Supersedes: 01/01/2001 (200-20)
Issuance Date: 01/26/2016
Issuing Office: Environment, Health & Safety
I. IN CASE OF INJURY
A. If needed, employees should seek treatment at a UC San Diego Center for Occupational & Environmental Medicine Clinic, or a UC San Diego Health Systems Emergency Department; information is available on Blink at the “Report a work-related injury, Illness or hazardous material exposure” webpage.
B. The injured employee should report the incident to the Workers’ Compensation Office using the on-line form available on Blink at “Report a work-related injury, illness or hazardous material exposure.” Serious injuries must be reported immediately by telephone, after hours contact UC San Diego Police. If the injured employee is unable to report the injury to the Workers’ Compensation Office, the injured employee’s supervisor should report the injury for the employee.
Report an Injury: 1-877-682-7778, 858-534-2454, 858-534-4785 or 858-822-2979
Report a Serious Injury: 1-858-534-2454, after hours contact UC San Diego Police at 858-534-4357
The University's self-insured Workers' Compensation Program was established in accordance with the Workers' Compensation Laws of California. This Program provides benefits to employees who are injured as a result of work related activities. The benefits may include payment of a portion of the employee's salary and payment of all expenses for necessary medical care. The amount and type of benefits available vary depending upon the specifics of each situation.
(firstname.lastname@example.org, 858-534-2454, 858-534-4785 or 858-822-2979).
Risk Management is a division of Environment, Health & Safety. This office coordinates all Workers’ Compensation activities for campus-funded employees and volunteers. Please contact Risk Management to report work-related injuries and exposures and to obtain assistance regarding Workers’ Compensation policies and procedures.
EH&S is responsible for providing information and advice regarding safe work practices, observing and advising the establishment and maintenance of safe work places, and presenting accident prevention information on a continuing basis. Any incident which creates a hazard to personnel should be immediately reported to EH&S.
3. Sedgwick CMS
Sedgwick CMS is under contract with the University to manage all Workers’ Compensation claims. In this capacity Sedgwick CMS, acting on behalf of the University, determines the validity of each claim and the benefits due as a result of the work related injury.
All persons serving the University as employees or registered volunteers qualify for coverage. Students (other than student employees) and employees of outside agencies are not covered, even though the claimed injury may have occurred at UC San Diego. The validity of each claim and coverage is determined in accordance with California Law.
C. Claim Acceptance
The Workers’ Compensation Office and Sedgwick CMS will make reasonable efforts to ensure that all claims are quickly reviewed. The submission of an “Employee’s Occupational Incident Report” form does not imply that a claim will be automatically accepted. If there is a delay in a decision on a claim, other University benefits may be available. Contact the Campus Benefits Office for further information.
III. REPORTING PROCEDURES
A. Initial Injury
1. Any occurrence, which results in injury, illness, exposure or death arising out of or in the course of employment, should be reported to the Workers’ Compensation Office immediately by completing the form available on Blink at “Report a work-related injury, illness or hazardous material exposure.”
2. When required, the Workers’ Compensation Office will provide a claim form to the injured employee and will be responsible for completing the employer’s section of the form. The Workers’ Compensation Office will provide a copy of the injury report to the employee and the employee’s supervisor.
3. If needed, injured employees should seek medical treatment at a UC San Diego Center for Occupational & Environmental Medicine Clinic, or a UC San Diego Health Systems Emergency Department. Information is available on Blink at the “Report a work-related injury, illness or hazardous material exposure” webpage.
4. The injured employee should advise the supervisor of a work-related injury and keep the department updated with their current work restrictions.
5. If the injured employee is unable to report the injury to the Workers’ Compensation Office, the supervisor should report the injury for the employee.
B. Change in Status
Any change in the injured employee's status should be reported to the Workers’ Compensation Office immediately. A change in status would be a change in doctors or any lost time from work. Copies of any medical documentation received by the department should be forwarded to the Workers’ Compensation Office.
IV. PAYMENT OF BENEFITS
Upon acceptance of the claim, Sedgwick CMS will pay all medical expenses related to the injury and a portion of the employee’s lost wages. When there is time lost from work due to injury, the employee may supplement the Workers’ Compensation payments with accrued sick leave and vacation leave to receive 100% salary. When selected leave accruals are exhausted, the employee may then be eligible to receive extended sick leave. Extended sick leave, if available, is paid by the employee’s department and supplements the Workers’ Compensation payments to provide the employee with pay equal to 80% of normal salary.
B. Payment of Medical Bills
Usually the hospital or physician will bill Sedgwick CMS directly. However, if the injured employee receives a bill, it should be forwarded directly to the Workers’ Compensation Office at mail code 0925.
C. Payment of Temporary Disability
1. Any absence on the day of injury is Administrative Leave with Pay for the injured worker.
2. After the day of injury, eligibility for temporary disability begins on the fourth calendar day the employee cannot work as authorized by the employee’s treating doctor. Lost time from work on the three days before temporary disability begins may be covered by the employee’s sick leave, accrued vacation, compensatory time accruals, or extended sick leave. The three-day waiting period is waived if the injury results in immediate hospitalization or the employee is off work for more than fourteen days.
3. Temporary disability provides two-thirds of the employee’s normal salary up to a maximum amount established by the State of California. If the employee’s weekly salary is more than the amount paid by Workers’ Compensation, the remainder of the employee’s salary may be paid through the UC San Diego payroll system using the employee’s accrued sick leave. The Payroll Office will issue a full paycheck minus the amount already paid to the employee by Sedgwick CMS.
4. After sick leave has been exhausted, the injured employee may choose to supplement the Workers’ Compensation payments by using accrued vacation and/or comp time balances to receive 100% salary. The Workers’ Compensation Office will provide the employee with an opportunity to make this choice via a written notice that is filed with the Payroll Office.
D. Payment of Extended Sick Leave
1. When sick leave and other chosen accruals are exhausted, the injured employee may be eligible to receive extended sick leave for up to 26 weeks in accordance with the University of California Absence from Work Policy. If extended sick leave is available, funds from the employee’s department will be utilized to supplement the difference between the Workers’ Compensation payment and 80% of the employee’s actual salary.
2. An eligible employee who does not have sufficient accrued sick leave to cover any lost time on the three (3) calendar days before Workers’ Compensation payments begin shall receive extended sick leave payments to cover any part of the waiting period not covered by sick leave.
3. While on extended sick leave, vacation and sick leave hours will be accrued at 100% regular rate. However, the employee must return to work before this accrued vacation and sick leave can be used. If an employee separates without returning to work, the employee shall be paid for any vacation time earned for the period the employee received extended sick leave payments (refer to University of California Absence from Work Policy).
4. Extended sick leave may continue for 26 weeks or until the employee returns to work. If the employee continues to be off work beyond the 26 weeks of extended sick leave, the employee will then be placed on leave without pay and will receive only the Workers’ Compensation payment from Sedgwick CMS. The employee will be instructed by the Workers’ Compensation Office to contact the Benefits Office about applying for additional disability payments that may supplement the Workers’ Compensation payments.
5. An employee who elects not to use all accrued sick leave will not be eligible for extended sick leave benefits.
6. Extended sick leave benefits shall not apply to safety members who qualify for leave with
full salary for a work-incurred disability under State law.
A. It is the responsibility of each employee to report all injuries as required under this policy and to keep the department updated with their current work restrictions.
B. It is the responsibility of each supervisor to complete the supervisor’s section of the online injury reporting form, to advise the injured employee to report the injury to the Workers’ Compensation Office and to encourage the injured employee to seek any necessary medical treatment. If the injured employee is unable to report the injury to the Workers’ Compensation Office, the employee’s supervisor should also complete the employee’s section of the online reporting form. The supervisor is responsible for ensuring the cause of the injury is investigated and preventive action initiated. The Environment, Health & Safety Office is available to assist in recommending safety measures and necessary corrective action.
C. It is the responsibility of the injured employee’s supervisor to participate in the evaluation of Transitional Return to Work (TRTW) assignments for each of their injured employees, see the TRTW Guidelines for more information.
D. To the extent required by California Workers’ Compensation Law, it is the responsibility of each department administrative unit to retain the injured employee’s position. In addition, departments shall fully fund all Transitional Return to Work Assignments identified (by TRTW staff) for their employees while they recover from their work-related injuries. TRTW Assignments will be pursued outside of the injured employee’s home department when available if the home department is not able to accommodate their injured employee’s work restrictions.
E. It is the responsibility of each department timekeeper to ensure that the injured employee's payroll records are maintained in accordance with this policy. The department timekeeper should coordinate with the Campus Payroll Office and the Workers’ Compensation Office to ensure the injured employee receives proper payment.
F. It is the responsibility of the Workers’ Compensation Office to ensure that all claim forms and reported injuries are processed in a timely manner and all questions concerning the Campus Workers' Compensation Program are answered promptly.
It is the responsibility of Sedgwick CMS, acting on behalf of the University, to investigate and ensure that appropriate benefits are provided within the framework provided by the California’s Workers' Compensation laws.
B. Personnel Policies for Staff Members (PPSM)
PPSM 66 Medical Separation
PPSM 81 Reasonable Accommodation
C. UC San Diego Implementing Procedures
3 HR-S-3 Volunteer Staff Employment
66 HR-S-1 Medical Separation
81 HR-S-1 Reasonable Accommodation
D. UC San Diego Policy and Procedure Manual (PPM)
516-18 Injury and Illness Investigations
516-21 Occupational Health
E. Medical Center Policy and Procedure Manual (MCP)
611.8 Employee Workers' Compensation Program
VII. REVISION HISTORY
2016/01/26 - This policy was revised to include updated language and include the transitional return to work program including formatting updates.