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Workers' Compensation: Frequently Asked Questions for Employees

Summary: Answers to questions about workers' compensation for employees

• When is an injury or disease covered by Workers' Compensation?
• How do I report a Workplace Incident, Injury or Occupational Illness?
• When is an Incident considered Worker's Compensation?
• Who is covered by the Campus' Workers' Compensation Program?
• Who is not covered by the Campus' Workers' Compensation Program?
• What must an employee do to be eligible for University extended sick leave benefits?
• Will employees be over paid during the time they are using their sick (and vacation) leave to supplement their workers' compensation temporary disability payments to 100% of regular earnings?
• How much sick leave should be credited back to an injured employee's sick leave accrual when the employee's temporary disability payments are deducted from the employee's regular pay?
• Where can I get the forms?
  

When is an employee's injury or disease covered by Workers' Compensation?

To be covered by workers' compensation an employee injury or disease must have all three of the following elements:

1. There must be an actual injury or disease process as opposed to a mere exposure -for example a mere incidental contact with asbestos is not an injury for the purposes of a workers' compensation claim, it is merely an exposure;
2. The injury or disease must occur in the course of employment (COE) - meaning that the employee must be at the work site and on pay status at the time the employee is injured or contracts the disease; and
3. The injury or disease must arise out of employment (AOE), meaning that the employee was doing his or her job duties or tasks related to such job duties at the time of injury. 

In summary, the employee must have incurred some injury or illness that is job related.

How can an employee report a workplace incident, injury or occupational illness?

There are two methods by which an employee can report a worplace incident, injury or occupational illness to the University:

1. The employee may simply advise his or her supervisor or a University Official that he or she has suffered an incident, injury or incurred some illness as a result of the employee's University work. NOTE: Such notification may be made in numerous ways such as: by phone, voice, or email, or by members of the employee's family or friends or legal representatives on the employee's behalf. On occasion, an employee may call in to report off work due to an injury and not specifically state whether the injury is work related. In these situations, it will be necessary to clarify with the employee exactly how the employee was injured and where the injury occurred in order to determine whether or not an incident report should be filed.
2. The employee may complete and return a UCSC Incident Report Form to either his or her supervisor or a University Official with Affirmative Action, Risk Services, Human Resources, Equal Employment Opportunity/Affirmative Action (EEO/AA) or the Campus Title IX Office.

If either or both of the above are done by the employee, an incident is officially filed.

When is an incident considered a workers' compensation claim?

1. If an employee of UCSC is covered under the campus workers' compensation program (see criteria below) and requires or requests medical treatment or consult with a medical practitioner as a result of a work related incident, injury (or occupational illness), the employee may make an appointment with Santa Cruz Occupational Medical Center (610 Frederick Street, Santa Cruz), a UCSC medical provider as designated outside the Santa Cruz area, or a pre-designated physician (the name of the workers' compensation pre-designated physician must be on file in the Office of Risk Services (ORS) prior to the date of injury).
2. The employee must provide the treating physician with a completed UCSC Employee Authorization for Medical Treatment form.
3. The treating physician will determine if the injury requires medical treatment beyond "first aid". If the determination is made by the medical provider that a workers' compensation claim is necessary, the Office of Risk Services will provide a workers' compensation claim form. If a claim form is mailed to you, please complete the employee section of the claim form and submit the completed form to the Office of Risk Services.
4. If an employee wishes to file a claim form independent of the medical provider determination, please contact the Workers' Compensation Claims Coordinator at 459-2850.

Who is covered by the Campus' Workers' Compensation Program?

There are three categories of persons who may be covered by the Campus' Workers' Compensation Program. These are:

1. Employees - including both staff, faculty and student employees; full, part-time, and temporary employees; and student research assistants (SRA's) and teaching assistants (TA's) if paid with University funds. The basic rule is that anyone working in California who is paid on the University payroll is eligible for coverage by the Campus' Workers' Compensation program.
2. University Volunteers - persons providing service for the primary benefit of the University (as opposed to providing service for the primary purpose to obtain some type of certification, obtain academic credit, or work off some type of fine or punishment) may be covered by the Campus' Workers' Compensation Program PROVIDED such volunteers have:
   • Completed a UCSC Volunteer Election form prior to their injury AND
   • The University Unit/Department for which the volunteer is providing service has maintained a written record of the dates and times when volunteer services were provided and the duties assigned to the volunteer. In the event of a volunteer injury this information will be required to determine whether or not the volunteer was engaged in service for the University at the time of injury.
3. Persons for whom the University has agreed in a formal written contract with another institution to provide workers' compensation coverage. All such contracts must have the approval of the Office of Risk Services for coverage to be effective.

Who is not covered by the Campus Workers' Compensation Program?

1. OUT-OF-STATE EMPLOYEES - Persons who are not California Residents AND who are hired by the University to work at a work-site outside of the State of California are not covered by the Campus Workers' Compensation Program. Special Workers' Compensation coverage must be secured in advance for such employees. To obtain the coverage, the employee's Unit/Department must complete a Request for Out of State Workers' Compensation Coverage form and forward the form to the Workers' Compensation Unit in the Office of Risk Services (ORS) not less than 30 calendar days prior to the employee's start date. The employee's unit will be billed by Office of the President, Risk Services (OPRS) for the insurance premium.
2. CONTRACTOR EMPLOYEES - Persons such as contract employees and vendor employees are not covered by the Campus Workers' Compensation program. If such employees report an injury, they should be directed to contact their direct supervisor. If such employees are very seriously injured, call 911 to arrange for transport to emergency medical care.
3. STUDENTS are not covered by the University's Workers' Compensation Program for their activities unless they are either
   • engaged in University volunteer service or
   • are being paid by the University as a University employee at the time of injury.
4. ALL OTHERS - Any other person, such as a campus visitor, who is not included within one of the three classes of persons covered by the Campus Workers' Compensation Program is not covered by the Program.

What must an employee do to be eligible for University extended sick leave benefits?

The University extended sick leave benefit provides salary continuation up to 80% of the employee's pre-injury wage for 26 weeks. Only university employees who are eligible for sick leave benefits and who have been approved for temporary disability payments by our workers' compensation third party administrator are eligible for University extended sick leave benefits. The employee can elect to use both sick and vacation accruals to supplement the temporary disability payments to 100% of regular earnings, but the employee is not required to do so. Forms for employee use in electing to use sick leave and vacation are available from the Office of Risk Services x 2850 and are automatically provided to all eligible employees who lose more than three days of work because of a work-related injury. NOTE: sick leave accrual balances must be exhausted before extended sick leave benefits begin.

Will employees be over paid during the time they are using their sick (and vacation) leave to supplement their workers' compensation temporary disability payments to 100% of regular earnings?

Employees eligible for sick leave (and vacation) benefits will be paid by the university to 100% of their regular earnings while they have sick leave (and/or vacation leave if elected) balances to cover their absence. While the employee is using his or her sick leave (and vacation if the employee so elects), the employee will be receiving regular pay from the University and temporary disability (TD) payments from Sedgwick, CMS. The employee will therefore be overpaid by the amount of the Sedgwick, CMS TD payments, and these TD payments will subsequently be deducted from the employee's University pay. (Note: There is often a delay in the TD deduction appearing on the employee university paycheck/paystub so employees are cautioned against spending more than 100% of their usual pay. There is NO financial windfall with Workers' Compensation.)

How much sick leave should be credited back to an injured employee's sick leave accrual when the employee's temporary disability payments are deducted from the employee's regular pay?

The amount of sick (vacation) leave credited back to the employee's sick (vacation) accruals is equal to the total of the workers' compensation temporary disability payments deducted from the employee's pay divided by the employee's hourly pay rate. For example an employee receiving temporary disability (TD) payments of $800 who earns $15 per hour would be entitled to reimbursement of 53 hours of sick (vacation) leave (800/15). Vacation time used to compensate an employee while on workers' compensation temporary disability is credited back as sick leave.

Where can I get the forms?

Last revised: October 24, 2007 (am)