For More Information

Renee Relerford
Benefits Analyst
(781) 736-4451

Accident Form

Workers Compensation

Brandeis employees are covered by the laws of the Commonwealth of Massachusetts relating to Workers Compensation Insurance. The coverage provides a weekly cash benefit and payment for medical expenses relating to an accidental injury while at work for the university. Brandeis has elected to self-insure for workers compensation.

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Supervisor Responsibility

If an employee is injured, their supervisor needs to complete an accident report and send to Human Resources right away (attention: Veronika Quinn, Sr. Benefits Analyst).  The Commonwealth of Massachusetts, Department of Industrial Accidents, requires the Employer report the event of an injury within one week, involving 5 or more calendar days of total or partial incapacity from earning wages.

Injuries with no time lost, medical only, should also be reported to Human Resources, attention, Veronika Quinn, Sr. Benefits Analyst, (ext 64471, right away so that medical bills may be sent directly to the Self-Insurance Company, Future Comp, for payment.

Calculation Time and Payment

The First 5 days of time away from work due to the injury is paid through the employee’s sick time and is calculated as follows:

The employee is paid through Brandeis University for the day of the accident, i.e., January 9th. The next day is calculated as the first day out, 1/10 and the fifth day would be 1/14. The Department of Industrial Accidents counts 5 days, regardless of whether or not there are days off in between. Their theory is that the injured employee may have another job on their days off and therefore loses the capacity of earning money at their part-time job.

Human Resource completes the Commonwealth of Massachusetts Department of Industrial Accidents Employer’s Notification of Injuries form using the Supervisor’s Report of Illness/Injury form. All forms are sent to Future Comp, Self-Insurance Company for Brandeis University. If time lost is involved, a copy is sent to Commonwealth of Massachusetts, Department of Industrial Accidents.

If the employee is out of work beyond 5 days, a doctor’s note must be provided stating approximate time employee is restricted from work. These notes must be provided on a monthly basis. Human Resources will put the employee on unpaid leave of absence (effective the day after the fifth day) as the employee will be mailed weekly indemnity payments by Future Comp (self-insurer company) at 60% of their average 52 week, weekly wage. When an employee returns from Worker Compensation, Human Resources will end the Workers Compensation leave of absence.  The date of return to work is determined by the doctor’s note stating the date they can return to work with no restrictions (full clearance).