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Workers’ Compensation FAQs for Employees

Frequently Asked Questions

Related

QUESTION GROUPS
Injury Report General Info Medical Care
Claim Status TD Benefits Return to Work

REPORTING AN INJURY OR ILLNESS -Top-

GENERAL INFORMATION -Top-

MEDICAL CARE-Top-

CLAIM STATUS -Top-

WORKER’S COMPENSATION TEMPORARY DISABILITY BENEFITS AND UC BENFITS -Top-

RETURN TO WORK -Top-

REPORTING AN INJURY OR ILLNESS -Top-

When should I report an Injury or Illness? -Top-

All injuries and illnesses, no matter how trivial, should immediately be reported to your supervisor. A delay in reporting an injury may result in a delay in providing benefits, or may even jeopardize your eligibility for benefits.

You should also immediately report all injuries and illness which you believe may be work-related, even if you are not absolutely sure they are. This will protect your right to any benefits that may be due you.

If the injury is work-related, how do I file a claim?-Top-

Report the injury to your supervisor. After s/he reports the injury on the Supervisor Incident Report; claim forms will be sent to you.

You may also print and complete the online form. The form can be found at the following site: http://ucsfhr.ucsf.edu/files/EIR.pdf

Or, you can call Disability Management Services at (415) 476-2621, and we will send you the form.

To whom do I give the completed Employee Incident Report?-Top-

If you have printed the EIR form from the website, fill it out and give it to your supervisor.

If you received the form from Disability Management Services, fill it out and return it to Disability Management Services at:

UCSF Human Resources
Disability Management Services
Box 0964
San Francisco, CA 94143-0964
Or, you can fax the forms to DMS at (415) 476-2328.

Do I need to be off work to file a claim? -Top-

No. Many people continue to work while receiving workers' compensation benefits (medical treatment for instance). You can file a claim whether or not you have lost any time from work.

Who will contact me after I have filed the claim forms? -Top-

Your Claims Administrator at Sedgwick CMS, (510) 433-5300, will call you to discuss your injury and to explain the workers' compensation benefits and procedures in detail.

GENERAL INFORMATION -Top-

Who coordinates the Workers' Compensation Program and can answer my questions?-Top-

Disability Management Services (DMS) is a unit of campus Human Resources.

We are located at the Laurel Heights campus, Suite 330.

UCSF Human Resources
Disability Management Services
Box 0964
San Francisco, CA 94143-0964
Tel: (415) 476-2621
Fax: (415) 476-2328

What is Workers' Compensation?-Top-

A no-fault, employer-paid insurance system designed to assure that employees who sustain work-related injury or illness receive complete medical attention for the injury or illness, and a degree of financial and other support in returning to gainful work.

Who at UC has Workers' Compensation insurance coverage? -Top-

All University employees are covered, including temporary employees.

What are the main Workers' Compensation benefits? -Top-

Who decides if I am eligible for benefits and who provides workers' compensation benefits? -Top-

Sedgwick CMS, 510-302-3180

Who is Sedgwick CMS and how do I contact them? -Top-

Sedgwick CMS is the University's Third Party Workers' Compensation Administrator. Sedgwick CMS is responsible for administering the workers' compensation claims, deciding which benefits are due, and paying them.

Is there an informational pamphlet for new employees?-Top-

Yes: The Time of Hire Pamphlet

Is there an informational brochure about the UC Workers' Compensation Program? -Top-

Yes: There is a UC Brochure which discusses worker’s compensation. The brochure can be found at the following site: http://atyourservice.ucop.edu/forms_pubs/misc/workerscomp.pdf

Is there an informational poster for the workplace? -Top-

Yes, there are posters printed in both English and Spanish.

Is there a State of California office to answer my questions? -Top-

Yes: You can call an Information & Assistance Officer at the nearest office of the State Division of Workers' Compensation. You can locate the nearest office on the Division of Industrial Relations website: http://www.dir.ca.gov/dwc/dir2.htm

Who do I contact if my injury or illness in NOT work-related? -Top-

Contact Benefits & Financial Planning at (415) 476-1400. They can advise you regarding other benefits you may be eligible for.

MEDICAL CARE -Top-

Where do I go for medical treatment? -Top-

Who authorizes medical treatment? -Top-

All medical treatment that is beyond First Aid or Emergency care must be authorized by your claims examiner at Sedgwick CMS.

No one else may authorize such medical care.

Can my supervisor authorize medical treatment? -Top-

Your supervisor can make an initial referral for:

But, your supervisor cannot authorize any follow-up care. Only Sedgwick CMS can authorize medical care beyond the initial referral.

In the case of a need for Emergency care, your supervisor should refer or escort you to the nearest emergency care facility, or call an ambulance, as circumstances require.

Can I go to my own doctor? -Top-

If you and your personal physician filled out the Personal Physician Predesignation form before the injury happened, you can go to your personal physician immediately after the injury.

If you and your personal physician did not fill out the Predesignation Form before the injury happened, you can begin treating with your personal physician thirty (30) days after the date on which you reported the injury to your supervisor.

Where can I get the forms to pre-designate my personal physician to be my treater after an injury, and to pre-designate my personal chiropractor or acupuncturist in case I wish to change treating physicians? You can print the forms from this website. Or, you can call Disability Management Services, and we will send you one.

Send the completed form to Disability Management Services.

Can I change doctors? -Top-

Yes. You have the right to one change of physician, which you can request at any time.

If you request a change of physician during the first thirty (30) days after you report your injury to your supervisor, you can change to your personal chiropractor or personal acupuncturist if you filled out the predesignation forms before the injury occurred.

If you request a change of physician thirty (30) or more days after you report your injury to your supervisor, you can be treated by any physician of your own choice.

Who do I contact if I want to: change doctors, obtain a copy of my medical report, or talk about my medical care or about medical bills I’ve received (related to my worker’s compensation treatment)? -Top-

Contact your Claims Administrator at Sedgwick CMS
510-302-3180

What is UC's Workers' Compensation policy number? -Top-

The University is self-insured for Workers' Compensation. Instead of having a "carrier", the University has a Third Party Administrator: Sedgwick CMS.

Since the University is self-insured, there is no insurance policy number.

If your doctor's office asks you for the name and address of your employer's workers' compensation "carrier", and for your employer's "policy number", give them the following information:

Sedgwick CMS: 510-302-3180

Insurance Policy Number: No Policy. Self-Insured

CLAIM STATUS -Top-

What actually happens if my claim is accepted? -Top-

Sedgwick will begin to provide benefits immediately. Most claims are accepted.

What should I do if my claim is delayed? -Top-

It can take up to ninety (90) days from the date you reported the injury to your supervisor for Sedgwick to make a decision on your claim. During this time, workers' compensation disability benefits will not be paid.

During this time, you may be eligible to receive benefits under other UC disability plans.

Contact the Benefits & Financial Planning Division at (415) 476-1400, to inquire into filing for UC Supplemental Disability benefits.

WORKER’S COMPENSATION TEMPORARY DISABILITY BENEFITS AND UC BENEFITS -Top-

If I am off work, am I entitled to benefits and who do I contact about these benefits?-Top-

While you are off work on an approved medical leave and recovering from your injury or illness, you will receive Temporary Disability (TD) payments from Sedgwick CMS.

Temporary Disability partially replaces lost wages. It is always less than 100 percent of your regular earnings. The amount of the TD benefit depends on your average weekly earnings at the time you were injured and upon maximums set by law. For most employees, TD pays approximately 2/3 of your gross earnings.

How will I be paid while I am off of work due to a disability? -Top-

If your claim is ACCEPTED by Sedgwick:

If your claim is DELAYED by Sedgwick CMS: If your claim is DENIED by Sedgwick CMS:

For more detailed information, see PPSM 44, your Collective Bargaining Agreement, or the DMS Worker’s Compensation Payroll Process website: http://ucsfhr.ucsf.edu/index.php/workcomp/article/2517.

How will I be paid if I am disabled part-time? -Top-

You may be entitled to Temporary Partial Disability (TPD) payments from Sedgwick CMS. If so, this will pay a portion of your wage-loss while working on a part-time schedule:

  1. The University will pay you for the time you work.
  2. If eligible, Sedgwick will pay you TPD benefits.
  3. Sick Leave, or Sick Leave and Vacation, can supplement the above up to 100%.
  4. Afterwards, Extended Sick Leave can supplement the above up to 80%.
  5. Afterwards, UC Supplemental Disability may supplement the above. Call the Benefits & Financial Planning office at (415) 476-1400 to see if you are eligible.

For more detailed information, see PPSM 44, your Collective Bargaining Agreement or the DMS Worker’s Compensation Payroll Process website: http://ucsfhr.ucsf.edu/index.php/workcomp/article/2517.

How do I fill out my timesheet? -Top-

You fill out your timesheet, indicating the hours you worked, and sick or vacation leave used outside of the time you were off for your injury.

Then, each month, your department's Payroll Processor will reconcile your timesheet, based on any workers' compensation payments made by Sedgwick CMS.

If your claim has been accepted by Sedgwick, and you elected to use both Sick Leave and Vacation Leave to supplement the workers' compensation payments made by Sedgwick, you can begin to use your Vacation Leave hours once your Sick Leave hours run out.

If your claim has been delayed by Sedgwick, you are not automatically permitted to use your Vacation Leave. You must obtain the approval of your department.

If your claim has been denied by Sedgwick, follow your department’s usual procedures.

Do I use Sick Leave to attend medical visits? -Top-

You fill out your timesheet as you normally would, using hours of Sick Leave for your lost time to attend medical appointments. TD is paid during periods of time you are medically precluded from working, and attendance at a doctor’s appointment does not constitute a medical preclusion from work.

Do I use Sick Leave for the three-day waiting period? -Top-

Yes. Temporary Disability is usually not paid for the first three days of disability.

You must use your Sick Leave. If you do not have sufficient Sick Leave to cover the entire three days, and if you are eligible for Extended Sick Leave, then Extended Sick Leave will apply to the remainder of the three days, and will pay you at 80% of your regular earnings, even though Temporary Disability is not being paid.

Will I continue to accrue Sick Leave and Vacation Leave while off work? -Top-

While using Sick and/or Vacation Leave to supplement Temporary Disability payments:

After Extended Sick Leave runs out, while you are on Leave of Absence Without Pay and still receiving Temporary Disability payments: