Need Workers' Comp Help?
Call 831-459-2850

Other Risk & Insurance Help
Call 831-459-5154

Fax 831-459-3268
risk@ucsc.edu

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Workers' Compensation: Frequently Asked Questions for Supervisors

Summary: Answers to questions about workers' compensation for supervisors

• What should a supervisor do if an employee is very seriously injured at work?
• What should a supervisor do if an employee is injured at work?
• When should an injured employee receive an employee Claim Form?
• If an employee is seriously injured or reports an injury by phone or email rather than in person, how can a supervisor report the injury?
• What if an employee tells me that s/he was injured at work but that s/he does not want to file a Workers' Compensation claim?
• What is "first aid" medical treatment for the purpose of Workers' Compensation?
• Are supervisors required to provide employee claim forms for first-aid treatment?
• What documentation is required of an employee who loses more than three days from work because of a work-related injury?
• If an employee is injured in a unit other than the one in which the employee is employed, and reports the injury to the supervisor of the other unit, who is responsible for completing the forms?
• Is an employee who has not completed a physician designation form required to be treated by Santa Cruz Occupational Medical Center?
• What are University extended sick leave benefits?
• Who can supervisors/employees call if they have questions regarding workers' compensation benefits, workers' compensation program coverage, job accommodation, or campus workers' compensation procedures?

What should a supervisor do if an employee is very seriously injured at work?

1. CALL 911 IMMEDIATELY if on Campus to arrange for emergency transport of the severely injured employee to Dominican Santa Cruz Emergency Department located at 1555 Soquel Drive.
2. Report the injury immediately to:
   • The Office of Risk Services at (831) 459-2850
     If no answer, call the Director of Risk Services at (831) 345-0950.
   • Environmental Health and Safety at (831) 459-2553
3. Do the paperwork after dealing with the emergency - speedy medical treatment for severe injuries is the University's primary goal.

What should a supervisor do if an employee is injured at work and requires/desires medical treatment?

• During the hours of 8:00 a.m. to 4:30 p.m. on Monday through Friday: Send or transport (as required) the injured employee to Santa Cruz Occupational Medical Center at 610 Frederick St., Santa Cruz. You may assist with scheduling by calling (831) 457-7118.

• At ALL OTHER TIMES: Send or transport (as required) the injured employee to the Dominican Hospital Emergency Department at 1555 Soquel Drive - tell the injured employee to advise the Emergency Department personnel that he or she is an injured UCSC employee seeking medical care for an industrial injury.

FORMS - Upon being advised of an employee incident, injury or occupational illness, a supervisor or other University official to whom the incident is reported, has the following responsibilities:

1. For those employees requiring medical care, provide the injured employee with a "UCSC Employee Authorization for Medical Treatment" (Medical Authorization) form, completing the top portion of the form. Please note that employees may only be seen by their private physician if the employee has filed a "UCSC Employee Physician Designation Form" (Physician Designation Form) with the Office of Risk Services prior to the injury, and the physician designated on the form is one who has both treated the employee in the past and has the employee's medical records.

When the medical authorization form is completed, the University official providing the form should make a photocopy, fax a copy of the completed form to Risk Services and give the original copy to the employee. The employee will give this authorization to his/her medical provider.

2. The employee's supervisor must assure the completion of the UCSC Incident Report form within 1 business day of knowledge of the incident, injury or occupational illness. If the employee is unable to complete their portion of the form, the supervisor must complete the form on their behalf. Once completed, the supervisor should fax a copy to Risk Services (459-3268) and send the original copy to Risk Services.

CONTACT - If your employee requires medical treatment at the time of a work related injury, direct your employee to call you immediately if the doctor advises the employee that he or she will be unable to return to work that day and to bring you the work status report from the physician. If your employee advises that they anticipate missing more than three days of work, advise your employee that he or she will be required to obtain and provide you with a medical release from the doctor in order to return to work.

If your employee is off work for an extended period, keep in periodic contact. Call your employee weekly to inquire how the employee is doing, whether the employee has any questions on his or her workers' compensation or University benefits, if there is anything the Unit could do to help the employee return to work, whether the doctor has indicated when the employee might return to work, and to assure the injured worker that he or she is a valued employee and is being missed by the Unit.

EXCEPTION: An exception to contacting injured employees may exist where an employee has a psychiatric claim. In these situations, the Office of Risk Services (459-2850) should be contacted prior to any contact with the injured employee. Do not contact the injured employee without first consulting UCSC Risk Services.

When should an employee receive an Employee Claim form (DWC-1)?

The Office of Risk Services will provide an employee with the Employee Claim Form (DWC-1). By law, the employer is required to provide a Claim form to an industrially injured employee within one business day of knowledge of the injury. If the employee's injury or illness is medically determined to be beyond First Aid treatment the employee will be provided with a Workers' Compensation Claim form (DWC-1) either by the Office of Risk Services or the clinical practitioner.

If an employee is seriously injured or reports an injury by phone or email rather than in person, how can a supervisor assure that the employee is provided a claim form?

The employee's supervisor should immediately notify the Office of Risk Services then complete the UCSC Incident Report and the UCSC Authorization for Medical Treatment. Both forms should be faxed to Risk Services. The Office of Risk Services or the medical provider will provide the employee with the Claim form if medical treatment is beyond First Aid.

What if an employee tells me that s/he was injured at work but that s/he does not want to file a Workers' Compensation claim?

The supervisor and employee are required to report the incident, injury or occupational illness. The supervisor must complete the same investigation and paperwork and forward same to Risk Services. Incident reporting ensures there is a record on file with the employer. The employee should be made aware that their private health insurance may not pay for treatment for an on-the-job injury or illness!

Having reported their injury to their supervisor documents the employee's claimed injury and preserves their rights under workers' comp. Risk Services reports the case to Sedgwick CMS as an incident only.

IMPORTANT: Sometimes employees hesitate to file a workers' comp claim out of fear of appearing disloyal. Employees should be relieved of this misperception and helped to understand the importance of receiving appropriate treatment early. If they think their injury is severe enough to warrant a medical examination, the supervisor must complete a UCSC Incident Report form and the UCSC Authorization for Medical Treatment form.

What is "first aid" treatment for the purpose of Workers' Compensation?

First Aid means any one-time treatment, and any follow-up visit(s) for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. The one-time treatment, and follow-up visit(s)for the purpose of observation, are considered first aid even though provided by a physician or by registered professional personnel.

Are supervisors required to provide employee claim forms for first-aid treatment?

No. Under the current process, supervisors do not provide employees with the Employee Claim form (DWC-1) under any circumstances. This task is performed, if necessary, by the Office of Risk Services. Supervisors must complete the UCSC Incident Report form for any incident, injury or work related illness.

What documentation is required of an employee who loses more than three days from work because of a work-related injury?

The employee must provide his/her supervisor with a medical release to return to work from the employee's treating physician. Such medical releases may contain temporary job restrictions which are required for the employee to return to work. Office of Risk Services (ORS) encourages units to accommodate employee temporary job restrictions whenever possible by providing modified transitional work assignments. If there are any questions regarding a unit's ability to accommodate an employee's temporary job restrictions, contact ORS at 459-1787.

If an employee is injured in a unit other than the one in which the employee is employed, and reports the injury to the supervisor of the other unit, who is responsible for completing the forms described above?

The supervisor or University Official to whom the injury is reported should provide the employee with a UCSC Employee Authorization for Medical Treatment and contact the employee's supervisor to have the other forms completed.

Is an employee who has not completed a physician designation form required to be treated by Santa Cruz Occupational Medical Center?

Yes, unless the employee both lives and works outside the Santa Cruz area, in which case they will be directed to a local UCSC-designated facility.

What are University extended sick leave benefits?

Extended Sick Leave (ESL) benefits are benefits paid by an industrially injured employee's unit which supplement the employee's workers' compensation temporary disability payments to 80% of the employee's regular earnings for up to 26 weeks, after the employee has exhausted his/her sick leave accruals.

Who can supervisors/employees call if they have questions regarding workers' compensation benefits, workers' compensation program coverage, job accommodation, or campus workers' compensation procedures?

Last revised: April 23, 2008 (am)