Workers' Compensation

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Tracy Gardner
Workers' Compensation Claims Analyst
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Workers' Compensation Insurance (WC) provided by The University of Texas at Arlington (UTA) is funded by The University of Texas System (UT System) through a self-insured WC program. Cannon Cochran Management Services Inc. (CCMSI) administers this program. Administering the program includes receiving, investigating, and making liability determinations on WCI claims. Individual names who appear on the employer payroll are eligible for Workers' Compensation Insurance.

For an injury or illness to be work related, it must originate while you are engaged in the work your job requires you to do for the university.

The Environmental Health & Safety Office (EH&S) is responsible for coordinating the UTA Workers' Compensation Program. The UTA WC Claims Analyst serves as a facilitator between UTA injured employees and all UT System WC Insurance entities by submitting appropriate forms in a timely manner and making every effort to negotiate modified duty assignments.

Reporting an Injury

Immediately inform your supervisor of the injury, no matter how minor it may seem; UTA policy states injuries must be reported within twenty-four (24) hours of the injury. Failure to notify within 30 days may result in denial of the claim.
If necessary, report unsafe working conditions to your supervisor or to us at 817-272-2185 or ehsafety@uta.edu
The injured employee, supervisor or designee is advised to notify the UTA Workers' Compensation (WC) office of the injury at 817-272-5563 or email workerscompensation@uta.edu about the incident.

Required Reporting Forms

*Complete Injury Packet

The injury packet forms should be completed and emailed to workerscompensation@uta.edu within 24 hours of the injury. If immediate medical treatment is required, these forms may be submitted as soon as practical after medical treatment has been provided.

The following forms are included in the injury packet:

Notification of Work-Related Injury or Occupational Illness - Give to medical provider.
Employee's Report of a Work-Related Injury or Occupational Disease - Complete and sign form as soon as possible after the injury.
WC Network Acknowledgement form - Complete and sign. (Spanish/Vietnamese)
Notice of Network Requirements for UT System - Please read. (Spanish/ Vietnamese)
Supervisor's Report of Employee Work-Related Injury or Occupational Disease Complete and sign.
Choose traditional prescription form or Text2Fill.
WCI Employee's Leave Election - If one or more workdays are lost due to injury, complete and sign.
Injury Leave for Peace Officers Only - Complete and sign.

Medical Treatment

The decision to seek or not seek medical treatment is up to the employee.
For life-threatening injuries, please call UTA dispatch at 817-272-3003 for transportation to a hospital emergency room. Once your situation has been stabilized, you must follow-up with an IMO Network provider.
For non-life-threatening injuries, medical treatment must be made from the list of doctors approved by The UT System Network- Injury Management Organization (IMO) approved doctor list. The online search tool to find a provider: https://injurymanagement.com/find-a-provider/ OR see Providers Nearest to the University
Injuries requiring a specialist, the IMO Network treating doctor will make a referral.
Employees that do not seek medical treatment are assumed to be at full duty status.

Telemedicine Services

UTS-IMO Telemedicine is a convenient 24/7 effective option for many non-life-threatening injuries (minor strains/sprains, bruises, minor burns, minor cuts, scrapes, work-related rashes) and/or after-hours care.

Post Injury Responsibilities

Communicate all changes in work status to supervisor and the WCI Employer representative immediately.

Healthcare Network Information

Required Employer Notices

Office of Injured Employee Counsel Ombudsman Program Notice
Office of Injured Employee Counsel Ombudsman Program Notice (Spanish)

Helpful Links

EH&S Forms