Note: This form must be completed in its entirety by management and submitted to the State Self Insurance Fund (SSIF) within 24 hours of the supervisor’s awareness of the injury.
Prior authorization is not required for emergency treatment but the supervisor should inform the SSIF as soon as possible at 785‐296‐2364.
The State Self Insurance Fund is legally entitled to choose the treating physician. If an employee self‐selects a doctor and does not have prior authorization for treatment from the 24/7 Nurse Triage line, the SSIF will only be responsible for the first $500 in unauthorized medical bills from the self‐selected physician (s) once the injury has been found compensable.
It’s a good practice to receive prior authorization by calling the 24/7 Nurse Triage line at 1-833-756-2007 before sending the employee to the doctor in non‐emergency situations to assist in determining compensability.
Please note that all phoned in reports must be followed‐up with a completed electronic Employer’s Report of Injury within 24 hours. The State Self Insurance Fund does not guarantee that any doctor visit will be covered until compensability is determined.
The State Self Insurance Fund utilizes the CompAlliance provider network for workers compensation medical care. This vast network of doctors provides great opportunities in treating injured state workers.
The Elixir program is designed to help the injured worker in the following ways:
Compensability is determined from the electronic Employer’s Report of Injury and/or a phone call with the agency management reporting the facts of the injury. The SSIF claim representatives utilize the Kansas Laws and Regulations to determine compensability of a claim.
Please reference this list of network pharmacies.
The employee will need to pay for the visit or submit the bill to their medical insurance provider. The employee will receive a denial letter from the SSIF that can be sent to the medical insurance provider and/or their personal health insurance.
You will be entitled to mileage when you drive to your authorized provider’s office if the distance is more than 5 miles roundtrip. A Mileage Form is available for your use in keeping track of your miles and may be submitted periodically, usually monthly, as you drive.
Your provider may prescribe certain drugs or other items during the course of your treatment. Please refer to question 7 above as to where you may have your prescriptions filled. We usually will not pay for over the counter items, aspirin, band aids, etc. Your claim representative will assist you with such purchases if you have a problem.
NOTE: Please do not purchase or rent any other items such as electrical stimulators or other hardware until you check with your claim representative.
You may be compensated at the rate of 2/3 of your gross average weekly wage, subject to a weekly maximum, if a physician restricts you from all work or if your employer can not accommodate physician directed restrictions. This compensation is termed Temporary Totally Disabled or "TTD". In general, you are not eligible for weekly compensation for the first 7 days unless you are totally disabled from work 21 consecutive days. The SSIF will issue you a separate check in the same time frame (biweekly) as State employees receive regular pay. Your agency will be advised of the SSIF paid compensation and will make necessary adjustments to your time and leave balances. If you receive SSIF compensation, please check with your personnel officer about sick leave, vacation leave or FMLA considerations.
Workers compensation wage loss payments are not subject to State or Federal income tax.
No, however, most employees do supplement "TTD" with leave to make up for any shortage in their pay since TTD is 2/3 to a certain level. See your agency personnel office for more details or call your claim representative.
Shared leave is not intended to cover employees who are receiving workers compensation. (K.A.R. 1‐9‐23).
Your supervisor, agency and claim representative will begin the process of getting you back to work as soon as possible. The treating physician will determine if you have physical restrictions. You, your supervisor and claim representative can then review any restrictions to decide if you can return to duty. This could be in the form of accommodated duty or shortened hours so long as they do not exceed physical restrictions. If the agency can accommodate restrictions, you will be expected to return to work. As your restrictions are adjusted, your accommodations will be evaluated until you are back to regular duty.
Your primary assistance is the claim representative (or adjuster) at 785‐296‐2364. Located in Topeka, the claim representative will advise you and will see that you receive the necessary information and compensation. Another source is in the Division of Worker’s Compensation in Topeka which has claim advisors who can provide you with consultation on a toll free number, 1‐800‐332‐0353. Also, mediation or a hearing before an administrative law judge in the county where the accident occurred is available. Your claim representative or advisor can explain the administrative hearing process to you.
Correct the situation if it is within your scope of responsibility or decision making. Otherwise, report it to your supervisor. Your agency may also contact the Division of Labor at 1‐800‐332‐0353 for workplace hazard prevention services and consultation.
The SSIF occasionally receives reports that someone who is off work on workers compensation is working another job or participating in activities that would indicate the person could be working. Please report these with as much specific detail as possible to the SSIF at 785‐296‐2364.
You may get suggestions from co‐workers, friends and others to get representation. Initially, your best source of information about how claims are administered and how they are "settled" comes from your claims representative. You could also call the Division of Workers Compensation’s toll free 1‐800‐332‐0353 or local Topeka number (296‐2996) and speak with an advisor. We suggest you try to resolve any situation through this process before considering representation.
Please contact the State Self Insurance Fund at 785‐296‐2364 if you have any other questions.