Workers Compensation

IF THE INJURY IS LIFE THREATENING OR AN EMERGENCY - CALL 911 OR SEEK IMMEDIATE HELP FIRST. 


Workers Comp is available to part time & full time employees who are injured while doing work for the Archdiocese. If the injured person is a volunteer, see the Volunteer Accident Policy. If the injured person is a participant, student or attendee, the location Liability Policy will apply.

In compliance with State & Federal requirements, the Archdiocese provides comprehensive Worker's Compensation insurance, administered by Church Mutual to employees of the Archdiocese. 

It is the employer's responsibility to report the accident AS SOON AS SAFELY POSSIBLE to Church Mutual Insurance Co., so the employee can be fairly compensated and so the hazard that caused the accident can be eliminated.

 

TIME IS IMPORTANT IN REPORTING A WORKER'S COMP CLAIM - TO BE IN COMPLIANCE - YOU OR THE EMPLOYEE MUST REPORT THE INJURY TO CHURCH MUTUAL INSURNANCE CO. AS SOON AS POSSIBLE FOR THE EMPLOYEE TO QUALIFY FOR WORKER'S COMP BENEFITS; see 24/7 phone numbers below.

    1. For any work site injury, no matter how minor, the employee should notify the employer as soon as possible. If the employee has not yet received medical care, the supervisor/manager (with the employee present) should contact the Church Mutual Nurse Hotline listed below. In case of medical emergency, the employee should be transported to the nearest hospital emergency department.
    2. If the employee contacts the employer after medical treatment, complete the EMPLOYER'S ACCIDENT REPORT, (see below right). Fax the completed report to Church Mutual (Fax Number listed below). DO NOT submit the Accident Report to the Kansas Division of Workers Compensation listed on the form.  

      Kansas State Law limits the reporting time to file a worker's compensation claim.  An employee has 20 days and an employer has 28 days from the date of injury to report an accident to Church Mutual.  If this date is exceeded, Church Mutual still recommends filing a claim.  If they denies the claim, the employer can submit the letter of denial of Worker's Compensation to BCBS to see if they will cover the medical expenses.

    3. FMLA/Federal Family & Medical Leave Act: FMLA should not be used for a workers comp leave.

    4. The Archdiocese HR office recommends that employers pay a set amount of 20% of the employee's daily rate from employee available entitlements, (sick, personal, vacation and or pto,) during the one week waiting period before the work comp benefits begin to pay out. The one week waiting period is often paid retroactively as part of the work comp claim. We also recommend that the employer continue to provide pay, after the one week waiting period, from employee entitlements, (vacation, sick, pto or personal), to supplement the work comp benefit at the same set rate of 20% of the employee's daily rate if the employee has available leave pay.  Work comp benefits are non-taxable.
      Employers are encouraged to contact the employee during recovery at home to show interest in their recovery. An injured worker often needs encouragement to return to the work force. One on one communication makes a difference. Getting the employee back to work means reduction in lost wages and medical costs. Church Mutual works toward this goal.

The Archdiocese values the safety of every employee and takes many precautions to prevent work-related injuries. An employee should be assured that reporting a work place injury will not result in threat, harassment or reprisal in any form by the employer or other employees.

Dayforce Instructions: Instructions to determine employee daily rates are below under "NOTE:".

For Exempt Employees:
1. Do a Quick Entry with a Code of Sick, Personal, Vacation or PTO.

2. Enter the "Amount"  (the 20% supplemental amount for work days on that pay period on workers comp)
3. In the Comments field enter “Workers Comp”
4. For salary employees, do a Second Quick Entry with a Code of "Regular" (unless there were regular days worked in this pay period, then see #6.)
5. Enter the "Amount" as 0 and check mark the Replace box  
6. For salary employees who worked regular work days in this pay period before the accident, make a Quick Entry with a Code of "Regular" and an amount equal to the pay for the days that were worked before the accident. Check mark the Replace box.
- These 2 Quick Entries will pay the employee for supplemental pay only and track it as Workers Comp.

For Non-Exempt Employees:
Use the employee's hourly rate to determine how many hours and minutes to enter into Timesheets, as a Pay Adjustment Type - Sick, Personal, Vacation or PTO.  (The 20% supplemental amount of hours not paid by work comp.)  

NOTE:
- To determine the gross daily rate to supplement employee pay - You will need to determine thier daily rate.  Be sure the pay does not exceed 100% of the employee's gross wage when combined with the payment from Church Mutual.  Check with Church Mutual to determine the work comp pay.
- To determine daily rate for salary employees or contract teachers;
Divide their annual or contract pay by the number of weekdays in a a year - 260 days (261 days in leap year)
- To determine daily rate for hourly employees
Multiply their normal daily hours by their hourly rate
- To determine the number of hours each day that can be supplemented during disability;
Determine 20% of the daily rate that should be supplemented from the employee's available entitlements.


- Be sure to check the employee's earnings statement in Payroll before you commit.  

Also be sure to get a doctor's release when the employee returns to work.

Church Mutual Group

IF THIS IS AN EMERGENCY MEDICAL SITUATION, SEEK HELP FROM A HOSPITAL OR URGENT CARE FACILITY FIRST BEFORE CALLING THE CLAIM IN.

Policy # 0320990-07-910297
(indicate Archdiocese of Kansas City in KS as employer name)

Nurse Hotline: 1-844-322-4662 available 24/7 
(call before medical treatment, if non-emergency) 

Claims Line:  1-800-554-2642 available 24/7
(call if outside medical treatment has begun)

Claims Fax:  (715) 539-4651

Email: claims@churchmutual.com   

Mailing Address:
Church Mutual
PO BOX 342
Merrill WI 54452

LIST OF OCCUPATIONAL HEALTH CLINICS
Please print this screen with the current provider Church Mutal Group contact info & policy number and pass this info on to the clinic you visit. Thank you

Forms:   
Employer's Accident Report - KS

FMLA forms

Important - Be sure to get FMLA forms completed as soon as is reasonable.
Incomplete or incorrect information & dates can affect eligibility of employee leave & benefits.
FMLA forms are not sent to Hartford. FMLA forms should be filed at your location separate from the normal employee file with any other medical or private information.

Employee & Doctor FMLA Forms:

1. FMLA Fact Sheet  or  FMLA Fact Sheet/Guide (Spanish)

2. FMLA Leave Request Form (for the employee)
3. Physicians Certification of Employee's Health Condition  (for the doctor) 
OR  
Physicians Certification of the Family Member's Health Condition 

Employer Forms for the employee:
4. FMLA Employer's Notification of Eligibility - Required to be given to the employee within 5 days of Employee request for FMLA leave
5
FMLA Employer's Response - FMLA Designation Notice - Required to be given to the employee within 5 days of receiving Physicians Certification

Employer's FMLA Forms:
1. Federal FMLA Fact Sheet for Employers regarding Employer notification requirements

Month at a glance calendar - may be helpful to print & chart employee FMLA & disability leave days, payroll pay, sick or vacation pay used, and benefits & premiums due. Enter month & Year and click Download PDF Calendar & Print.