This policy directs and outlines the responsibilities for UCSF employees; supervisors; UCSF Disability Management Services; and UCSF Workers’ Compensation should a work-related injury or illness arise within the course and/or scope of employment.
Every person in the service of an employer under any appointment or contract of hire or apprenticeship, express or implied, oral or written, whether lawfully or unlawfully employed.
The personal physician is a licensed physician, surgeon or chiropractor who has treated the employee in the past and maintains the employee’s medical records. If an employee wishes to designate this physician to be their PTP, the employee must do so in writing before the injury occurs. In addition, before the injury occurs, the physician must agree to treat the employee for a work related injury or illness. This process is called pre-designation. The form for pre-designation is available from UCSF Campus Disability Management Services or UCSF Health Workers’ Compensation.
The University’s third party administrator or TPA reviews information, makes determinations regarding the compensability of an injury, and manages all benefits due injured workers. The TPA for workers’ compensation for the University of California is Sedgwick.
The UCSF department responsible for the local administration of workers’ compensation benefits for UCSF Campus employees
The UCSF department responsible for local administration of workers' compensation benefits for UCSF Health System employees
A work-related injury or illness is any injury or illness arising out of and during the course of employment. The determination as to whether an injury or illness is considered work-related is determined by the University’s third party administrator using all available information. This information may include statements by the employee, manager and witnesses, medical information from the treating physician and prior medical records of the injured worker. Whether medical expenses and compensation are payable and the amount and duration of such payments are prescribed by state or other statutes and not by the University or the third party administrator.
The University is committed to meeting its obligation under the state Workers’ Compensation program to provide medical, rehabilitation, wage replacement, and other benefits to eligible employees who sustain work-related injuries or illnesses. This policy ensures that UCSF employees who suffer injury or illness in the course and scope of employment are provided benefits through the Workers’ Compensation program in accordance with provisions in the California Labor Code and returned to work as soon as they are medically able.
A. Employee Responsibilities if a work-related injury or illness has occurred:
- Get Emergency Treatment if Needed. If an employee is hurt and is in need of medical care, call 911 or go to an emergency room for help immediately. Tell the medical staff that the injury or illness is job-related. If the employee does not need emergency treatment, the employee should contact Occupational Health or other UCSF designated occupational medicine provider.
- Report the Injury or Illness. The employee must notify his or her supervisor of a specific workplace injury as soon as possible.
- For follow-up care or non-emergent cases, it is the employee’s responsibility to contact Occupational Health Services or other designated UCSF occupational medicine providers to schedule an appointment. (An employee who completed the physician pre-designation process should arrange follow-up care with his or her pre-designated personal physician).
- An employee is responsible for keeping his or her supervisor apprised of work status by providing the Occupational Health Work Status form directly to the supervisor.
- If the employee is certified for disability by his or her primary treating physician, the employee is responsible for providing the supervisor with medical certification of any and all disability leave dates (including any or all future changes to those dates).
- Leave of absence due to a workers’ compensation injury or illness may be designated as Family and Medical Leave Act (FMLA) leave. Notice of eligibility for FMLA leave will be sent directly from Human Resources to the employee.
B. Supervisor/Employer Responsibilities if a UCSF supervisor, manager or other department management representative becomes aware that an employee may have incurred an occupational injury:
- In the event of an emergency, the employee should be escorted to the nearest emergency room for treatment. If needed, call 911.
- The supervisor or other department management representative is required to give the employee the appropriate form and complete the appropriate Supervisor Report within one business day after report of injury or illness.
- UCSF Campus: Provide an Employee Incident Report (EIR) form to the employee and complete the Supervisor Incident Report (SIR). The completed forms should be immediately forwarded to UCSF Campus Disability Management Services.
- UCSF Health: Complete an Employee Incident Report through rlSolutions. (UCSF Health employee access only)
- The supervisor or other department management representative must notify UCSF’s third party administrator, Sedgwick, and/or UCSF Campus Disability Management Services and/or UCSF Health Workers’ Compensation of changes in employee work status and respond to inquiries.
- If the employee is released to modified or transitional work activity, the supervisor or department management representative should consult with UCSF Campus Disability Management Services or UCSF Health Workers’ Compensation for assistance.
C. UCSF Campus Disability Leave Management (for Campus employees) or UCSF Health Workers’ Compensation (for UCSF Health employees) upon receiving notification of an employee work-related injury will:
- Inform all employees/departments of coverage available under the Workers’ Compensation Insurance program;
- Provide the employee with Workers’ Compensation Claim Form (DWC 1), if appropriate;
- Ensure all claims are reported in a timely manner and all appropriate parties are notified;
- Obtain necessary information to comply with insurance carrier reporting;
- Provide all required and requested information needed to enable final resolution of claims;
- Coordinate efforts to determine cause, prevent recurrence, and mitigate loss;
- Ensure all employees who have incurred an injury or illness in the course and scope of employment are treated fairly and equitably, provided access to transitional work and/or reasonable accommodation assistance, and returned to work as soon as they are medically able; and
- Initiate the interactive process to assist the employee and cost center/department in identifying transitional work options if the employee is partially restricted but may be able to engage in modified or restricted work activity.
D. Third Party Administrator Responsibilities
- After a claim is filed with UCSF Campus Disability Management Services or UCSF Health Workers’ Compensation, Sedgwick will conduct an investigation to determine whether the injury arose out of and in the course and scope of employment (AOE/COE).
- If a claim is approved, Sedgwick will make all necessary claims-related arrangements and any payments. Disability compensation (temporary disability or total temporary disability) payments are made directly to the injured worker and as applicable, the workers’ compensation payroll procedures will be initiated by the UCSF payroll processing units.
UCSF Campus - Disability Management Services
3333 California Street, Suite 330
San Francisco, CA 94143
Phone: (415) 476-2621
UCSF Health - Workers' Compensation and Ergonomics
2320 Sutter Street, Room 203
San Francisco, CA 94143
Phone: (415) 885-7865
UCSF Occupational Health Services
1600 Divisadero, Box 1661
San Francisco, CA 94143-1661
Phone: (415) 885-7580
UCSF Medical Center Administrative Policy (UCSF Health employee access only)
Related UC Policy
- University of California Business and Finance Bulletin BUS 81 - Insurance Programs
- Collective Bargaining Agreements (Represented Employees):
Applicable Leaves of Absence, Rehabilitation/Reasonable Accommodation, and/or Work-Incurred Injury or Illness Articles