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Workers' Compensation Handbook - Chapter 8
Summary: Chapter 8 - Responsibilities
Contents Index Previous Next
Introduction
The responsibilities of various members of the campus community with regard to occupational injuries are described in this chapter. These lists include both preventive behaviors and process steps for recovery. The responsibilities of individual employees, supervisors, and campus units are provided below. Responsibilities are listed for the following groups of people:
* Injured or ill employees
* Supervisors
* Santa Cruz Occupational Medical Center (SCOMC)
* Dominican Hospital Emergency Department
* Physician/Health Care Provider
* Risk Services
* Environmental Health and Safety Office
* Sedgwick Claims Management Services (Sedgwick CMS)
* Staff/Academic Human Resources Office
* Payroll Office
* Fire and Police Departments
* Disability Management Services
* Benefits Office
* Employee Assistance Program (EAP)
* Equal Employment Opportunity Office (EEO)
* Labor Relations Office
* Ombudsman
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Employee Responsibilities
An employee with a work-related injury or illness is responsible for taking the actions described in this section. Also, all employees need to follow the preventative measures described below.
- Report work-related injuries and illnesses promptly to the supervisor.
- Cooperate with UCSCs efforts to provide timely, fair, and equitable benefits pursuant to state laws and UC procedures.
- Comply with all Occupational Safety and Health Standards (OSHA) and campus safety rules, regulations, and orders, which are applicable to your own actions and conduct.
- Take every reasonable precaution to work in a safe manner and not put yourself or others at risk.
- Do not remove, displace, damage, destroy, or carry off any safety device, notice, or warning furnished for use in any place of employment or interfere in any way with the use by any other person.
- Use safety gear provided to you to perform work tasks in a safe manner.
- Learn about potential job hazards and observe potential warning signs.
- Immediately inform your department about any work restrictions and/or capabilities as outlined by your physician when you return to work.
- Provide your supervisor with a doctors release to return to work if absent from work more than three (3) days.
- Participate in modified transitional work assignments.
- Comply with policy or bargaining agreement terms regarding workers compensation.
- Maintain and retain a copy of accurate time and attendance records regarding time off work for workers compensation-related absences.
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Supervisor Responsibilities
Supervisors are expected to assure safe work conditions and safe work practices in the workplace. A list of specific responsibilities is provided below.
- Obtain immediate emergency medical care for serious injuries. Direct injured employees to Santa Cruz Occupational Medical Center (SCOMC), for less than life or limb-threatening injuries (see Treatment in Santa Cruz County.)
- Provide an injured or ill employee with a UCSC Medical Authorization form immediately if the employee wishes to seek medical treatment for their work-related injury or illness.
- Complete and process the UCSC Incident Report form within 24 hours of knowledge of the employee’s injury or illness.
- Notify the academic or staff human resources representative when an employee is off work or returns to work. (The workers’ supervisor is responsible to ensure that Risk Services, Benefits, Payroll, and Sedgwick CMS get notified.
- Notify Staff/Academic Human Resources, Risk Services, and Sedgwick CMS when the employee’s illness or injury is Permanent and Stationary (P&S).
- Forward signed time sheets to the employee’s Staff/Academic Human Resources Representative.
- Coordinate personnel actions involving industrially injured employees with Staff/Academic Human Resources, and Labor Relations.
- Secure appropriate return to work certification from an employee prior to or at the beginning of the shift on date of the employees return to work.
- Become knowledgeable about appropriate safety practices and personal protective equipment required by subordinates to safely perform job duties, and reinforce compliance with safety practices and use of personal protective equipment.
- Attend Workers' Compensation training.
- Review available Safety information.
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Santa Cruz Occupational Medical Center (SCOMC)
Santa Cruz Occupational Medical Center (SCOMC)
610 Frederick Street
Santa Cruz, CA
831-457-7118
8 a.m. to 4:30 p.m. Monday through Friday, except holidays
Santa Cruz Occupational Medical Center agrees to provide the following services for occupationally injured and ill UCSC workers:
- Provide occupational medical management and treatment;
- Prescribe occupational therapy and physical therapy when needed;
- Order on-site ergonomic workstation/workstyle assessments when indicated;
- Provide specialty referrals for injured and ill employees on an as-needed basis:
- Medical Specialty consultants
- Pain Management Program for injections
- Chiropractic assessment and adjustments
- Transitional strengthening and conditioning at the UCSC Wellness Center
- Acupuncture treatments
- Work with UCSC and Sedgwick CMS to help the injured employee be able to safely return to work as quickly as possible;
- Review medical status bi-monthly with Sedgwick CMS, Disability Management Coordinator and Risk Servicesof all injured employees being treated by SCOMC;
- Complete the Doctors First Report and subsequent work status reports and fax them to Risk Services at 459-3268 and to Sedgwick CMS.
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Dominican Hospital Emergency Department
Dominican Hospital Emergency Department
1550 Soquel Drive
Santa Cruz, CA
(831) 462-7710
Dominican Hospital Emergency Department agrees to provide care for injured and ill UCSC workers when SCOMC is not open. Their care provider(s) will then complete the Doctor's First Report and identified work restrictions and fax them to Risk Services at 459-3268 and to Sedgwick CMS. Patients will be referred to SCOMC for follow-up visits.
UCSC Student Health Center
Cowell Student Health Center no longer provides medical or first aid treatment for occupational work injuries (including work injuries involving student employees). Employees who report to the Cowell Student Health Center with an occupational injury or illness will be referred to Santa Cruz Occupational Medical Center, 610 Frederick Street, Santa Cruz, CA.
Under no circumstances should a request for emergency ambulance transport to Dominican Hospital be delayed in order to move a life or limb-threatened employee to the Student Health Center.
Cowell Student Health Center may provide limited emergency interaction to assist in stabilizing an employee with a life or limb threatening work injury while arranging transportation to Dominican Hospital Emergency Department.
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Personal Physician/Health Care Provider
A health care provider examining and/or treating an employee for a work-related illness or injury has the following responsibilities:
- Complete the Doctors First Report and fax it to Risk Services at 459-3268 and to Sedgwick CMS.
- Provide information regarding the employees medical status, physical limitations, anticipated return-to-work date, and prognosis for 100% capacity to perform the essential functions of the job.
- Participate in the evaluation of physical restrictions.
- Complete documents verifying date of injury, treatment(s), and anticipated return to work date.
- Comply with all provisions of the California Labor Code for employee-selected physicians.
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Risk Services
The Risk Services manages the UCSC workers compensation program. Specific responsibilities include coordination, facilitation, analysis, reporting, advising, and providing consultations and training. Specific descriptions are listed below.
- Coordinate UCSC Workers Compensation Program activities.
- Process and submit the Employers Report of Occupational Injury and Illness to Sedgwick CMS.
- Process sick leave and vacation Extended Sick Leave (ESL) supplement forms.
- Develop and interpret workers compensation policy and procedures and facilitate understanding of them.
- Provide interpretation of workers compensation laws, benefits, and regulations.
- Facilitate program communication flow and solicit input and feedback from other areas involved.
- Act as campus liaison with workers compensation third-party claims administrator (Sedgwick CMS) and legal counsel.
- Coordinate information for cases that have concurrent personnel actions occurring or in which multi-forum claims have been filed.
- Facilitate multi-forum claim settlements in conjunction with Labor Relations.
- Coordinate workers compensation claim litigation with campus personnel and the Office of General Counsel.
- Recommend allocation of workers compensation costs and negotiate unit contributions to multi-forum settlements involving workers compensation claims with involved units.
- Recommend appropriate measures for use of rate additive funds to reduce workers compensation program costs.
- Identify departments warranting special injury prevention efforts.
- Collect and analyze data regarding the program and recommend changes to departments.
- Prepare reports of workers compensation loss experience.
- Counsel department representatives and employees regarding Workers Compensation principles, practices, and procedures.
- Recommend loss prevention and loss control programs.
- Answer employee and department questions about coverage.
- Provide training to departments on ways to reduce Workers Compensation costs.
- Advise and consult regarding communication with injured employees.
- Advise departments of sick leave buy back, the start of extended sick leave, and related ESL benefits questions.
- Maintain completed Physician Designation forms.
- Authorize temporary disability and wage loss payments using the Temporary Disability Register and fax it to payroll.
- Coordinate Transitional Return to Work activities for those employees with temporary work restrictions as a result of their work-related injury or illness.
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Environmental Health and Safety Office
The Environmental Health and Safety Office (EH&S) provides services designed to protect the health and safety of staff, academics, and students and prevent injuries. These services are listed here:
- Interpret health and safety regulations and helps departments meet these requirements.
- Assist departments in developing training, monitoring compliance, and delivering accident prevention programs to prevent injuries and work-related illnesses.
- Inspect campus facilities to evaluate health and safety concerns and makes recommendations for reducing or eliminating hazards.
- Investigate employee and student complaints regarding hazardous campus conditions, evaluate the hazard, and recommend and facilitates hazard abatement.
- Provide training for supervisors in occupational safety and employee injury prevention.
- Perform on-site investigations of employee injuries, reporting to injured employees supervisor, Staff/Academic Human Resource designees, and Risk Services the cause of the injury, any hazardous situation found, and recommendations for correction of any hazard or prevention of further or additional injuries.
- Report injuries and illnesses to Cal-OSHA., when deemed necessary due to one or more of the following situations:
- hospitalization for more than 24 hours for reasons other than observation
- amputation
- death
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Sedgwick Claims Management Services
Sedgwick CMS is the UCSC Workers' Compensation Claims Administrator. See Contact Info.
Sedgwick CMS is an independent claims management firm contracted to service the University of California Workers Compensation Program statewide. Known as the Third Party Administrator (TPA), Sedgwick CMS contracts with UC to administer workers compensation claims filed by UC employees and provide workers compensation benefits to eligible UC employees. Specific responsibilities include the following functions:
- Promptly investigate all reported claims, obtaining employee medical and personnel records as needed.
- Determine the liability associated with occupational injury or illness claims.
- Determine the compensability of claims, promptly accepting compensable claims and denying non-compensable claims, in strict accordance with California law.
- Authorize medical treatment.
- Determine eligibility for Workers' Compensation benefits (e.g., Temporary Disability, payment of medical expenses, and Permanent Disability).
- Retrieve medical information regarding an occupational injury/illness from the treating doctor or facility.
- Ensure that an employee receives legally mandated Workers' Compensation notices.
- Ensure prompt payment of benefits due to injured employees in accordance with the California Labor Code.
- Advise UCSC of injured worker medical status, physical restrictions, and potential ability for employee to return to work.
- Coordinate employee return-to-work with UCSC Transitional Return to Work Coordinator.
- Arrange for UCSC defense of litigated compensation claims and coordinates such defense through Risk Services.
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Staff/Academic Human Resources
Staff/Academic Human Resources Representatives' responsibilities may include the following jobs:
- Notify UCSC Risk Services when an employee is off work or just returning to work.
- Notify Risk Services, Payroll, and Sedgwick CMS when employee is off work or just back to work - under direction of the workers supervisor.
- Determine employee eligibility and process forms needed to place injured employee on Family and Medical Leave.
- Perform OEU (online entry update in PPS) to reflect appropriate leave status.
- Provide accurate vacation and sick leave totals to Risk Services.
- Work with units to ensure continuity of staffing levels while injured employee is off work, unable to perform the full range of job duties, or working a reduced schedule.
- Complete the workers compensation insurance application for all out-of-state employees and forward application to Risk Services.
- Advise Risk Services of termination of out-of-state-employees.
- Process and maintain time and attendance records which reflect reinstatement of sick leave, extended sick leave, reduced work schedules, disability leaves, etc., related to workers compensation claims.
- Process payroll which reflects extended sick leave, reduced work schedules, etc. related to workers compensation.
- Process medical separations in consultation with Disability Management Services.
- Provide consultation, HR policy interpretation and procedural information in conjunction with other departments on the following topics:
- Compensation
- Leaves of Absence
- Performance Management
- Employee Relations
- Attend Workers' Compensation training.
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Payroll Office
The responsibilities of the Payroll Office are listed below:
- Provide guidance to Staff Human Resources in calculating and reporting time for employees during various stages of the workers compensation process.
- In conjunction with the Benefits office, process insurance continuation payments from employees who are either ineligible for or who have exhausted all extended sick leave benefits and have subsequently been placed on leave without pay.
- Obtain recovery of temporary disability advances and wage loss payments, either through the payroll system or through Series Z if the employee terminates, crediting appropriate departmental FOAPAL (fund-organization-account-program-activity-location code).
- Obtain recovery of unit advance payments of outstanding temporary disability payments from employee workers compensation claim settlements when possible.
- Ensure proper tax treatment/reporting.
- Provide detailed listing to Risk Servicesof recovery of temporary disability advance or wage loss payments processed through the payroll system.
- Respond to employee inquiries regarding workers compensation deductions from paychecks.
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Fire and Police Departments
Fire and Police departments are expected to inform the service center and Risk Services when their department(s) receives a reimbursement from Sedgwick CMS and forwarding a copy of the check to Risk Services.
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Disability Management Services
The following services may be provided or recommended by the Campus Disability Management Coordinator or by an external professional:
- Determination of disability status and coordination of employment accommodations
- Counseling
- Job analysis
- Medical separation (processed by campus Vocational Rehabilitation Coordinator only)
- Job modification assistance
- On-the-job training or formal training for alternative employment
- Job placement assistance
- Consultation to departments and employees in returning injured workers with permanent disabilities to the job
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Benefits Office
The Benefits Office provides the following services.
- Administers comprehensive UC benefits programs and provide information and counseling for staff, faculty, and eligible dependents regarding health and assistance plans, including disability insurance.
- Provides consultation and information regarding the University of California Retirement and Disability Income Plan (UCRP).
- Processes direct premium payments from employees to continue University sponsored health and welfare benefits.
- Assists industrially injured employees in applying for non-industrial disability benefits while Sedgwick CMS is investigating the employees compensation claim.
- Authorize medical premium payment from system-wide contingency fund for employees on approved leave without pay and receiving payments from Sedgwick CMS.
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Employee Assistance Program (EAP)
The EAP is an employee assistance program that provides confidential consultation and referral services for UCSC staff and academics for personal and work-related problems. United Behavioral Health provides UCSC employees with EAP services. Their staff is available 24 hours a day, seven days a week at 1-866-808-6205 or 1-800-842-9489.
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Equal Employment Opportunity Office
The Equal Employment Opportunity Office provides consultation on ADA rights and responsibilities for employees who have active workers compensation claims.
Labor Relations Office
The Labor Relations Office provides consultation and contract and policy interpretations when an employee who has an active workers compensation claim also files a grievance with Labor Relations.
Additionally the Labor Relations Office participates in the resolution of multi-forum claims including global settlements in conjunction with Risk Services for workers with a workers compensation claim.
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Ombudsman
The Ombudsmans Office assists students, staff, and faculty in achieving informal resolution of complaints and conflicts which stem from UCSC policies, procedures, practices, and intracampus relationships. They are responsible to do this in a confidential, impartial, and neutral manner.
Last revised: January 15, 2008 (am)
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