When There is a Workers' Compensation Injury
1. Get the Injured Employee Medical Attention
Severe Injuries call 911*
Severe injuries and/or hospitalized overnight require an immediate call to Environment Health & Safety at (310) 825-9797.
OHF at 67-120 Center for Health Sciences at 10833 Le Conte Avenue. Call (310) 825-6771
7:30 a.m. to 4:30 p.m. Monday - Friday
After OHF Hours use Emergency Medicine Center/EMC
757 Westwood Plaza (ER entrance Gayley Ave, north of Le Conte)
OFF-CAMPUS EMPLOYEES = MORE THAN 30-MINUTES TRAVEL TIME FROM UCLA CAMPUS
If the injured employee works at an off-campus location that would take more than 30 minutes to get to the UCLA Occupational Health Facility, then the employee can be seen at an Occupational Health Clinic Partner. A listing of Occupational Health Clinic Partners is located at the following link: http://ohfs1.mednet.ucla.edu/IRM/index.html
2. Complete the Injury Reporting Process Within 24-Hours of Notice of Injury
*UCLA Single Sign On – ID & Password
*Web Browser must be Firefox or Google Chrome (Not compatible with Internet Explorer)
*Employee must be in the employee database (EDB). This system cannot be used for volunteers
If completing the Incident Report & Referral form, Employee and Supervisor complete and sign the top two sections. Send the form with the employee to give to the medical provider.
Please try to accommodate any temporary work restrictions. If you have questions call Transitional Return to Work Coordinator at (310) 794-6955.
3. If the Injury is more than First Aid, Give the Employee:
a) The Employee complete sections 1-8.
b) The Supervisor completes the bottom section 9 through 17.
c) Give the Employee a completed-signed copy.
d) Send the original form to your HR (Human Resources)/Payroll/Personnel representative.
4. If You Are a Supervisor, Amend the Employee's Payroll
Verify that your department's payroll coordinator has implemented the appropriate Workers' Compensation payroll procedures for any injured employee who loses time from work due to an industrial injury.
Information regarding payroll procedures may be obtained by calling the Workers' Compensation Claims Coordinator.
Additional Information for Employees, Visitors, and Volunteers
Employees who have already filed a claim should call Sedgwick/CMS, the University's third-party administrator for Workers' Compensation. When an injury is reported, Sedgwick/CMS assigns the claim to an administrator who determines eligibility and administers the benefits accordingly. For general questions, contact the Workers' Compensation Manager or Workers' Compensation Claims Coordinator.
See the related articles for information on visitor and volunteer injuries.
Workers' Compensation Coordinator: (310) 794-6952
Workers' Compensation Manager: (310) 794-6954
Transitional return to Work Coordinator: (310) 794-6955
Claim Report line: (877) 682-7778