Employee Information

The Claim Process

You are required to report any work-related illness or injury to your supervisor immediately. If you are seriously injured, you should seek immediate medical treatment.
You should ask to fill out the University’s Accident/Incident/Quality Improvement Report (form UoW1428) as a record of the incident. This form is an internal document and will not initiate a workers’ compensation claim.

All workers’ compensation claims are filed through your treating physician’s office.
You must file a claim in a timely manner (one year for injuries and two years after receiving written notice from a doctor that you have an illness is work related.) For additional information on the Washington State Injury/Illness definitions, see the L&I website.
You should complete the worker’s section of the Department of Labor & Industries claim form at your doctor’s office. When indicating the business name and employer address on your claim form please use:

University of Washington
Office of Risk Management
Box 351276
Seattle, Washington 98195-1276

Please make sure that you fill out the claim form completely. Once your claim is allowed, you may be eligible for medical coverage and time loss payments.
The Office of Risk Management is the only University department authorized to complete and sign the employer section of the L&I claim form. Please have your doctor forward the employer copy to:

University of Washington
Office of Risk Management
Box 351276
Seattle, Washington 98195-1276

L&I should contact you within 14 days of receipt of your claim. Additional investigation may be necessary before the Department of L&I can make a decision about allowing or rejecting your claim.
If you receive correspondence from L&I that is incorrect or that you do not understand, contact the Office of Risk Management or your L&I claims manager.

If time off work is ordered by your doctor, you must provide a statement to your supervisor that includes what dates you are unable to work and your physical restriction(s). If you cannot bring the statement to your supervisor, inform your supervisor by phone and mail in the statement as soon as you can.
You and your supervisor should stay in touch during your absence so he or she will be aware of your medical progress. If you are off for more than three days, you will need to stay in contact with the Office of Risk Management and your Human Resources Representative.
Each time your physician extends your leave, or changes your physical restrictions, documentation from your doctor must be promptly submitted to your supervisor.
If you are working part time or with restrictions, contact your L&I claims manager for Loss of Earning Power forms. The Office of Risk Management is the only University department authorized to complete and sign the employer section of the L&I Loss of Earning Power form. Please contact Workers’ Compensation Specialist with questions or for further information.

The University of Washington offers you many options for coding your industrial injury leave. You may use your accrued sick leave, vacation time, comp time, leave without pay (LWOP), or a combination of the above. For additional information visit the HR Benefits page.
You are not eligible for shared leave; however, you may be eligible for Family Medical Leave Act (FMLA). If you use LWOP, please contact your HR representative with questions regarding the impact on benefits.

The University of Washington is required to have a buy back program for eligible workers who are paid for sick or vacation leave hours from the University and also receive time loss payment from L&I for the same period of time. The Buy Back Program reconciles this “double payment” and allows for reinstatement of a proportionate amount of leave to your leave record. You are required to buy back sick leave, but it is optional to buy back vacation leave. See Frequently Asked Questions/Procedures About Buy Back for details. Contact Workers’ Compensation Program Coordinator with questions or for further information.