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Workers Compensation
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NEW...Check Out the Workers' Comp "Know-How"

Workers' Compensation is an employer paid benefit that provides compensation and medical benefits if you are injured or become ill due to a work-related condition. This includes serious injuries as well as injuries only requiring first aid. Under Workers' Compensation law, you will receive help if you are injured. See On the Job Injuries  for reporting information.

If you become disabled, you may be eligible for Industrial Disability Leave (IDL), or you may choose Temporary Disability (TD); if you fail to make a choice within fifteen days from the date of notice of benefits eligibility, you will be placed on IDL unless TD benefits are greater. If, when your condition is permanent and stationary, you cannot return to your usual occupation due to the injury or illness, you may be eligible for permanent disability.

In case of death from a work related injury or accident, qualified surviving dependents are eligible to receive benefits. The maximum death benefit is up to $160,000.00, depending on the number and types of dependents. There is also a separate allowance of up to $5,000.00 for burial expenses.

Industrial Disability Leave (IDL)

If you are an active member of PERS, you may be eligible to receive IDL disability benefits in lieu of Workers' Compensation temporary disability benefits. For the first twenty-two work days of disability, you will be paid an amount up to full pay. If the disability continues, IDL will pay two-thirds of your gross pay for a period not to exceed a total of fifty-two weeks within two years.

To receive IDL benefits, you must meet the following conditions:

1) be an active member of PERS;

2) have a disability that has been verified and accepted by Octagon Risk Services;

3) choose to receive IDL benefits: and

4) be unable to work as a result of a work related injury or illness.

There is a waiting period of three calendar days before you become eligible for IDL. It may not apply if:  1) you are disabled because of a criminal act of violence against you; or 2) you are immediately hospitalized; or 3) you are hospitalized later because of the disability; or 4) you are disabled for more than fourteen calendar days. In these instances, you are eligible for IDL benefits payments from the first day of injury. Furthermore, the waiting period need not be consecutive; partial days of absence relating to the disability shall be accumulated to full days towards the waiting period.

Deductions for federal/state taxes, FICA, and/or Medicare will not be made from IDL payments.  IDL payments are not reported as taxable wages or Other Compensation on Form W-2. Retirement contributions and voluntary deductions (credit union loans, savings accounts, bonds, parking fees, health insurance premiums, etc.) will be deducted from all IDL payments. IF YOU NEED TO CANCEL ANY VOLUNTARY DEDUCTIONS, CONTACT THE BENEFITS COORDINATOR (x-4425) FOR ASSISTANCE IN THIS PROCESS. While you are receiving IDL payments, you will continue to accrue sick leave, vacation, and service credits.

You may also be eligible to supplement your IDL benefits with accrued sick leave credits, provided that you have sufficient credits. Total benefits and supplementation cannot exceed your regular salary or wage. The supplementation portion will be reported as taxable earnings. You may select supplementation if you provide written notice to the Benefits Coordinator within fifteen calendar days from the date of notice of benefits eligibility. Supplementation will begin on the twenty-third day of IDL benefits.

Temporary Disability

Temporary disability compensation is determined by law and is generally two-thirds of your wages with a minimum of $126 per week and maximum of $728 per week. This benefit stops when the treating physician releases you for work or states that your injury has reached a point of maximum improvement.

The waiting periods and exceptions for TD are the same as for IDL. You may also be eligible to supplement your temporary disability benefits with accrued sick leave credits, provided that you have sufficient credits. Total benefits and supplementation cannot exceed your regular salary or wage.

Permanent Disability

Permanent disability is compensation paid to you for any permanent disability you may suffer from due to a work-related illness or injury. The amount you will receive depends on the extent of your disability. Workers' Compensation law provides guidelines to determine the amount of the compensation. Your age and job at the time of your injury or illness are also factors that are considered when calculating permanent disability.

Medical Treatment

For first aid and emergency treatment of your work related injury or illness, medical service is provided by the Concentra Medical Center, 740 Nordahl Road, Suite 117, San Marcos, CA. During the three day waiting period, sick leave accruals will be used for time off and for medical appointments. After thirty days from the date of your injury, you may be treated by a physician of your choice or at a facility of your choice within a reasonable geographic area, or one selected from a panel of physicians provided by the University. The University retains the right to require periodic re-evaluation by its own physician or facility, as deemed necessary. If you have notified Risk Management & Safety (RM&S) in writing, prior to the date of injury, the name of your personal physician (a doctor of medicine or osteopathy who has treated you in the past and maintains your medical records), you have the right to be treated by that physician from the first date of injury.  A Designation of Personal Physician form is available for this purpose.

Appeal Process

If at any time you have complaints about the IDL actions taken, you may seek to remedy them through the appeal process. You should first notify RM&S of any complaint in writing within thirty days of its origin. If RM&S cannot resolve your complaint, you may appeal to the Workers' Compensation Appeal Board of the Division of Industrial Accidents. There are certain time limits during which appeals may be filed; therefore, appeals should be filed as soon as possible.

FORMS NEEDED

• DWC1 - Employee's Claim for Workers' Compensation Benefits. This form will be provided to you by RM&S within 24 hours after the injury is reported to RM&S.

HOW TO APPLY

After sustaining an injury or illness on the job, immediately report it to your supervisor. Complete the "employee" section of the DWC1 claim form and return it to the Workers Compensation Coordinator in RM&S. Keep the copy marked "Employee's Temporary Receipt" until you receive the dated copy from RM&S.

 

The purpose of this summary is to provide a general orientation to Workers' Compensation. Benefits are subject to the terms and conditions of specific policies and/or applicable legal agreements.

Additional information about Workers' Compensation Benefits in the State of California is available from the Division of Workers' Compensation.