UC IRVINE ADMINISTRATIVE POLICIES AND PROCEDURES
Sec. 300-15: Work-Related Accidents and Injuries Procedures
Responsible Office: Human Resources
Revised: April 2012
References / Resources
- California Division of Workers' Compensation
- California Division of Occupational Safety and Health
- Family Medical Leave Act (FMLA)
- California Family Rights Act (CFRA)
- UC Business and Finance Bulletin
- BUS 81, Workers' Compensation Self-Insurance Program
- UC Office of Risk Management
- UC Academic Manual (APM) - 710
- UC Personnel Policies for Staff Members
- UCI Administrative Policies and Procedures
- Personnel Procedures for UCI Staff Members
- UCI Guidelines: Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA)
Contact: HR-Workers' Compensation at (949) 824-9152 or firstname.lastname@example.org
The University's Workers' Compensation Self-Insurance Program was established in accordance with Calfornia workers' compensation laws. The benefit structure defines what injured workers are entitled to receive when they sustain an injury arising out of and in the course of their employment. Depending on the nature and severity of the worker's injury, the potential benefits are:
- Medical services reasonably required to cure or relieve the effects of the injury, with no deductible or co-payments by the injured worker.
- Temporary disability benefits to help replace lost wages.
- Permanent disability benefits to compensate if the employee does not completely recover.
- Supplemental job displacement benefits (for injuries in 2004 or later): Voucher to help pay for retraining or skill enhancement if the employee does not recover completely or return to work for the employer.
- Death benefits for dependents in the case of fatal injury.
For questions, contact Human Resources-Workers' Compensation at (949) 824-9152 or email@example.com.
B. Workers' Compensation Insurance Coverage
All persons working for the University as employees or registered volunteers qualify for coverage. Students (other than student employees) and employees of outside agencies are not covered, even though the claimed injury may have occurred at UCI. The validity of each claim and coverage is determined in accordance with California law.
Workers' Compensation may not cover injuries that result from the employee's voluntary participation in any off-duty recreational, social, or athletic activity that is not a part of the employee's regular work-related duties.
C. Medical Treatment
For serious injuries, the employee should obtain treatment at the nearest Emergency Room or, if necessary, call the University Police at 911 for paramedic response. Any incident that creates a hazard to personnel should be reported immediately to Environmental Health & Safety (EH&S) at (949) 824-6200.
- Medical Facilities
See Obtain Medical Care for clinic locations and contact information.
- Using Off-Campus Medical Facilities
When employees visit any medical facility for treatment of work-incurred injuries, they should inform the facility that the insurance administrator for UCI is:
Lexington, KY 40512-4533
(619) 319-1440 / fax (619) 321-1449
- Changing Physicians
After thirty days, the employee is entitled to a change of physicians. Written notification of a request for change of physicians should be directed to Human Resources-Workers' Compensation, or Sedgwick CMS.
- Pre-Designation of Medical Provider
Employees may use their personal physician, instead of the above-named providers, if they have filed a Pre-Designation of Personal Physician form prior to the date of injury. The employee must complete the form and give it to their home department. The department must send a copy to Human Resources-Workers' Compensation, ZotCode 4600, as well as retain a copy in the employee's personnel file. Refer to the Pre-Designation of Personal Physician form for more information.
- Medical Facilities
D. Reporting the Work-Related Injury or Illness
Injured employees must promptly report the injury or illness to their supervisor by e-mail, telephone, or in person, and submit an Incident Report using one of the following options: a) complete the Incident Report online OR b) call 1-877-682-7778 to be connected to the insurance administrator’s call center. Injured employees will be given a DWC-1 (claim form) and Notice of Potential Eligibility (NOPE). If the injured worker chooses to file a claim, the DWC-1 must be completed and returned to the employer. For more information see How To: Report a Work Related Injury/Illness - for Employees.
If immediate medical attention is necessary, the supervisor should assist the employee. Instruct the employee to submit an Incident Report using one of the following options: a) complete the Incident Report online OR b) call 1-877-682-7778 to be connected to the insurance administrator’s call center. Give a DWC-1 (claim form) and Notice of Potential Eligibility (NOPE) to the employee within one working day of notice of potential work-related injury/illness. Within 24 hours of notification of any work-related injury or illness, the supervisor must report it to Human Resources-Workers' Compensation at (949) 824-9152. All completed forms should be sent to Human Resources-Workers' Compensation, ZotCode 4600.
E. Time Lost From Work Due to a Work-Related Injury or Illness
Employees must give their supervisor a doctors' release to return to work prior to the return date. If there are restrictions in the release, the employees must contact their supervisor and provide a copy of the physician's restrictions before returning to work.
Employees are responsible for providing ongoing medical authorization for Workers' Compensation leaves of absence to the employer. In all cases, the supervisor should receive an updated medical authorization from the employee by the ending date of the prior authorization.
Personnel Procedure 44, Work-Incurred Illness and Injury, describes the employee's responsibilities and disability benefits.
When employees are unable to work due to a work-incurred injury or illness, supervisors must notify Human Resources-Workers' Compensation. Personnel Procedure 44 contains guidelines for initiating a Workers' Compensation Leave.
Supervisors are responsible for identifying the injured employee's total days lost and days restricted. When applicable, supervisors must provide temporary modified work as described in Section 300-17, Transitional Work Program Guidelines.