When There is a Workers' Compensation Injury
1. Get the Injured Employee Medical Attention
Severe Injuries call 911*
Severe injuries and/or hospitalized requires an immediate call to Environment Health & Safety Hotline 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 Ronald Reagan Emergency Room
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 may be seen at an Occupational Health Clinic Partner. A list of Occupational Health Clinic Partners is located at the following link: OHF Clinic Partners
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 your employee's temporary work restrictions if any. If you have questions contact Employee Disability Management via e-mail at: [email protected] or call (310) 794-6948 and select option 2. For further information use the staff resources directory.
3. If the Injury is more than First Aid, Give the Employee:
a) The Employee complete sections 1-9.
b) The Supervisor completes the bottom sections 12-14 and 17-19.
c) Give the Employee a completed-signed copy.
d) Send the original form to your HR (Human Resources)/Payroll/Personnel representative.
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.
Workers' Compensation Program Analyst: (310) 794-6952
Workers' Compensation Program Manager: (310) 794-6954
Employee Disability Management: (310) 794-6948 select option 2
Claim Report line: (877) 682-7778