Workers' Compensation FAQ's for Employees
What do I do if I get injured?
If you are injured on the job, immediately inform your supervisor. Here are four important facts for you to keep in mind:
- If your injury is beyond first aid, your supervisor will provide you with a "Workers' Compensation Claim Form (DWC-1) & Notice of Potential Treatment" form within one working day of notifying them of the injury/illness.
- If your injury requires a medical evaluation, your supervisor will provide you with an “Incident Report & Referral for Medical Treatment” to the Occupational Health Facility (OHF) at 67-120 Center for Health Sciences at 10833 Le Conte Avenue. OHF operates Monday through Friday from 7:30 a.m. to 4:30 p.m.
- If your injury occurs outside of these hours, or you require urgent immediate medical attention, you may receive treatment 24 hours a day at the Emergency Medicine Center, located at 757 Westwood Plaza (ER entrance Gayley Ave, north of Le Conte).
- If your injury occurs off campus and it requires acute attention, please seek treatment at the nearest emergency care facility. If your injury is not of an urgent nature, please call your supervisor, who will obtain a referral for you to see a University-approved physician nearby.
What is the purpose of Workers' Compensation?
The purpose of Workers' Compensation is to provide certain benefits to workers who are injured at work or who develop a job-related illness as a result of their employment. Benefits pay medical bills and a portion of lost wages. All job-related injuries and illnesses sustained by UCLA employees are covered by the University's Workers' Compensation self-insurance program.
Who administers and pays for Workers' Compensation Claims?
When you report an injury, the Workers' Compensation office uses documents such as your claim form, doctor's report or the OHF referral slip to generate an "Employer's Report of Occupational Injury or Illness." This report is forwarded to Sedgwick, CMS, the administrators of the University of California's self-insurance program and assigned to a claims administrator. The claim administrator may discuss your claim with you, investigate your injury/illness and determine what Workers' Compensation benefits you are entitled to receive. Although Sedgwick, CMS administers the claims and issues Temporary Total Disability checks for disability and medical payments, the funding for Workers' Compensation payments is provided by the University of California.
The University is self-insured, which means we do not pay premiums to an insurance company. Medical Center and Campus cost centers are assessed premiums, which are paid into a trust fund set up exclusively for paying Workers' Compensation benefits.
May I use my own doctor for a Workers' Compensation Injury/Illness?
If you sustain an industrial injury/illness, medical care will be arranged for you for the entire course of your treatment. If you wish to be treated by our own doctor within the first 30 days of an injury/illness, you must have on file with your department a written "Designation of Treating Physician" form prior to any illness or injury occurring. This form is found on the last page of The new employee pamphlet.
Your doctor must agree to provide treatment, reporting and billing per the guidelines of CA. Workers' Compensation. This form must be completed prior to any injury/illness and kept on file in your department.
What types of benefits does Workers' Compensation provide?
"Benefit" is the term given to all payments and services provided to you by Workers' Compensation. Here are the key benefits:
- Medical Coverage: Workers' Compensation will pay all approved medical, hospital and prescription bills arising from the industrial injury/illness.
- Temporary Disability: If the treating physician determines that you are temporarily unable to work, you will be eligible for temporary disability. These disability payments are issued every two weeks and represent 2/3 of your gross wage, up to the current statutory maximum amount.
- Eligibility for temporary disability starts with the fourth calendar day you are unable to work. The three-day waiting period is waived if you are hospitalized or disabled for more than 14 days, in which case your eligibility begins the next day after you were injured or became ill.
- While you are temporarily unable to work, you should check in regularly with your supervisor and provide them with disability status updates, as a courtesy to your department. This is in addition to regular contact with your Sedgwick, CMS claims administrator.
If the treating physician determines that the industrial injury resulted in permanent disability that causes a significant handicap in performing work, the injured worker is entitled to a permanent disability rating. In rating Permanent Disability, consideration is given to the nature of the injury, occupation, age at the time of injury and diminished ability to compete in an open labor market. The percent of disability is determined in accordance with a schedule adopted by the Administrative Director of the State of California, Division of Workers' Compensation.
Supplemental Job Displacement Benefits For Injuries on or after January 1, 2004, if the injury causes permanent disability and the injured employee does not return to work for the employer within 60 days of the termination of Temporary Disability, the injured employee is eligible for a supplemental job displacement benefit in the form of a nontransferable voucher for education-related retraining or skill enhancement, or both, at state–approved or accredited schools. The voucher must be used for tuition. The amount of the voucher is determined by the amount of rated Permanent Disability.
How do I coordinate Workers' Compensation benefits with disability benefits?
- Extended Sick Leave Benefit: Once your claim is received, the Benefits Coordinator from Workers' Compensation Office (Office of Insurance & Risk Management for campus employees or Medical Center Workers' Compensation Office for Medical Enterprise employees) will contact you information on the different options for supplementing your temporary disability (TD) benefits with the use of sick leave and vacation. For example, to maintain 100% of your base salary, you may elect to use earned sick leave and/or vacation to supplement the TD payments from Sedgwick CMS (which are 2/3 of your base wages up to an established maximum). If all leave accrual is exhausted, the University will supplement your TD payments to maintain your salary at 80% of your base. This Extended Sick Leave benefit may not exceed 26 weeks for any injury or illness.
- Employee-Paid Disability
Once the 80% Extended Sick Leave Benefit has been exhausted, and if you are still unable to work and are enrolled in Employee Paid Disability (EPD), you may supplement your TD payments with up to 70% of your base salary through the EPD program. The EPD payments are sent by Liberty Mutual.
Do I need a note from my doctor when I return to work?
Once the treating physician has released you to return to work, you must present appropriate medical documentation to your department. The treating physician must either clear you to perform all the regular duties of your position, or list all work restrictions such as maximum lifting capacity.
What happens if I can't perform all my regular job duties?
If the treating physician determines that you can't return to your usual job. You and your department must contact the Employee Disability Manager, at the Insurance & Risk Management Office. You may qualify for Supplemental Job Displacement benefit.
Where do I call if I have any questions regarding Workers' Compensation?
- If you have questions concerning your Workers' Compensation claim, please call Sedgwick, CMS.
- If you have questions regarding supplemental disability benefits, please contact the Workers' Compensation Claims Coordinator in Insurance & Risk Management.
- Contact the Workers' Compensation Manager, at Insurance and Risk Management.