When There is a Workers' Compensation Injury

When There is a Workers' Compensation Injury

February 22, 2013

1. Get the Injured Employee Medical Attention

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)

Severe Injuries call 911*

Severe injuries and/or hospitalized overnight require an immediate call to Environment Health & Safety at (310) 825-9797.

2. Complete the Injury Reporting Process Within 24-Hours of Notice of Injury

Complete this via the Electronic First Report (EFR) System. In order to use EFR, the following is required:

      *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 you are unable to access EFR, then complete this Incident Report & Referral form and submit a copy to: wcreports@irm.ucla.edu


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.

2) When an Injury Occurs Pamphlet

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.

Contact Information

 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