2Who is eligible?Career, casual, Per Diem employees are covered from the first date of employmentVanpool injuriesNon-UCLA employees are covered by their respective employers, e.g. Traveler’s, Registry, other temporary workersVolunteers
3Initial Employee Contact Was this injury work related?If the employee believes it was work-related or is unsure, provide Workers’ Compensation forms and direct the employee to seek immediate medical treatment at either Occupational Health Facility or the UCLA Emergency DepartmentEmployee should tell the UCLA Emergency Department that they are a UCLAMC employee and that they are being treated for a work-related injuryFollow all procedures for a leave of absenceWhere to send the employee for treatment?Employee should be seen by Occupational Health Facility or the UCLA Emergency Department for the first 30 days
4Cal-OSHAIn case of Serious Injury or DEATH or if an employee is hospitalized: Page the Health System Safety Department pager immediately or call the Campus 24-hour call-in phone number EH&S Hotline: Call Health System Safety Department (310) for any follow-up OSHA requires notice within 8 hours of Serious Injury Serious Injury is: Death Amputation Concussion Crushing injury Fracture Burn Laceration with stitches or significant bleeding Hospitalization beyond Observation
5WHEN AN EMPLOYEE IS INJURED ON THE JOB... Provide the employee with:A completed Workers’ Compensation Claim Form (DWC-1) and Notice of Potential EligibilityThis form must be provided within 1 working day of notice that an injury or illness has occurred as mandated by California state law. (Exception: First Aid incidents)2. A completed UCLA Incident Report and Referral for Medical Treatment3. Workers’ Compensation Information Sheet(SEE HANDOUT FOR LINE BY LINE INSTRUCTIONS)
6WHAT TO DO WITH THE PAPERWORK? Please review and complete all lines. Sign where appropriate.The person to whom the injury is reported should sign all forms where indicatedDepartment keeps one copy for department records.If notification was by phone, mail the form to the employee. Certified mail is advisable as proof of mailing.Immediately:FAX a copy of the completed form to the WC FAX line Health System HR orto orCALL 877-6UC-RPRT ( ) with the information on the form (see Step #5)Employee keeps one copy of completed form.Send all other copies of the form immediately to Health System HR for further distribution.Notify Health System HR Workers’ Comp x40500 as soon as you know an employee has been taken off work.6
7WORKERS’ COMPENSATION PROCESS Employee notifies supervisor that a work-related incident has happened. Supervisor provides UCLA Incident Report and Referral for Medical Treatment form and directs Employee to Occupational Health or the Emergency Medicine Center for medical treatment. Medical Treatment is provided. Medical provider completes a Work Status slip. Employee gives Work Status slip to Supervisor immediately. IF EMPLOYEE WAS SEEN AT THE EMERGENCY ROOM, direct employee to follow-up at UCLA Occupational Health. If treatment is beyond First Aid - Employer provides Workers’ Compensation Claim Form (DWC 1) within 1 working day of injury or knowledge of injury - Employee signs Workers’ Compensation Claim Form (DWC 1) and returns it to Department or Health System HR
8Claims ProcessSedgwick CMS (Third Party Administrator or TPA) makes 3-point contact: with Employee, with Supervisor, and with Medical ProviderReturn all phone calls from Sedgwick CMS as soon as possible.Employer may investigate an incident. The law allows up to 90 days to delay a decision on compensability. If the claim form was provided and returned timely, medical treatment will be provided up to $10,000 during the decision processTPA reviews the claim and determines what benefits the employee should receive. TPA notifies the employee by mail and by phone whether claim is accepted, delayed, or denied.If the injury is delayed or denied and the employee is taken off work by a medical provider, employee should file for disability benefits.COMPLETE THE ONLINE LEAVE OF ABSENCE NOTIFICATION ON THE HR WEBSITEIf the injury is approved as work related and the employee is taken off work by a medical provider, the employee will receive a temporary disability check from TPA.Health System HR WC contacts the employee about WC Options via phone or letter to the employee and also notifies the department EDB preparer.8
9Work status, work status, work status Work status, work status, work status! Part One – Temporary RestrictionsDepartment is responsible for their employee --Employee must provide manager/department with updated medical disability slips prior to returning to work and throughout the leave.WHEN THE MEDICAL PROVIDER DETERMINES THAT THE EMPLOYEE HAS TEMPORARY WORK RESTRICTIONS –OHF or Workers’ Compensation Provider gives the employee a work status slip with any medical restrictions and the approximate durationEmployee immediately gives work status slip to supervisorSupervisor finds temporary transitional modified duty assignment compatible with medical restrictions for up to 90 calendar daysEmployee should have restrictions updated by OHF or Workers’ Compensation Provider within 45 calendar days or earlier if appropriate.If the department/supervisor does not have modified duties available, supervisor must contact the Return to Work Coordinators for possible placement elsewhereIf the employee refuses the assignment all temporary disability payments may ceaseIf employee feels at any time that he/she cannot work due to the work-related injury, direct employee back to their Workers’ Comp medical provider immediately to get medical certification of time off.
10Important Information Employees should be paid for the time at OHF/EH and/or the EMC (to complete the work shift.) Charge hours to Home Cost Center Employees must use SL for any time at off-site (non-OHF/EH or EMC) appointments, and for time taken for therapy, diagnostic appts Employee may return to temporary work on a modified work schedule or modified duties at any time. Charge actual Modified duty hours worked as ‘Modified Duty Workers’ Comp’and to the Return to Work Cost Center.
11Who is eligible to use Cost Center/Paycode? Open WC claimWork restrictions are:Temporary ANDRestrict one or more regular job duties (performed at least once weekly) and/or at least one essential function of the job ANDDocumented by Medical Provider with a start and end date to the work restrictionsEmployees working in a modified assignment related to a non-work related injury or illness are not eligible to utilize these cost centers.
12RTW Cost Center/Paycode Procedure Determine if the employee meets criteria. Health System HR/Return to Work coordinators will provide requesting manager/supervisor with the cost center number.Record the hours worked by the employee on HBS using pay code MDH ‘Modified Duty Workers Comp’ when the hours meet the above criteria for the dates indicated on the work status notePerform ‘Lookup’ function for the cost center and charge the hours to the appropriate Modified Duty Cost CenterBOTH the pay code and the Cost Center must be used together
13Contacts for Return to Work Program Contact Health System HR Workers’ Compensation/ Return to Work coordinators to confirm employee meets eligibility criteriaHealth System Human Resources WCMark BriskieCynthia VazquezIngrid GarciaReturn to Work CoordinatorsMark BriskieSuzanne Bleibtreu
14Leave of Absence Procedure – 3 day Waiting Period If the employee is taken off work completely by the Workers’ Comp Medical Provider, a 3-day waiting period may apply before WC benefits are paid -- The employee must use his/her sick leave for first three (3) calendar days of the leave only. Employee may request the use of VAC/HOL/COMP if wishes to receive full pay for the 3-day waiting period. If the employee does not have enough sick leave to cover the 3-day waiting period, the employee is entitled to receive 80% of his/her regular salary through the 80%Extended Sick Leave benefit. Notify Health System HR WC if the employee does not have enough sick leave and wants to access this benefit. Record no sick leave/vacation on timesheet after waiting period.3-day Waiting Period --For 12-hour employees, up to the first 24 scheduled work hours within the first 3 calendar days
15Leave of Absence Procedure – Beyond Waiting Period If the employee’s leave continues past the 3-day workers’ comp waiting period, direct the employee to submit an online Leave of Absence Notice at the Health System HR websiteEmployee can also find additional information regarding the WC leave of absence.Employee should review the COMPARISON OF PAYMENT OPTIONS and contact Human Resources, Workers’ Compensation coordinator Cynthia Vazquez/Ingrid Garcia, at (310)WC leave may qualify employee for FMLA leaveIf the employee is eligible for FMLA, employee will be on a FMLA leave first, then a WC leave if claim was approvedOnline Leave of Absence - Workers’ Compensation PendingIndicate the last day on pay status using sick leave (or other requested accruals) for the 3-day Waiting Period onlythe 4-digit leave code that is generated to the HR Representative to begin the processNotify EDB preparer as you receive updated work status slips from the Medical Provider throughout the course of treatment so that HR Representative can update Leave of AbsenceNotify EDB preparer when the employee returns from leave so HR Representative can update and close the Leave of Absence file15
16WC Options – to supplement WC benefits This process is manual and handled through the HR Rep, Payroll and Health System HR offices.This significantly impacts the employee’s health and welfare benefits. Please have the employee review and contact HS HR Workers’ Comp unit to elect a WC Option.Option 1Employee elects to receive only the workers’ comp TTD checkEmployee will be billed for health and welfare benefits as applicableOption 2Employee elects to use sick leave only to supplement the workers’ comp TTD checkHealth and welfare benefits contributions are taken on regular paydaysOption 3Employee elects to use sick leave and vacation time to supplement the workers’ comp TTD checkLeaves must be updated regardless of which WC Option is chosen
17Work status, work status, work status Work status, work status, work status! Part Two – Permanent RestrictionsDepartment is responsible for their employee --Employee must provide manager/department with updated medical disability slips prior to returning to work and throughout the leave.WHEN THE TREATING PHYSICIAN DETERMINES THAT THE EMPLOYEE HAS PERMANENT WORK RESTRICTIONS WHICH MAY AFFECT EMPLOYEE’S ABILITY TO PERFORM ALL OR PART OF HIS/HER JOB DUTIES –Contact the Employee Disability Manager Mark Briskie immediately to advise of the permanent work restrictions.Consider whether you can permanently modify the employee’s job duties to accommodate the restrictions ORIf there is permanent alternate work in the department to accommodate the restrictionsDocument all discussion with employee regarding accommodationAn offer of medically appropriate work must be sent to the injured employee within 30 days of the termination of TD payments.Employees may use any available accruals to return to pay status while accommodations are discussed17
18Injury Prevention resources Health System SafetySAFETY INSPECTIONS/TRAINING ERGONOMIC EVALUATIONACCIDENT INVESTIGATION COORDINATIONErik Egginsphone fax PAGER 90248Ergonomic Evaluation Request Formon HR website
19DirectorySEDGWICK CMS P.O. Box Lexington KY Mail code Phone Fax CAMPUS PAYROLL UCLA Wilshire Center, Suite 620 MC Phone Fax UCLA HEALTHCARE PAYROLL UCLA Wilshire Center, Suite 1700 MC Phone FaxOCCUPATIONAL HEALTH FACILITY (OHF)Center for Health SciencesMonday through Friday7:00 a.m. to 4:30 p.m.Mail CodePhoneFaxEMERGENCY DEPARTMENT757 Westwood Plaza(ER entrance Gayley Ave, north of Le Conte)PhoneOpen 24 hours a daySMH Emergency RoomPhone
20Other Information Health System Policy HS 7318 EMPLOYEE WORK-RELATED ILLNESS AND/OR INJURYRequired WorkPlace posting DWC 7Notice to Employees – Injuries Caused By WorkHR WebsiteNew Employee PamphletDistributed at time of Hire by HR RepPre-designation of Physician form
21Health and Welfare, Other benefits Sick leave and vacation accruals Retirement Accruals WC Options
22OPTION 1If FMLA eligible, the employee will be on a FMLA Leave Without PayIf not eligible for FMLA, the employee will be on Workers’ Comp Leave Without PayEmployee is fully responsible for insurance contributions according to the FMLA guidelines.Employee must make employee contribution for health.Benefits Office will notify the employee directly regarding all benefits which are not paid for by FMLA.Employee will also need to pay directly for health, dental, and vision once the 12 weeks of FMLA exhaust.Employee is eligible to accrue full sick leave and vacation while on Option 1 but accruals are awarded only upon Return to Work.Employee does not earn service credit while on Option 1.Upon return to work, should contact Benefits Office to initiate service-credit buy-back if applicable
23OPTION 2 If FMLA eligible, the employee will be on FMLA Leave With Pay If not eligible for FMLA, the employee will be on Workers’ Comp Leave With PayEmployee’s regular contributions for insurances, parking, 403(b), and other voluntary deductions are taken from supplemental pay.Employee’s own contribution for health and other insurances is deducted following normal payroll process.All contributions remain the same unless employee elects to make a change, e.g. cancels Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes insurances or covered members.Employee is eligible to accrue full sick leave and vacation while on Option 2 AND sick leave accruals are used as accruedOnce the employee’s own sick leave exhausts, the employee is eligible to receive 80% Extended Sick Leave benefit.Employee earns service credit at 100% of % appointment while on Option 2.
24OPTION 3 If FMLA eligible, the employee will be on FMLA Leave With Pay If not eligible for FMLA, the employee will be on Workers’ Comp Leave With PayEmployee’s regular contributions for insurances, parking, 403(b), and other voluntary deductions are taken from supplemental pay.Employee’s own contribution for health and other insurances is deducted following normal payroll process.All contributions remain the same unless employee elects to make a change, e.g. cancels Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes insurances or covered members.Employee is eligible to accrue full sick leave and vacation while on Option 3 AND sick leave and vacation accruals are used as accruedOnce the employee’s own sick leave and vacation exhausts, the employee is eligible to receive 80% Extended Sick Leave benefit.Employee earns service credit at 100% of % appointment while on Option 3.
2580% Extended Sick LeaveIf FMLA eligible, the employee will be on a FMLA Leave With PayIf not eligible for FMLA, the employee will be on Workers’ Comp Leave With PayEmployee’s regular contributions for insurances, parking, 403(b), and other voluntary deductions are taken from supplemental pay.Employee’s own contribution for health and other insurances is deducted following normal payroll process.All contributions remain the same unless employee elects to make a change, e.g. cancels Parking, decreases 403(b) contributions on-line (Fidelity website), cancels or changes insurances or covered members.Employee is eligible to accrue full sick leave and vacation while on 80%Extended Sick Leave but accruals are awarded only upon Return to WorkEmployee earns service credit at 80% of % appointment while on 80% Extended Sick Leave.Upon return to work, should contact Benefits Office to initiate service-credit buy-back if applicable
26After 80% Extended Sick Leave Employee will be on a WC Leave Without Pay until Return to Work with or without given Permanent RestrictionsEmployee may apply to Liberty Mutual for the Employee-Paid Supplemental Disability to supplement the WC checks.Health Insurance coverage may continue --UC Regents will continue to pay the employee’s full health benefits (Employee and University contribution) via the Health Contingency Fund while the employee continues to receive temporary disability payments AND has not been separated.Employee is eligible to accrue full sick leave and vacation while on receiving WC TTD checks but accruals are awarded only upon Return to WorkEmployee must make payment for all other insurances and Benefits that he/she wishes to keep currentBenefits will coordinate direct payment of premiums for all other benefits with employee.