Workers’ Compensation Frequently Asked Questions and Answers  


WHAT IS THE EXCHANGE WORKERS’ COMPENSATION PROGRAM?  

  • The Exchange Workers’ Compensation Program provides benefits for medical care and time lost from work due to an on-the job injury or illness. 


HOW IS THE PROGRAM STRUCTURED? 

  • The Exchange is self-insured for Workers’ Compensation coverage.  This means the Exchange pays all expenses, dollar-for-dollar, and there is no insurance company. 

  • We have a third-party claims administrator – Contract Claims Services Inc. (CCSI) 

  • State workers’ compensation laws do not apply 

  • Coverage is under the Non-Appropriated Fund Instrumentality Act – Longshore & Harbor Workers’ Compensation Act – Federal laws 

  • US Government employee workers’ compensation laws under the Federal Employees Compensation Act (FECA) do not apply 

  • The US Department of Labor is responsible for claim oversight 

 

WHO HANDLES WORKERS’ COMPENSATION CLAIMS UNDER THE PROGRAM? 

  • The Human Resources Support Center Workers’ Compensation (HRSWC) team reviews all accident reports and initiates all initial paperwork following the guidelines under the laws. 

  • Contract Claims Services Inc. (CCSI) is our contracted third-party claims administrator and handles all aspects of the claim.  CCSI claim adjusters make the actual determination as to whether any claim should be paid.  All payments for medical care and time loss are made by CCSI. 

  • All medical information must be forwarded to CCSI for review/payment 

  • Contact Information: HRSCWC – 214-312-6190 hrscwc@aafes.com  or CCSI (800) 743-2231 

 

WHAT DOES AN ASSOCIATE DO IF INJURED ON THE JOB OR DEVELOPS AN ILLNESS RELATED TO WORK? 

  • Immediately report the injury to a supervisor or manager on duty 

  • If emergency medical attention is required, the supervisor or manager on duty should make the necessary arrangements 

  • If medical attention is required, but is not of an emergency nature, contact the HRSCWC to obtain the necessary paperwork for the initial visit 

  • If unable to immediately make contact with the HRSCWC, do so as soon as possible.  Be prepared to provide the name and contact info for the medical facility/doctor that provided initial treatment. 

  • The supervisor or manager on duty must complete an accident report (AR) 

 

WHAT ARE THE NEXT STEPS? 

  • The HRSCWC team will review the accident report 


  • The information will be verified with the associate, supervisor, and/or manager. It is critical there is a prompt response to this verification. 


  • If it is determined that a claim needs to be filed, the HRSCWC team will send a packet of paperwork to the associate that must be completed in a timely manner. 


  • Once the claim is filed, the CCSI claims adjuster will review the information to determine whether the claim should be paid.  The claims adjuster may reach out to the associate, supervisor, or manager for additional information. 


  • All time lost from work and any medical information received must be reported to CCSI. 

 

WILL AN ASSOCIATE GET PAID IF OFF WORK DUE TO AN INJURY OR WORK-RELATED ILLNESS? 

  • Reasonable time away from work on the date of injury is considered administrative leave.  Reasonable time is determined by the medical provider’s visit notes regarding a return to work. 


  • Compensation for the first three daysor work shifts, of time lost from work following the date of injury is not paid unless the lost time exceeds 14 days. Sick leave, then vacation leave, is authorized for the time away from work if the associate wants to use leave. If the lost time continues for more than 14 daysthe claims adjuster will pay compensation for the first three daysThis period includes weekends and scheduled days off. 

  • If the Exchange has paid full sick or vacation leave benefits for any period of time and the associate also received WC benefits, the associate MUST buy-back a portion of this leave timeThe HRSCWC team will calculate the leave buy-back and advise how payment should be made. 

 

THE CLAIM (LOST TIME-MEDICAL BENEFITS) IS NOT BEING PAID 

  • Contract Claims Services Inc. (CCSI) handles all payments for workers’ compensation claims. 

  • Contact CCSI directly and speak with the claims adjuster handling the claim. 

 

WHAT BENEFITS ARE PAID 

  • Once the injury/illness is accepted, payments are made for: 

  • Lost time from work due to the injury/illness 

  • Paid at 2/3rds of the associate’s average weekly wage for the year prior 

  • Paid bi-weekly by the claims administrator 

  • The first 3 days of lost time are not paid unless time loss is greater than 14 calendar days  

  • Medical care 

  • Emergency care 

  • Continued medical care 

  • Therapy and other related medical care approved by the claims adjuster. 

  • All questions regarding payments should be directed to the CCSI claims adjuster. 

 

HOW ARE INSURANCE BENEFITS/PREMIUMS PAID IF OFF WORK DUE TO AN INJURY? 

  • If the associate chooses to use leave benefits, the amount of the insurance premiums may be covered. If not, or the associate chooses not to use leave, it is the associate’s responsibility to make the necessary insurance premium payments in a timely fashion to continue coverage.  

  • Benefits will be terminated if more than 2 pay periods (4 weeks) of premiums are not paid. 

  • The Exchange does not pay the employee portion for any benefits while out on workers’ compensation 

 

MAY I CHOOSE MY OWN DOCTOR? 

  • Associate has the right to select his/her choice of physician  

  • Must complete a choice of physician form as part of the WC packet provided by the HRSCWC team 

  • Cannot change physicians without a valid referral from the choice of physician or without prior approval of the claims adjuster (CCSI) 

  • Emergency treatment immediately following an accident does not constitute choice of physician 

 

DOES AN ASSOCIATE HAVE TO USE LEAVE? 

  • If associate loses time on the DATE OF INJURY, this will be administrative leave 

  • Associate may choose to use a portion of his/her leave to supplement the workers’ compensation benefit 

  • Review the BENEFITS MEMORANDUM provided in the WC packet.  Make election on that document 

  • The first 3 days of lost time will be leave or leave without pay based upon the election 

  • If associate does not elect to use leave, the associate will be placed in a LEAVE WITHOUT PAY STATUS  

  • If associate elects to use leave, associate will receive approximately 1/3rd of the normal work hours in leave benefits. This is based on the associate’s average weekly wage and compensation rate as determined by CCSI, so it may not be exactly 1/3rd. 

  • Usually this is enough to cover bi-weekly benefit costs 

  • Sick leave will be used first and then annual leave, until all leave is exhausted.  At that point associate will be placed in a LEAVE WITHOUT PAY STATUS 

  • If paid benefits through CCSI for any days also paid full leave benefits, a leave buy-back MUST be processed  

 

WHAT IS A LEAVE BUY-BACK? 

  • Leave buy-backs MUST be accomplished for any period that is double-compensated (full leave used AND paid through workers’ compensation) . The HRSC WC Tech will prepare the leave buy-back and provide the information to the associate's supervisor and local HR.


The most common occurrence is the first 3 days of lost time as this is originally charged as leave, but will be paid through workers’ compensation if more than 14 calendar days of lost time occurs .


LEAVE WITHOUT PAY 

An associate is placed in a leave without pay (LWOP) status when: 


Sick/annual leave is exhausted if associate elected to use leave 


Immediately if associate elected not to use leave 


Associate is responsible for making all bi-weekly benefits payments while out on LWOP 

A Notice of Entitlements form will be sent that outlines the benefits payments to make and how to make those payments 


Service award base date and retirement base date will be adjusted by any time in a LWOP status 


When an associate returns to work, s/he may request prior service credit for retirement by completing the REQUEST FOR PRIOR SERVICE CREDIT form under RETIREMENT PLANNING in Employee Self-Service 


Associate will be separated from employment at the end of one year of LWOP 

 

DOES THE ASSOCIATE NEED TO CONTACT MANAGED DISABILITY? 

Yes –if the associate is in a RFT or RPT position, the associate must contact managed disability if out more than 5 calendar days CONTACT: US 800-644-2386, OVERSEAS Collect 813-775-0093 


See What is Managed Disability and Does it Apply to Me.


While short or long-term disability payments may not be made during any period that workers’ compensation benefits are paid, eligibility for these benefits will still be determined 


Failure to call managed disability could result in the loss of those benefits 


WHEN CAN ASSOCIATE RETURN TO WORK? 

  • Full Duty 

  • Obtain a full-duty release and provide to the CCSI claims adjuster 

  • Take a copy of the release to the local HRO so a determination can be made regarding the return to work and reporting date/time 

  • If associate has not been out more than 180 days of combined leave and LWOP time or 90 days of LWOP time (AFGE contract specified 180 days period), then the associate will be returned to the former position as soon as s/he can be placed on the schedule 

  • If associate has been out more than 180 days of combined leave and LWOP time or 90 days of LWOP time, the local HRO will determine what position(s), if any, are available. 

  • Restricted/Light Duty 

  • Obtain a restricted/light duty release outlining specific work restrictions and provide to the CCSI claims adjuster 

  • Take a copy of the release to the local HRO so a determination can be made regarding the return to work and reporting date/time 

  • The facility will make every effort to accommodate restricted duty, however, this depends upon the work restrictions and skills 

  • Associate must be able to complete the essential functions of the position 

  • Associate may be temporarily transferred to another position that can better accommodate the restrictions 

  • Associate’s schedule may be modified 

  • If the restrictions are permanent, the facility will evaluate if the restrictions can be accommodated based on the severity of the restrictions and the essential duties of the position.   

  • If the local Exchange is not able to accommodate restrictions, contact the claims adjuster immediately 

 

WHAT IS THE LS-202? 

  • The LS-202 is a Department of Labor form  

  • This is the EMPLOYER’S first report of injury 

  • This form is completed by the HR Support Center WC (HRSCWC) team if an associate seeks medical attention or loses more than one shift from work 

 

WHAT IS THE LS-203? 

  • The LS-203 is a Department of Labor form 

  • This is the EMPLOYEE’s first report of injury 

  • When a claim is filed with the Department of Labor, they will send the LS-203 form to the associate 

  • The associate may choose to complete the form and return it to the Department of Labor 

  • Completing the form secures the claim status with the Department of Labor – essentially the associate is formally making a claim for benefits against the Employer. 

 

WHAT IS THE LS-1? 

  • This is the first authorization for medical care as a result of an injury 

  • The form is completed by the HRSCWC team. 

  • This is provided to the treating physician for the FIRST medical appointment – not the first one with a new provider, the very FIRST medical appointment 

  • Only 1 LS-1 can be provided per injury 

  • If the associate has already sought medical care, an LS-204 will be issued instead of an LS-1. 

 

WHAT IS THE LS-204? 

  • The LS-204 is a mechanism for a medical provider to provide information about an associate’s medical condition and treatment. 

  • The LS-204 can be used for any medical treatment provided following the initial medical care 

  • This form may be used in lieu of the LS-1 in certain cases: 

  • The associate has already received medical care prior to reporting the injury 

  • There is a gap in the time the injury was reported and the associate sought initial medical care 

  • There is no obvious direct relation between the injury/illness reported by the associate and the workplace as indicated by the facts