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Need Workers' Comp Help? University Business Services © UC Santa Cruz
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Workers' Compensation Handbook - Chapter 5 Summary: Chapter 5 - Disabled Workers Benefits
IntroductionBenefits available for injured or ill employees who lose more than three days from work are described in this chapter. These benefits include the following possibilities:
Additionally, the UCSC Payment Process is described. Temporary Disability BenefitsWorkers Compensation Temporary Disability (TD) is a cash salary replacement used to assist the temporarily disabled employee in meeting life expenses. The payments normally begin on the fourth day after the injury or illness occurs. If the disability lasts beyond the 14th day, or the employee is hospitalized as an in-patient, the three-day waiting period is waived. Temporary Disability payments are never made for the day of the injury. An employee is eligible for two-thirds of his/her average salary, to a maximum of $916.33 per week. These Workers Compensation benefits will continue until the employee is able to return to work or the medical condition stabilizes. The benefit is tax exempt. Options for Supplementing TDWhen an injured or ill employee files a workers compensation claim, UCSC Risk Services sends a Claim and Benefits Letter and an Option Form to the employee's address on file with the university. This letter describes the claim process, the benefits available while an injured employee is off work due to the work-related injury, and the employees options for supplementing their pay up to 100%. See Replacing Lost Wages for more information about TD payments provided to disabled workers. Two options for supplementing workers compensation payments are available for employees:
Alternatively a disabled worker may decide not to supplement their TD or may not be eligible to accrue sick leave (e.g., Faculty) (Option Three.) Option Two is the default. To select Option One, the Option Form must be completed and returned to UCSC Risk Services within ten (10) business days. If the employee does not return the Option Form within ten days, the use of sick leave only (Option Two) is automatically selected. Selection of Option One or Option Two will result in the employee receiving two checks for the same period of disability (one from Sedgwick CMS in the amount of 66 2/3% pay and one from UCSC Payroll in the amount of 100% or 80% pay.) An overpayment results from the employee's receipt of both checks, which is reconciled by Risk Services in the form of reimbursement to the employee's sick leave balance for the full amount and value of the temporary disability check. Once sick leave is reimbursed to the employee's sick leave balance, Payroll will then deduct the full amount of the temporary disability check from the employee's next UCSC payroll check. Therefore, employees are advised to save (not spend) their temporary disability check from Sedgwick CMS until the affected employee sees the workers' compensation deduction on their UCSC pay stub. Option OneThe injured employee elects to use sick leave and vacation to supplement Workers Compensation benefits. Option One allows a worker to be paid 100% of their regular earnings by using sick leave and vacation to supplement Workers Compensation Temporary Disability benefits. After sick leave and vacation accruals are exhausted, the employee will receive Supplemental Disability benefits from the University for up to 26 weeks, which combined with Workers Compensation Temporary Disability payments, will equal 80% of their regular salary. Supplemental Disability Benefits are also known as Extended Sick Leave Benefits (ESL). Option TwoThe employee elects to use only accrued sick leave to supplement Workers Compensation benefits. This is the default option. Option Two allows a worker to be paid 100% of their regular earnings by using only sick leave to supplement Workers Compensation Temporary Disability benefits. After sick leave is exhausted, the employee will receive Supplemental Disability Benefits from the University for up to 26 weeks, which combined with Workers Compensation Temporary Disability payments, will equal 80% of their regular salary. Option ThreeSick leave or vacation will not be used to supplement temporary disability paid by Sedgwick CMS. The employee will only receive temporary disability checks from Sedgwick CMS with NO Supplemental Disability benefits. For this option, if the employee wants to continue his/her personal health insurance coverage during her/his time off from work, the employee must contact UCSC Employee Benefits at (831) 459-4602 and arrange to pay the full cost of their health care premium directly. No University contributions for medical insurance coverage will be made. For the exception, see the FMLA Leave of Absence Guidelines and Procedures (pdf) (provided by Staff Human Resources). Workers Compensation' TD compensation is payable to a maximum of $916.33 a week or up to two-thirds of the employee's salary, whichever is less. Family Medical Leave (FMLA) EligibilityIt is the policy of the University of California to provide family and medical leave to eligible employees in accordance with the federal Family and Medical Leave Act of 1993 (FMLA). Departments are required to place their eligible employees on Family Medical Leave (FMLA). As soon as an employee misses more than three days of work due to an industrial injury, supervisors should contact the injured employee's HR Service Team to begin the process of placing the injured employee on FMLA. Extended Sick Leave Benefits
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| Option 1 | Option 2 | Option 3 | |
|---|---|---|---|
| Description | Employee chooses to use accrued sick leave (SL) and vacation leave (VL) to supplement TD payments. | Employee chooses to use only accrued sick leave (SL) to supplement TD payments. | Employee chooses not to use accrued sick leave (SL) or vacation leave (VL) or does not accrue either. (Casual employees may not receive all benefits listed.) |
| Compensation (TD = 66 2/3% gross salary to a maximum of $916.33 per week.) |
100% gross salary: TD+ SL/VL = 100% (2 checks) 80% gross salary: After SL/VL is exhausted, TD+UC salary check = 80% gross salary. UC check for Extended Sick Leave (ESL) continues up to 26 weeks (2 checks). 66 2/3% gross salary: TD check only after ESL (80%) benefit ends. The employee is now on Leave Without Pay (LWOP) from department. |
TD+ SL = 100% (2 checks). 80% gross salary: After SL is exhausted, TD+UC salary check =80% gross salary. UC check for Extended Sick Leave (ESL) continues up to 26 weeks (2 checks). 66 2/3% gross salary: TD check only after ESL (80%) benefit ends. The employee is now on Leave Without Pay (LWOP) from department. |
66 2/3% gross salary: TD check only. (Any UC check received for the same time period is an OVERPAYMENT and must be returned.) |
| Employee-Paid Disability Benefit (EPD) (If Enrolled) | After 80% gross salary ends, EPD + TD = 70% gross salary up to a $10,000 maximum per month. | After 80% gross salary ends, EPD + TD = 70% gross salary up to a $10,000 maximum per month. | Not eligible. |
| Health Insurance (LWOP - Medical Plan) | Both the employees + UCs contribution continue while on 100% and 80% pay.When 80% ends, UC continues contribution provided employee is on Leave Without Pay and receiving TD/VR maintenance allowance. | Both the employees + UCs contribution continue while on 100% and 80% pay.When 80% ends, UC continues contribution provided employee is on Leave Without Pay and receiving TD/VR maintenance allowance. | Must pay full premium to continue coverage. |
| Credit for Sick and Vacation Leave | At 100% pay, SL/VL is accrued at the normal rate and may be used as earned.At 80% pay, SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If employee terminates, employee will be paid for earned VL. | At 100% pay, SL/VL is accrued at the normal rate and may be used as earned.At 80% pay, | SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If employee terminates, employee will be paid for earned VL. SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If the employee terminates, employee will not be paid for earned VL. |
| Retirement Benefits (UCRS, PERS) | At 100% pay, deduction and service credit continue at the normal rate.At 80% pay, deduction and service credit continue at 80% the normal rate. | At 100% pay, deduction and service credit continue at the normal rate.At 80% pay, deduction and service credit continue at 80% the normal rate. | The employee must pay both the employee and the UC contribution to continue membership. |
| Voluntary Deductions (Life, Credit Union, etc.) | At 100% or 80% pay, deductions continue at normal rate.After 80% pay ends, employee must make arrangements to pay directly. | At 100% or 80% pay, deductions continue at normal rate.After 80% pay ends, employee must make arrangements to pay directly. | Employee must make arrangements to pay directly. |
| Taxability | Sedgwick CMS checks are tax free. |
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TD checks are mailed directly from Sedgwick CMS to an injured worker's home address. The employee's department will provide normal salary checks to an employee who is using sick and/or vacation leave. If both the TD & UC checks are cashed, the employee will be OVERPAID. UCSC Risk Services will send paperwork to instruct Payroll to deduct the employee's TD amount from the employee's paycheck. To reconcile, the employee needs to contact UCSC Risk Services at 459-2850 within a week of receiving the first TD check to discuss pay options.
Every two weeks, beginning with Sedgwick CMS's first payment of Temporary Disability (TD) benefits, the employee's Staff/Academic Resources Team will receive a Supplemental Workers' Compensation Benefits Calculation Instruction Sheet (Instruction Sheet) from Risk Services on how to process the employee pay and the sick leave/vacation used while the employee is on Workers' Compensation. These instruction sheets are based on the employee's option choice.
Last revised: November 05, 2007 (am)