report the injury to your supervisor. This ensures that the incident is officially documented and that the claim process can begin without delay.
- Acknowledgement and Forms from Workpartners: Once your employer reports your injury to UPMC Work Partners, you will receive an acknowledgment letter confirming receipt of the report. Expect to receive forms related to your injury, which may include a “Medical Authorization” form.
- Complete and Return Forms Promptly: It is crucial to fill out these forms with as much detail as possible and return them to UPMC Work Partners promptly. The “Medical Authorization” form is particularly important as it allows UPMC Work Partners to obtain your medical records directly from your treating physician. This access to your medical information enables us to make a timely and informed decision about your eligibility for workers’ compensation benefits.
- Contact from a Workpartners Representative: A representative from UPMC Work Partners may contact you to gather more information about your injury or illness. This is a standard part of the process to ensure we have a complete understanding of your situation.
- Reach Out with Questions: If at any point you have questions or need clarification, do not hesitate to call UPMC Work Partners at 1-800-633-1197. We are here to support you and provide the information you need.
What exactly is workers’ compensation?
Workers’ compensation is a system designed to protect employees who experience work-related injuries or illnesses. It acknowledges the obligations businesses have to their employees’ well-being. Workers’ compensation insurance provides coverage for employee expenses that arise directly from a workplace injury or illness. While specific plans and benefits can vary by state, workers’ compensation generally aims to cover:
- Wage Replacement: Weekly payments to replace lost wages while you are unable to work due to your injury.
- Economic Loss Compensation: Compensation for both past and future economic losses resulting from the injury or illness.
- Medical Expense Coverage: Reimbursement or direct payment of necessary medical expenses related to the work injury, including doctor visits, hospital stays, and surgeries.
- Death Benefits: Benefits payable to the dependents of workers who unfortunately are killed on the job or in the course of their employment.
What specific benefits are covered under workers’ compensation?
Workers’ compensation benefits can vary by state, but typically include coverage for:
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Medical Expenses: This encompasses all necessary and reasonable medical care related to your work-related injury or illness. This can include:
- Doctor visits and specialist consultations.
- X-rays and other diagnostic tests to determine the extent of the injury.
- Prescription medications required for treatment.
- Surgical procedures, if necessary.
- Hospitalization, including emergency care and necessary stays.
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Lost Wage Reimbursement: Workers’ compensation is designed to provide financial support if your injury or illness prevents you from working and earning your regular wages. It generally covers a portion of your lost wages to help you meet your financial obligations while you recover.
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Additional State-Specific Benefits: Depending on the state in which you work, you may be entitled to other additional benefits as provided by the specific workers’ compensation laws of your state. These could include benefits for permanent impairments or vocational rehabilitation services to help you return to gainful employment.
How will I know if my workers’ compensation claim is approved and I am entitled to benefits?
Once you file a workers’ compensation claim, a dedicated claims representative at UPMC Work Partners will thoroughly review the details of the accident and all related medical reports. They will conduct a comprehensive investigation into your claim to ensure accuracy and fairness. Following this review and investigation, a determination will be made regarding whether your injury or illness is compensable under your state’s workers’ compensation laws. If it is determined that your claim is compensable, you will be officially notified that you are entitled to receive workers’ compensation benefits. This notification will outline the benefits you are approved to receive and provide further guidance on accessing these benefits.
What can I expect if my workers’ compensation claim is accepted by UPMC Work Partners?
If your workers’ compensation claim is accepted, the primary focus becomes your optimal medical recovery and a safe and timely return to work. UPMC Work Partners is committed to working closely with you, your employer, and your medical providers to facilitate these goals. Here’s what you can expect:
- Medical Treatment: When you receive medical treatment for your work-related injury or illness, it is critical to inform your medical provider that you are receiving treatment under workers’ compensation. This step is important to ensure that medical bills are correctly processed and sent to UPMC Work Partners for payment, preventing bills from being sent directly to you.
- Prescription Coverage: Your prescriptions related to the work injury will be covered under workers’ compensation, generally ensuring no out-of-pocket expenses for you.
- Communication is Key: To support your recovery and return to work, it’s essential to keep both your employer and your UPMC Work Partners claims representative informed about your doctor appointments, treatment plans, and your return-to-work status.
- Return to Work Updates: As soon as your doctor releases you to return to work, even in a modified capacity, promptly inform both your employer and your claims representative. This helps in coordinating a smooth return to the workplace.
What should I do if I receive medical bills related to my workers’ compensation treatment?
If you receive bills from medical providers for treatment related to your accepted workers’ compensation claim, do not pay them directly. Instead, please send all medical bills to UPMC Work Partners at the following address:
Workpartners
PO Box 2971
Pittsburgh, PA 15230
UPMC Work Partners will handle the processing and payment of these bills directly with the medical providers, ensuring you are not burdened with these expenses.
Navigating the Leave Process with UPMC Work Partners
What is FMLA and how does it apply to UPMC Work Partners?
The Family and Medical Leave Act (FMLA) is a federal law that provides eligible employees with job-protected, unpaid leave for specified family and medical reasons. FMLA can be a crucial support when you need to take time off work for significant life events. Generally, FMLA provides leave when you are unable to work due to:
- Your Own Serious Health Condition: If you are experiencing a serious health condition that prevents you from performing the essential functions of your job.
- Caring for a Family Member with a Serious Health Condition: If you need to care for a parent, spouse, or child who has a serious health condition.
In certain situations, FMLA leave can be taken intermittently, meaning you can take leave in separate blocks of time or reduce your work schedule, rather than taking one continuous period of leave.
What types of leave qualify for FMLA under UPMC Work Partners?
Beyond the typical reasons, FMLA also covers specific types of leave, including:
- Military Leave: FMLA allows for leave for qualifying exigencies related to the foreign deployment of a covered military member (spouse, son, daughter, or parent). Additionally, you may be eligible for up to 26 weeks of FMLA leave within a single 12-month period to care for a covered service member who is undergoing medical treatment, recuperation, or therapy for a serious injury or illness incurred in the line of duty.
- Leave for Bonding, Adoption, or Foster Care: FMLA provides leave for new parents to bond with a newborn child. This right extends equally to both men and women. Leave is also available for the placement of a child with you for adoption or foster care. To bond with a new child, FMLA leave must be taken within one year of the child’s birth or placement. Typically, this leave should be taken as a continuous block, but employers may agree to allow intermittent leave, such as a reduced part-time schedule.
Who is eligible for FMLA through UPMC Work Partners?
To be eligible for FMLA, employees must meet specific criteria:
- Length of Employment: You must have worked for your employer for at least 12 months. These 12 months do not need to be consecutive.
- Hours Worked: You must have worked for at least 1,250 hours during the 12 months immediately preceding the start of your FMLA leave.
What conditions are considered a serious health condition under FMLA?
A serious health condition, as defined under FMLA, includes several categories:
- Inpatient Care: Conditions requiring an overnight stay in a hospital, hospice, or residential medical care facility.
- Incapacity with Ongoing Medical Treatment: Conditions that incapacitate you or your family member (unable to work, attend school, or perform regular daily activities) for more than three consecutive days and require:
- Ongoing medical treatment, which can include multiple appointments with a health care provider; or
- A single appointment with follow-up care, such as prescription medication.
- Chronic Conditions: Chronic conditions that cause occasional periods of incapacity and require treatment by a health care provider at least twice a year. Examples include asthma, diabetes, and epilepsy.
- Pregnancy and Prenatal Care: Pregnancy, including prenatal medical appointments, severe morning sickness, or medically required bed rest.
How do I request FMLA leave through UPMC Work Partners?
To request FMLA leave, contact UPMC Work Partners directly at 1-800-633-1197. UPMC employees have an additional option and can conveniently request FMLA through the My HUB portal.
How will I know if my FMLA leave request is approved?
After you request FMLA leave, a dedicated leave specialist from UPMC Work Partners will contact you to discuss your request in detail. They will follow up with written communication, typically within five business days, to inform you of your eligibility and provide further instructions. This written notification will outline the next steps and any additional information required to process your leave request.
Understanding Disability Benefits with UPMC Work Partners
What is typically covered by disability benefits offered through UPMC Work Partners?
Disability benefits serve as a crucial wage supplement, offered by some employers, to support employees who are temporarily medically unable to work due to illness or injury that is not work-related. It’s important to note that not all employers offer disability benefits, and the level of reimbursement can vary significantly between employers and plans. Disability benefits can come in two forms:
- Short-Term Disability (STD): This coverage typically begins after a short waiting period and replaces a portion of your income for a limited period, such as a few weeks or months, while you are temporarily disabled.
- Long-Term Disability (LTD): Long-term disability insurance is designed to provide income replacement if you are unable to work for an extended period or indefinitely due to a disability. LTD benefits usually start after short-term disability benefits end.
To understand the specifics of your employer’s short-term disability coverage, it is best to speak directly with your local human resources representative. They can provide detailed information about the disability benefits available to you, including coverage levels, eligibility requirements, and the process for filing a disability claim.
Communicating with UPMC Work Partners
I have completed my claim forms. Where should I send them?
Please send all completed claim forms and any other correspondence related to your UPMC Work Partners claim to the following address:
Workpartners
PO Box 2971
Pittsburgh, PA 15230
Who at UPMC Work Partners should I contact if I have a change of address?
If you have an active claim with UPMC Work Partners and need to update your address, please inform us immediately. You can directly contact your assigned Adjuster or Specialist, or you can call our main customer service line at 1-800-633-1197 to ensure your information is updated promptly.
How can I check if my workers’ compensation check has been issued and sent?
To inquire about the status of your workers’ compensation check, the most direct approach is to contact your assigned claims examiner. They have the most up-to-date information regarding your claim and payment status.
I can’t remember who my claims representative is. How can I find out who to contact?
If you are unsure of who your claims representative is at UPMC Work Partners, or if you need general assistance, please call 1-800-633-1197. Our customer service team will be able to assist you in identifying your claims representative or direct you to the appropriate contact for your needs.
Disclaimer: This website provides general information about services offered by Workpartners and is not intended to provide employee benefits, tax, or legal advice. For specific questions regarding your benefits or individual circumstances, please consult with your benefits, tax, and/or legal advisors.
