Navigating the complexities of employee benefits and support systems can be challenging. For individuals associated with UPMC, Workpartners UPMC stands as a crucial resource, offering a range of services designed to assist employees through various life and work events. This guide aims to provide a clear and comprehensive overview of how Workpartners UPMC supports its work partners, ensuring you have the information you need when you need it.
Getting Started with Workpartners UPMC
One of the first questions many individuals have is about accessibility and direct contact. It’s reassuring to know that Workpartners UPMC ensures you can always speak with a real person to get your questions answered. Each claim or leave case is assigned a dedicated specialist, whether it’s a workers’ compensation claims adjuster or a leave/disability specialist. This personalized approach means you have a consistent point of contact to guide you through processes, paperwork, and your return-to-work journey.
How to File a Claim with Workpartners UPMC
The process for filing a claim with Workpartners UPMC depends on the nature of the claim.
For Workers’ Compensation: If you experience a work-related injury or illness, timely reporting is key. Your first step is to immediately contact your direct supervisor or manager. You can also reach out to your state workers’ compensation agency to initiate the claim process. Prompt reporting ensures a smoother process and quicker access to the support you need.
For Leave and Disability Claims: Workpartners UPMC streamlines the leave and disability claim process. Many employers offer online claim submission portals, often accessible through your company’s intranet site. This digital approach simplifies filing. If you have any questions or need assistance, you can always call Workpartners UPMC directly at 1-800-633-1197 for guidance.
What Happens After Filing a Claim with Workpartners UPMC?
Once you’ve filed your claim with Workpartners UPMC, you might wonder about the next steps.
For Workers’ Compensation Claims: A dedicated claims examiner from Workpartners UPMC will take charge of your case. They will conduct a thorough claim analysis and investigation to understand the details of your situation. Following this review, a decision regarding compensability will be made promptly. Throughout this process, your claims examiner is your go-to person for any questions and updates.
Understanding the Workers’ Compensation Process with Workpartners UPMC
Navigating a workplace injury can be stressful. Workpartners UPMC provides a structured process to support employees through workers’ compensation.
Steps to Take If Injured on the Job
If you sustain an injury while working, remember these crucial steps when working with Workpartners UPMC:
- Report Immediately: Your immediate supervisor should be informed of the injury right away.
- Acknowledgment and Forms: Once your employer reports the injury to Workpartners UPMC, you will receive an acknowledgment letter. This letter may include forms related to your injury that need to be completed. Providing detailed information and returning these forms promptly to Workpartners UPMC is important for efficient processing. One of the forms you might encounter is a “Medical Authorization” form. This form is essential as it authorizes Workpartners UPMC to obtain your medical records directly from your treating physician, enabling a quicker determination of your eligibility for benefits.
- Contact from Workpartners UPMC: Expect to be contacted by a Workpartners UPMC representative who will discuss your injury or illness in more detail and guide you through the next steps.
- Direct Support Line: For any questions at any stage, you can call Workpartners UPMC at 1-800-633-1197 for immediate assistance.
What is Workers’ Compensation?
Workers’ compensation, facilitated by Workpartners UPMC, is a system designed to protect employees who experience job-related injuries or illnesses. It recognizes the obligations businesses have to their workforce. Workers’ compensation insurance, managed through Workpartners UPMC, covers necessary employee expenses directly resulting from workplace incidents. While specific benefits can vary by state, workers’ compensation generally includes:
- Wage Replacement: Weekly payments to compensate for lost wages during recovery.
- Economic Loss Compensation: Coverage for both past and future economic losses related to the injury.
- Medical Expense Coverage: Reimbursement or direct payment for medical treatments.
- Death Benefits: Benefits for dependents in cases of work-related fatalities.
What Benefits are Covered Under Workers’ Compensation?
The benefits covered by workers’ compensation, coordinated by Workpartners UPMC, can differ by state, but commonly include:
- Medical Expenses: Coverage for all reasonable and necessary medical costs related to your work injury or illness. This includes:
- Doctor visits
- X-rays and imaging
- Diagnostic tests
- Prescription medications
- Surgical procedures
- Hospital stays
- Lost Wage Reimbursement: Compensation for a portion of your lost income if your injury or illness prevents you from working. Additional benefits may also be available based on your state’s workers’ compensation laws.
Determining Eligibility for Workers’ Compensation Benefits
To determine if you are eligible for workers’ compensation benefits through Workpartners UPMC, a claims representative will thoroughly review the accident and medical reports, and conduct a detailed investigation of your claim. If it’s determined that your injury or illness is compensable under your state’s workers’ compensation laws, you will be entitled to receive benefits.
What to Expect When Your Workers’ Compensation Claim is Accepted
Once your workers’ compensation claim is accepted by Workpartners UPMC, the focus shifts to your optimal medical recovery and a safe return to work when medically appropriate. Workpartners UPMC collaborates closely with you, your employer, and your medical providers to support these goals. When receiving medical treatment, it’s crucial to inform your healthcare provider that you are being treated for a work-related injury or illness to ensure bills are correctly processed through workers’ compensation and not sent to you directly. Work-related prescriptions will be covered without out-of-pocket expenses. To facilitate your recovery and return to work, keep both your employer and your Workpartners UPMC claims representative informed about your doctor appointments and return-to-work status. Promptly notify your employer and claims representative when your doctor releases you to return to work.
Handling Medical Bills
If you receive bills from medical providers for your workers’ compensation treatment, and your claim has been accepted by Workpartners UPMC, do not pay them directly. Instead, send the bills to:
Workpartners PO Box 2971 Pittsburgh, PA 15230
Navigating the Leave Process with Workpartners UPMC
Workpartners UPMC also assists employees with understanding and utilizing leave options, including FMLA.
Understanding FMLA
The Family and Medical Leave Act (FMLA), administered with the support of Workpartners UPMC, generally provides unpaid, job-protected leave for eligible employees. It is designed to support employees who need to take time off work for:
- Their own serious health condition
- Caring for a family member (parent, spouse, or child) with a serious health condition.
In certain situations, FMLA leave can be taken intermittently, allowing for flexible scheduling to manage ongoing health needs.
Other Leave Types Qualifying for FMLA
Beyond serious health conditions, Workpartners UPMC helps employees understand that FMLA can also cover other types of leave:
- Military Leave: FMLA provisions extend to reasons related to certain military deployments. Furthermore, eligible employees may take up to 26 weeks of FMLA leave within a 12-month period to care for a covered service member with a serious injury or illness.
- Bonding/Adopting/Foster Care Leave: FMLA supports leave for new parents to bond with a newborn child, or for employees who are adopting or fostering a child. This leave must be taken within one year of the child’s birth or placement and typically must be taken as a continuous block of leave, unless the employer agrees to intermittent leave arrangements.
FMLA Eligibility
To qualify for FMLA through Workpartners UPMC, employees generally must meet certain criteria:
- Length of Employment: Have worked for their employer for at least 12 months.
- Hours Worked: Have worked for at least 1,250 hours during the 12 months immediately before the start of the leave.
What Constitutes a Serious Health Condition?
Workpartners UPMC recognizes several conditions as “serious health conditions” that may qualify for FMLA leave:
- Conditions requiring an overnight stay in a hospital or other medical care facility.
- Conditions causing incapacitation (inability to work or attend school) for more than three consecutive days, requiring ongoing medical treatment (multiple appointments with a healthcare provider, or a single appointment with follow-up care like prescription medication).
- Chronic conditions causing periodic incapacitation and requiring treatment by a healthcare provider at least twice a year.
- Pregnancy, including prenatal care, morning sickness-related incapacity, and medically required bed rest.
Requesting FMLA Leave
To request FMLA leave, employees should contact Workpartners UPMC directly at 1-800-633-1197. UPMC employees also have the option to request FMLA through the My HUB portal.
Determining FMLA Qualification
Upon requesting FMLA, a leave specialist from Workpartners UPMC will contact you to discuss your request and provide detailed information in writing. This review process typically takes up to five business days.
Disability Benefits Process with Workpartners UPMC
Workpartners UPMC also plays a role in managing disability benefits for employees.
Understanding Disability Benefits
Disability benefits, often managed through Workpartners UPMC, serve as a wage supplement for employees who are medically unable to work. It’s important to note that not all employers offer disability benefits, and the level of reimbursement can vary. For specific details about your employer’s short-term disability coverage, it’s best to consult your local human resources representative.
Communicating Effectively with Workpartners UPMC
Efficient communication is key when utilizing Workpartners UPMC services.
Where to Send Completed Forms
All claim-related correspondence and completed forms for Workpartners UPMC should be sent to:
PO Box 2971 Pittsburgh, PA 15230
Updating Contact Information
If you need to update your address while you have an open claim with Workpartners UPMC, it’s important to inform them promptly. Contact your assigned Adjuster/Specialist directly or call Workpartners UPMC at 1-800-633-1197.
Checking on Workers’ Compensation Checks
To find out if your workers’ compensation check has been sent, the quickest way is to contact your claims examiner directly at Workpartners UPMC.
Identifying Your Claims Representative
If you can’t recall who your Workpartners UPMC claims representative is, simply call 1-800-633-1197, and a representative will assist you in connecting with the right person.
Disclaimer: This guide provides general information about services available from Workpartners UPMC and is not intended as employee benefits, tax, or legal advice. For specific questions related to your benefits or individual circumstances, Workpartners UPMC recommends consulting with your benefits, tax, and/or legal advisors.
