UC IRVINE ADMINISTRATIVE POLICIES & PROCEDURES

Responsible Office: Human Resources Revised: April 2007 (reviewed July 2008)

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 73, Workers' Compensation Self-Insurance Program

UC Office of Risk Management

UC Personnel Policies for Staff Members

Policy 43, Leave of Absence
Policy 44, Work-Incurred Illness and Injury
Policy 66, Medical Separation
Policy 81, Reasonable Accommodation

UCI Administrative Policies and Procedures
Section 300-16, Transitional Work Program Policy
Section 300-17, Transitional Work Program Guidelines


Personnel Procedures for UCI Staff Members
Personnel Procedure 44, Work-Incurred Illness and Injury

UCI Information Packet: Family Medical Leave Act (FMLA) and California Family Rights Act (CFRA)

A. Overview

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.
  
• Compensation payments to help replace lost wages.
  
• Permanent disability benefits to compensate for diminished earning capacity.
  
• Vocational rehabilitation and reasonable accommodation.
  
• Death benefit for survivors in the case of fatal injury.

For questions, contact Human Resources-Workers' Compensation at (949) 824-7008 or workcomp@uci.edu.

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

1. Emergency

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.

2. Non-Emergency

a. Medical Facilities

If there is no pre-designated physician, the employee should be directed to one of the following medical facilities:


During regular business hours:

Newport Urgent Care, (949) 752-6300 (located off-campus, map)
Occupational Health Clinic, (714) 456-8300 (at UCI Medical Center, map)
Occupational Services, (562) 933-0085 (located near Long Beach Memorial Hospital, map)


After regular business hours and weekends:

Irvine Regional Medical Center, (949) 753-2244
Newport Urgent Care, (949) 752-6300 (located off-campus, map)
Occupational Health Clinic, UCI Medical Center, (714) 456-8300 (at UCI Medical Center, map)

Employees who are unable to seek medical attention at one of these clinics should contact Human Resources-Workers' Compensation, (949) 824-7008 or Sedgwick CMS, (619) 294-2178, for a clinic referral.

b. Transportation to the Medical Facility

For serious injuries not requiring emergency treatment, University Police will arrange transportation to Newport Urgent Care or Sand Canyon Urgent Care. Even if the injury is minor and unlikely to result in complications or disorientation, no employee should be left alone to seek medical assistance.

c. Using Off-Campus Medical Facilities

When employees visit an off-campus medical facility for treatment of work-incurred injuries, they should inform the facility that the insurance administrator for UCI is:

Sedgwick CMS
P. O. 639028
San Diego, CA 92163-9028
(619) 294-2178

d. 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 Octagon Risk Services.

e. 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.

The physician must be the employee's personal physician who has previously directed the employee's care and maintains employee's medical records. A personal physician is defined to include a corporation, such as Kaiser, partnership, or an association of doctors of medicine or osteopathy.

D. Reporting the Work-Related Injury or Illness

1. Employees

Injured employees must promptly report the injury or illness to their supervisor by e-mail, telephone, or in person, and complete an Employee Incident Report. Injured employees will be given a DWC-1 form, Employee's Claim for Workers' Compensation Benefits. If the injured worker chooses to file a claim, the DWC-1 must be completed and returned to the employer.

2. Supervisors

If immediate medical attention is necessary, the supervisor should assist the employee. Instruct the employee to complete the Employee Incident Report, and give a DWC-1 form, Employee's Claim for Workers' Compensation Benefits, 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) 824-7008. All completed forms should be sent to Human Resources-Workers' Compensation, ZotCode 4600.

If the employee is unable to complete the Employee Incident Report, the supervisior must complete it on their behalf. Additionally, if an employee is hospitalized for 24 hours or more, the department must immediately inform EH&S and provide:


1. Time and date of accident;
   
2. Employer's name, address and telephone number;
   
3. Name and job title, or badge number of person reporting the accident;
   
4. Address of site of accident or event;
   
5. Name of person to contact at site of accident;
   
6. Name and address of injured employee(s);
   
7. Nature of injury;
   
8. Location where injured employee(s) was (were) moved to;
   
9. List and identity any other law enforcement agencies present at the site of accident; and
   
10. Description of accident and whether the accident scene or instrumentality has been altered.

Also, work-incurred deaths must be reported immediately to EH&S at(949) 824-8024, as required by California Division of Occupational Safety and Health.

E. Time Lost From Work Due to a Work-Related Injury or Illness

1. Employees

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 medical authorizations prior to ending date of previous authority.

Personnel Procedure 44, Work-Incurred Illness and Injury, describes the employee's responsibilities and disability benefits.

2. Supervisors

When employees are unable to work due to a work-incurred injury or illness, supervisors must notify Human Resources-Workers' Compensation. Personnel Procedure 44 describes the department's responsibilities and procedure 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.

Obtain more workers' compensation information by visiting Human Resources-Workers' Compensation, calling (949) 824-7008, or emailing workcomp@uci.edu.