Workers' Compensation FAQ's for Employees

What do I do if I get injured?

If you are injured on the job, immediately inform your supervisor. Here are four important facts for you to keep in mind:

  1. Your Supervisor or HR Rep will provide you with Workers’ Compensation Claim Form (DWC-1) within one working day of notifying them of the injury/illness. Please complete and return the claim form to your supervisor within 24 hours. Also, you will be given this form if/when you are seen at UCLA Occupational Health Facility.
  2. If your injury requires a medical evaluation, your supervisor or HR Rep will send you to the UCLA Occupational Health Facility (OHF) at 67-120 Center for Health Sciences, 10833 Le Conte Avenue. OHF operates Monday through Friday from 7:30 a.m. to 4:30 p.m.
  3. If your injury occurs outside of these hours, or you require urgent immediate medical attention, you may receive treatment 24 hours a day at the Emergency Medicine Center, located at 757 Westwood Plaza (ER entrance Gayley Avenue, north of Le Conte Avenue). You must follow up with UCLA Occupational Health Facility the next business day.
  4. If your injury occurs off-campus and it requires acute attention, please seek treatment at the nearest emergency care facility. If your injury is not of an urgent nature, please call your supervisor, who will refer you to see a University-approved physician nearby.

What is the purpose of Workers' Compensation?

The purpose of Workers’ Compensation is to provide medical care and benefits to employees who are injured at work or who develop a job-related illness as a result of their employment. Benefits may include payment for medical bills, lost wages and a vocational rehabilitation voucher. All job-related injuries and illnesses sustained by UCLA employees are covered by the University’s Workers’ Compensation self-insurance program.

Who administers and pays for Workers' Compensation Claims?

Sedgwick Claims Management Services (CMS) administers and pays workers’ compensation claims on behalf of UCLA.  When you report an injury, the appropriate UCLA Workers’ Compensation office will report the injury to Sedgwick, CMS, for handling.  Your Sedgwick, CMS claim adjuster may contact you to discuss your claim.  It is important that you respond to the Sedgwick CMS adjuster as this will assist them in completing their investigation of your injury/illness to determine Workers’ Compensation benefits that may be owed.  Please note that failure to respond to the Sedgwick CMS adjuster may result in the denial of your claim.

May I use my own doctor for a Workers' Compensation Injury/Illness?

If you sustain an injury/illness, medical care will arranged for you for the entire course of your treatment. If you wish to be treated by your own doctor within the first thirty (30) days of an injury/illness, you must have on file with your department a written “Designation of Treating Physician” form prior to any illness or injury occurring. If an injury occurs and you choose to see your previously designated physician, you must immediately notify Sedgwick, CMS so that there is no delay in considering your medical bills for payment.

What types of benefits does Workers' Compensation provide?

“Benefits” is the term given to all payments and services provides to you by Workers’ Compensation. Here are the key benefits:

  • MEDICAL COVERAGE

Workers’ Compensation will pay 100 % of all approved medical, hospital and prescription bills arising from the industrial injury/illness with no out of pocket cost to the employee.

  • TEMPORARY DISABILITY

If the treating physician determines that you are temporarily unable to work, you will be eligible for temporary disability payments. Disability payments are issued every two weeks and represent 2/3 of your gross wage, up to a statutory maximum amount.  Eligibility for temporary disability starts with the fourth calendar day you are unable to work.  The three-day waiting period is waived if you are hospitalized or disabled for more than 14 days, in which case your eligibility begins on the day you were injured or became ill.  While you are temporarily unable to work, you should check in regularly with your supervisor as a courtesy to your department.  This is in addition to regular contact with your Sedgwick, CMS claims administrator.

  • PERMANENT DISABILITY

If the treating physician determines that you are to some degree permanently impaired from fully competing in the labor market, you may be eligible for permanent disability benefits.  Your particular disability is calculated, or “rated” per statutory guidelines, taking into account the body part affected, your occupation, age and rate of pay at time of the injury/illness.  This rating determines the amount to be paid to you to compensate you for the disability.

How do I coordinate Workers' Compensation benefits with disability benefits?

  • EXTENDED SICK LEAVE BENEFIT

Once your claim is received and if you are off work due to the injury for more than 3 days, your Human Resources Representative will provide information on the different options for supplementing your temporary disability (TD) benefits paid by Sedgwick CMS with the use of your sick leave and vacation accruals.  The Workers’ Compensation Election form (located on the UCPath Portal) must be completed and sent to UCPath and your Human Resources Representative. Link to this form - https://www.ucop.edu/ucpath-center/_files/mypath/new-forms/workers-compensation-election.pdf.  For example, to maintain 100% of your base salary, you may elect to use accrued sick leave and/or vacation to supplement the TD payments from Sedgwick, CMS (which are 2/3 of your base wages up to an established maximum).  If all leave accrual is exhausted, the University will supplement your TD payments to maintain your salary at 80% of your base.  This extended Sick Leave benefit may not exceed 26 weeks for any injury or illness.

  • DISABILITY BENEFIT

If you are missing time from work and your claim has been delayed by Sedgwick, you may apply for disability benefits with Lincoln Financial.  For information on these benefits, go to the following link: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/roadmaps/applying-for-disability-benefits.html.  If Sedgwick CMS later accepts liability for your injury, disability benefits would be reimbursed to Lincoln Financial.

Do I need a note from my doctor when I return to work?

Once the treating physician has released you to return to work, you must present appropriate medical documentation to your department.  The treating physician must either clear you to perform all the regular duties of your position, or list all work restrictions such as maximum lifting capacity.

What happens if I can't perform all my regular job duties?

If the doctor who is treating you determines that you can work but with temporary or permanent work restrictions, provide the medical documentation to your supervisor and Human Resources.  Also contact UCLA Disability Management and a Consultant will assist you with reasonable accommodations.

For UCLA Campus employees, please contact Insurance and Risk Management at (310) 794-6948 - Ask for Disability Management or email [email protected].

For UCLA Medical Center employees, please contact Health Systems HR Workers’ Compensation Unit at 310-794-0500 or email [email protected].

Where do I call if I have any questions regarding Workers' Compensation?

  • If you have questions concerning your Workers’ Compensation claim, please call Sedgwick, CMS.
  • If you have any questions regarding supplemental disability benefits, please contact your department Benefit Representative or your supervisor.

To view this information in brochure format, please click https://ucla.app.box.com/v/irm-when-an-inury-occurs.