These are the required forms to use when reporting and managing workers' compensation claims in Nebraska. If you have specific questions about any of these forms or resources, contact your SFM claims representative.
Employee's choice or change of doctor form
You are required by Nebraska state law to have your injured employees complete this form at the time of injury. Send the completed form to SFM along with the First Report of Injury. It is also available in Spanish.
Temporary prescription information sheet and cards
This prescription card allows employees to fill their initial work-related injury prescription without any out-of-pocket expense. Give it to your employee when he or she becomes injured and plans to see a doctor. A longer-term prescription card is mailed to the employee once SFM has received the First Report of Injury.
An employee in Nebraska who has sustained a work-related injury has the right to choose his treating physician only when there is a documented treatment history between the employee or an immediate family member and the specified physician. If the employee does not have or does not choose such a physician, then you, the employer, may select the physician except in special circumstances where major surgery is to be performed or if the injury involves dismemberment.
Additionally, Nebraska employers must notify an injured employee of his right to choose a treating physician at the time of injury. If you fail to do this, the employee can seek medical treatment with any physician. Use the Nebraska "Employee choice or change of doctor" form to satisfy the statutory employee notice requirements. Have the employee sign and date the form and send a copy to SFM.
In emergency medical treatment situations, the rules regarding choice and change of doctors don't apply until after the emergency is resolved.
State laws allow employers to have access to injured employees' medical records so they can see work restrictions ordered by physicians, which are usually documented on a Report of Work Ability form.
It's good to clarify work restrictions and transitional job tasks with the physician, but remember to document everything and keep the employee informed.
Other rules for handling confidential medical records:
By law, you cannot combine medical records with the employee's personnel file. Keep a separate medical file.
Never give medical information to a third party without the employee's written consent.
Don't use medical information as grounds to fire or discriminate against an employee. Doing so violates several federal and state laws.
HIPAA's effect on workers' compensation
For the most part, Health Insurance Portability and Accountability Act (HIPAA) privacy rules do not apply to workers' compensation claims. Some provisions apply, but only to the workers' compensation insurance company or the self-insured employer, not the general employer.
The general guideline for employers on handling workers' compensation is that you have a right to discuss an injured employee's progress and existing medical history with the physician, as it relates to the injury.
Medical providers may be unclear about the HIPAA law as it applies to work comp and may be reluctant to give you information. If you're having trouble getting information from a provider, call your SFM claims representative at (800) 937-1181.
Insurance fraud may come in many different forms, including an injured employee who intentionally misrepresents information or hides the truth with the intent to receive money or other benefits from an insurance company.
Even if you suspect fraud, you must still report the injury to SFM. Your SFM claims representative will investigate the claim and determine whether the evidence falls under the state's legal definition of fraud.
If you suspect a claim is fraudulent, contact your SFM claims representative or SFM's Special Investigations Unit at 800-937-1181, ext. 4288.
If the injured employee is missing time from work—either directly following the injury or any time during the course of recuperating from the injury—it is essential that you notify your SFM claims representative. Unless you tell SFM that an injured employee is missing work, the employee won't receive the workers' compensation wage-replacement benefits he or she is entitled to by law. That may trigger state penalties or prompt the employee to contact an attorney.
If the employee loses time from work after you've already submitted the First Report to SFM, call your claims representative immediately at (800) 937-1181 to let him or her know when the employee first began losing time from work. Your organization may be assessed a state penalty if you do not notify your SFM claims representative immediately after you have knowledge that the employee will miss time from work due to the injury.
State law requires a specific number of days to pass before an injured employee is eligible to receive workers' compensation wage-loss benefits. Additionally, most states require a specific number of days that the employee is off work before wage-loss benefits are retroactively paid from the beginning of the waiting period. The number of days in the so-called "waiting period" and the retroactive period varies by state. Each state also specifies which days count and what constitutes a day.
Employees who have been injured at work in Nebraska must wait seven days following an injury where they're losing time from work to be eligible to receive wage-loss benefits. Once an injured employee has passed six weeks off work because of the injury, he or she is entitled to be retroactively paid wage-loss benefits starting from the first day of the waiting period.
If the employee is injured at work and misses, say, 10 days of work, SFM would pay the employee wage-loss benefits for the 8th through the 10th days off work due to the injury. SFM would not pay wage-loss benefits for the waiting period since the employee did not hit the retroactive period.
A "day" is defined by Nebraska workers' compensation statute to be the first full or partial calendar day an employee misses work because of the injury.