Workers' Compensation Information

The North Carolina State Government Workers' Compensation Program was established in 1985 with the purpose of ensuring that all eligible employees who experience a work related injury or illness receive appropriate medical care and equitable benefits as provided under the North Carolina Workers' Compensation Act and the State Human Resources Policy. The Program covers all North Carolina State Government employees.

Employee Information

Workers' Compensation Employee Responsibilities

  • You are required to report all accidents and injuries to your supervisor immediately. If your supervisor is not available, contact the Workers’ Compensation Administrator ("WCA"), Ms. Abigail Troxell, at(910) 672-1451 or Ms. Ronnean Collins at (910) 672-1825.
  • If medically necessary, you will be taken, or sent, to the medical network provider listed below after obtaining a medical authorization form from the WCA.
  • Med One Care 413 Owen Drive Suite 202Fayetteville NC 28304
  • If possible, you will be given a medical authorization form to give to the medical provider to ensure that the bill for the treatment will go to CorVel, the workers’ compensation third party administrator, for payment.
  • As soon as possible, you are required to complete the Employee Statement and Leave Option Form. The completed form must be given to your supervisor, or the WCA, as soon as possible after the accident or report of illness.
  • If you are contacted by the CorVel Adjuster in the claim investigation or administration process, you must provide all required information in order to expedite claim processing.
  • Any absences from work related to the injury must be authorized with a statement from the treating physician. You must provide any such documentation given to you by the physician to the WCA as soon as possible.
  • You are required to provide a doctor’s note to the WCA stating any medical restrictions placed on you as a result of the injury.
  • You must adhere to any transitional duty(s) assigned to you as part of the FSU Return to Work Program.

CONTACTS:

Abigail Troxell, WCA (910) 671-1451
Ronnean Collins, WCA(910) 672- 1825
Cindia Wetherwax, Environmental Health and Safety Administrator (910) 672-1827
Melvin Lewis, Director of Emergency Management and EHS(910) 672-1456

Workers' Compensation Employee Responsibilities

Employee Forms

  • Workers' Compensation Employee Statement of Injury Form
  • Workers' Compensation Employee Leave Options Form
  • Witness Statement Form
  • Employee Release of Information- Medical and Claim Records
  • Employee Release of Information- Personnel Records
  • Workers' Compensation Refusal of Treatment

Supervisor Information

Worker's Compensation Supervisor Checklist

  • Immediately notify The University's workers compensation administrator ("WCA") of any possible "work-related" incident, injury, or condition(s).
  • In case of an emergency, or "after hours" incidents, notify The University's campus police department at (910) 672-1911, or (910) 672-1341
  • Obtain a "treatment authorization form", and ensure that the employee goes to the authorized medical provider. In the event of an emergency, send the employee to the nearest medical facility. A list of authorized facilities can be found in the "Workers Compensation" section of the Human Resources webpage.
  • Complete the "Supervisor Incident Investigation Report" within 24 hours, and submit it to The University's WCA.
  • Provide employee with the "Employee Statement and Leave Form", and ensure that it gets completed and submitted to The University's WCA within 24 hours. *Exceptions might be made in cases of emergencies, incidents occurring during the weekendsor, "after hours", and/or when the employee remains out of work due to the incident, injury, or condition.
  • Partner with the Environmental Health & Safety Office to investigate the incident.
  • Immediately notify The University's WCA of any changes in the employee's medical status, or any absences due to the incident, injury, or condition.
  • If necessary, identify modified duty and collaborate with The University's WCA to provide a reasonable accommodation.
  • Maintain periodic contact with employee, and with The University's WCA for an effective and efficient management of the case.
  • CONTACTS: Abigail Troxell, Benefits Specialist/WCA
  • (910) 672-1451Ronnean D. Collins, Benefits Manager
  • (910) 672-1825 Cindia Wetherwax, Environmental Health & Safety Professional
  • (910) 672-1827 Melvin Lewis, Director of Emergency Management & EHS, (910) 672-1456

Workers' Compensation Supervisor Checklist

Supervisor Forms

  • Workers' Compensation Supervisor's Accident/Incident Investigation Report Form 

Resources