Workers' Compensation

Has a UCOP employee been injured on the job?
What to do: Injured employee
What to do: Injured employee's supervisor

Program overview

California's compensation law, passed by the state Legislature more than 85 years ago, guarantees prompt, automatic benefits to workers injured on the job.

Sedgwick CMS is our Workers' Compensation Administrator. They will provide any medical or compensation benefits an injured worker is entitled to receive. If you have any questions, contact Sedgwick CMS or local Human Resources. (View addresses and phone numbers).

If you can't work because of an industrial injury, workers' compensation pays your medical bills and provides compensation to help replace your lost income until you can return to work. Benefits guaranteed under workers' compensation are:

Medical care to cure or relieve the effects of the industrial injury.
Compensation payments to help replace lost wages.
Permanent disability to compensate for diminished earning capacity.
Death benefits to be made to surviving dependents.
Disability management services to help in returning to work.

It's a no-fault system with benefits paid — no matter who is at fault.

The term "industrial injury" is used to describe any injury, illness, or disease which results from work or working conditions, and which occurs during the employee's service to the employer. Even first-aid type injuries are covered.

However, benefits may not be provided for injuries occurring during voluntary participation in any off-duty recreational, social, or athletic activity, not part of any employee's work related duty.

Obtaining benefits

You must report your injury to your supervisor or employer immediately. You will be given an Incident Report form. If your injury is beyond "First-Aid" or it results in lost wages beyond the date of injury then you will be given an Employee's Claim for Workers' Compensation benefits form (DWC-1) by the Occupational Health Facility. ("First aid" means any one-time treatment of minor scratches, cuts, burns, splinters or other minor work injury.) If you are being treated by a Pre-designated Physician, then you must contact Disability Management Services for a copy of the Employee Claim form (DWC-1).

The claim form will ask what, where, when and how the injury happened. The key to insuring your rights is prompt reporting of the injury. Your Department or Accommodation and Leave Services, along with Sedgwick CMS, will see that you get medical help right away, and make sure the necessary reports are filed.

Remember, prompt reporting is the key. Benefits are automatic, but nothing can happen until your employer knows about the injury, no matter how slight.

Medical care

Good medical care is important — and quality medical treatment is the quickest way to recovery.

Benefits include not only payment of doctor's bills, but also prescriptions, hospital costs, fees for lab tests, x-rays and even travel expenses. There is no deductible, so you should never see a bill.

If you become injured at work, GET MEDICAL CARE IMMEDIATELY. UCOP has Occupational Health Facilities to provide you with emergency medical treatment and follow-up care. If you have a special medical problem, you may be referred to a local medical specialist, who has expert knowledge of your specific injury. In addition, the doctor will be familiar with workers' compensation requirements and will report promptly so your benefits are not delayed.

If you want to change doctors for any reason, ask the Local Human Resources department or contact Sedgwick CMS who will provide you with a choice of other doctors.

You're entitled to be treated by your own personal physician if you've notified the University of the doctor's name and address in writing before the injury. (Your personal physician is one who has treated you in the past and maintains your medical records). Contact Accommodation and Leave Services for details on pre-injury physician designation.

If you haven't pre-designated a physician prior to the injury, you can switch to your own doctor after the employer's medical control expires. This can range from 30 days to up to a year after reporting the injury, so check with Sedgwick CMS. You should report your choice as soon as you make it so that your bills can be properly considered for payment.

Above all, don't treat yourself. Even minor injuries need expert care. Prompt, quality medical treatment is the best investment you and your employer can make.

There is a limit on some medical services for injuries occurring on or after January 1, 2004.

Replacing lost wages

Temporary disability benefits are paid to you if your physician certifies that your illness or injury causes you to lose time from work and suffer a loss of wages.

These benefits are not paid the first three days you're unable to work unless you're hospitalized as an in-patient or are unable to work for more than 14 days. In these instances, even the three-day "waiting period" will be paid.

Temporary disability payments are generally two-thirds of your actual wages subject to a minimum and maximum set by the state Legislature. The payments are tax-free and there are no deductions.

Your first check should be mailed within 14 days of disability. These payments will be sent every two weeks until the doctor releases you to return to work.

The University may have supplemental benefits available to you contingent upon receipt of temporary disability benefits. You should contact Local Human Resources for additional information.

In an effort to facilitate your recovery and return you to full duties, your doctor may return you to a part-time work schedule. In that case, partial temporary disability or "wage loss" benefits may be due subject to the same minimum and maximum limits.

Your doctor may also return you to work with restrictions. Take any written instructions from your doctor to your department so that you can assure the modified work meets the doctor's specifications. Sedgwick CMS and Accommodation and Leave Services will work closely with the doctor and supervisor to accommodate any restrictions.

Permanent Disability

After you recover to the fullest extent possible, the doctor who treated you will evaluate any permanent or lasting effects of your injury. You and your employer may agree to rely on the treating doctor's report to establish if there are any permanent disability benefits due. If you have questions about the report, you may contact the Information and Assistance Officer. If you don't agree with the report and are not represented by an attorney, you must choose an evaluating doctor from a panel list of three independent doctors provided by the state. If you are represented by an attorney, and you don't agree with the treating doctor's report, the attorney will arrange the medical evaluation.

Your permanent disability benefits will be based on the results of the doctor's evaluation and such factors as your age and pre-injury occupation. The weekly benefit is two-thirds of your income subject to minimums and maximums set by the state Legislature. The limits vary according to the date of injury and level of disability. If you have any permanent disability, the benefits calculation will be fully explained in a letter.

Death

Death benefit payments to survivors are set by state law according to the number of dependents. Payments are made at the same rate as temporary disability benefits. A burial allowance is also provided.

Workers' compensation payments are tax free. There are no deductions for state or federal taxes, Social Security, union or retirement contributions, etc.

Supplemental Job Displacement Benefit (SJDB)

If you do not return to work within 60 days after your temporary disability ends, and your employer does not offer modified or alternative work, you may qualify for a nontransferable voucher payable to a school for retraining and/or skill enhancement.

If you qualify, the claims administrator will pay the costs up to the maximum set by state law based on your percentage of permanent disability. SJDB is a benefit for injuries occurring on or after 1/1/04.

Dispute resolution

If you have additional questions regarding your workers' compensation benefits, contact Sedgwick CMS or Accommodation and Leave Services. If you still aren't satisfied, you may phone the nearest office of the state Information and Assistance Officer. They will inform you of your rights and, if necessary, will provide you with a full review of your claim for compensation. The information and assistance service is free. For the nearest office check the State Government Offices section of the phone book under "Industrial Relations Department" or call 1-800-736-7401. Some issues may need to be resolved by the Workers' Compensation Appeals Board, the state agency responsible for handling disputes. The Appeals Board is a court of law. You can represent yourself or you may want to hire a lawyer. If you hire an attorney, the fee will be deducted from any benefits awarded by the Appeals Board.

If it is necessary to go to the Appeals Board to resolve your claim, be sure to do it within one year from the date of injury, or one year from the date of your last medical treatment. Waiting longer could mean losing your rights to benefits.

California law prohibits discrimination against employees who file, intend to file, or settle a workers' compensation claim, or because they testify for a co-worker who was injured. The California Fair Employment and Housing Act prohibits discrimination or harassment based on a person's physical or mental disability. The federal Americans with Disabilities Act (ADA) prohibits discrimination against "qualified individuals with disabilities." Additional information on the ADA and the FEHA is available at the Information and Assistance Office.

Other benefits

In addition to workers' compensation benefits, you may be eligible for Social Security benefits. For information, contact the nearest office of the Social Security Administration. You can locate the number in the phone book under "United States Government Offices."

Workers' compensation sometimes is confused with another state program, State Disability Insurance (SDI). They seem similar, but there are important differences. Workers' compensation takes care of on-the-job injuries and illnesses, and is paid for by your employer. SDI covers off-the-job injuries or sicknesses and is paid for by employees. University of California employees are not eligible for SDI. SDI would only be applicable in the first eighteen months of your UC employment and would be based on your previous employment. However, if you have a second job not connected with the University, you may also be covered under SDI.

The University provides a Short-Term Disability insurance plan (Std) to eligible employees for non-industrial disabilities (Disability/Pregnancy Disability). The University also makes available a Supplemental Disability insurance plan (SD) which supplements both Std and Workers' Compensation benefits for temporary and long-term total disability. In the event your workers' compensation disability benefits are postponed for information gathering or medial clarification, you may be eligible for one of these programs during the period of delay. This period should not exceed 90 days.

Salary continuation for industrial disability and Extended Sick Leave benefits may be available to you. If you need assistance with your University benefits and related procedures, contact Local Human Resources.