Injury Occurs FROI* submitted to MCO by provider or employee Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room Supervisor gives employee claim filing packet. Medical Only Claims – Remain at Work (Less than 7 calendar days off work) BWC assigns a claim number & allows or disallows the claim POR releases employee with or without restrictions and identifies treatment plan, including duration of restrictions. Workers’ compensation specialist provides POR with employee’s job description. POR identifies specific work duties within restrictions POR releases worker to full duty without restrictions END Employee reports for duty and supplies supervisor with copy of restrictions. Supervisor offers employee modified work whenever possible Employee is rechecked by POR No restrictions Full Duty Employee completes/signs Part A (Incident Report) Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist. MCO* contacts employee and sends FROI to BWC* Supervisor forwards copy of work restrictions to workers’ compensation specialist LEGEND: FROI = First Report of Injury HSC = Health Science Campus MCO = Managed Care Organization POR = Physician of Record RTW = Return to Work Blue Text = Employee Action Red Text = Supervisor Action Green Text = Workers’ Compensation Specialist Action Follow up by BWC certified POR* If modified work is not possible employee remains off work and continues treatment. Supervisor contacts workers’ compensation specialist for work modification assistance

Injury Occurs Employee seeks medical treatment from Occupational Medicine at HSC, physician, urgent care center or an emergency room Supervisor gives employee claim filing packet. FROI submitted to MCO by medical provider or employee Employee completes/signs Part A (Incident Report) Lost Time Claims – Return to Work (Over 7 Calendar Days Off Work) Workers’ compensation specialist certifies/rejects the claim BWC assigns a claim number & allows or disallows the claim Follow up with BWC certified POR. Physician may prescribe therapy services and diagnostic testing; worker is unable to return to work. Test for diagnosis (health care services geared to early, safe return to work/transitional work) Workers’ compensation specialist gives physician a copy of employee’s job description. Diagnosis determined and medical care rendered Employee completes incident report Physician releases employee with restrictions, prescribes transitional work, including therapy intervention, on C-9 Form BWC begins paying compensation unless UT approves salary continuation FROI submitted to MCO by medical provider or employee Supervisor completes/signs Part B and sends completed Incident Report to workers’ compensation specialist. Employee notifies supervisor of lost time work status. Supervisor notifies workers’ compensation specialist. Employee’s time card reflects sick/vacation for first 7 calendar days off work. Wage Advancement obligates the employee to endorse to the University payments of Worker’s Compensation to the extent of the advancement. Workers’ compensation specialist faxes CWA Wage Advancement Agreement to BWC. BWC payments are sent directly to employee Supervisor forwards all Absence Reports to workers’ compensation specialist After missing work for 7 consecutive calendar days, BWC pays 72% of gross wage for the first 12 weeks of injury and 66 2 / 3 % thereafter. Employee is offered modified or transitional work Employee accepts modified or transitional work

Transitional plan approved by BWC Therapist develops transitional work plan & establishes a rehab schedule Monitoring of on-site therapy by workers’ compensation specialist & supervisor Transitional work ends when physician has released employee without restrictions or employee has participated in the program for 90 days. BWC stops payments if employee refuses modified or transitional work Employee is rechecked by POR No restrictions Therapist may do a functional capacity evaluation for abilities Supervisor offers employee modified work whenever possible If modified work is not possible employee remains off work and continues treatment. Supervisor contacts workers’ compensation specialist for work modification assistance Transitional Restrictions Full Duty Employee reports for duty and supplies supervisor with copy of restrictions. Supervisor forwards copy of work restrictions to workers’ compensation specialist