Understanding Workers Comp Claim Processing at UC San Diego


Overview


This article summarizes the process for reporting and managing work-related injuries and subsequent leaves for employees on the UC San Diego Campus.  UC San Diego Health Systems employees will follow their own processes.

Please Note: This article covers the Workers Compensation process only.  If you have questions about other applications, e.g. UCPath or Timekeeping, please reach out to the applicable Central Office (HR for questions about UCPath Leaves of Absence, and Core Central Payroll (CCP) for Timekeeping questions.

Critical Concepts


UC San Diego’s Risk Management Office explains the process and responsibilities of parties involved in the Worker's Compensation Employee's Guide.

Click here to review the UC San Diego Workers Compensation Business Process.

Steps to Take


When a work-related injury occurs, the employee notifies the Workers Compensation Office at UC San Diego by completing a form on BLINK.  Once employee completes the form, the supervisor must complete one as well:

Employees may also call the 1-800 Reporting Line: 877-6UC-RPRT (877-682-7778) to report the incident, and supervisors complete the Supervisor Report page of the online Workers' Compensation Supervisor’s Occupational Incident Report (link above).

Important: Completing an Occupational Incident Report form does not file a claim for workers’ compensation benefits.

After receiving employee’s Occupational Incident Report form, the UC San Diego Workers’ Compensation Office will monitor their medical treatment to determine if level of care exceeds first aid treatment. First aid treatment may be appropriate treatment and is not considered a workers’ compensation benefit, although first aid costs will be paid by employer. If medical treatment exceeds first aid treatment at the initial or subsequent medical visits, the UC San Diego Workers’ Compensation Office will send employee a State of California Workers’ Compensation Claim Form (DWC-1).

The Workers' Compensation Office obtains the information necessary to determine the category of your injury or illness:

  1. Incident - No medical treatment received. The Report of Injury is retained at the Workers' Compensation Office.
  2. First Aid - Minor medical treatment is received, no time is lost beyond the day of injury, and there are no modifications of job duties. The Report of Injury is forwarded to Sedgwick for payment of the first aid bill.
  3. Claim – Employee’s injury will be processed as a claim when any of the following occur:

When a work-related injury is classified as a claim, numerous offices at UC San Diego are involved.  These offices include Environment Health & Safety/Risk Management Office, Human Resources, Core Central Payroll, employee’s Department or VC HR administration, to name a few.  The roles and responsibilities of each are explained in the UC San Diego Processes link in Critical Concepts above.

In cases where the injury requires the employee to be absent from work, HR Initiators must initiate a Request for Extended Leave of Absence in UCPath. Please refer to the following Job Aid: How to Request a Leave of Absence

Please Note:  For VC -Resource Management Planning, Human Resources, Information Technology Services and VC - Advancement, Marco Hermosillo (mahermosillo@ucsd.edu) will submit the leave request in UCPath. 

The Worker’s Compensation Election Form must be provided to the employee for their completion, and it must be added as an attachment to the transaction when Worker’s Comp leave type is selected. 



In addition to the state-mandated benefits, the University of California provides supplemental benefits described as follows: 
Supplemental Leave - If employee works 50% time or more, they will remain on 100% salary by using sick leave to supplement the Workers' Compensation temporary disability payments paid by Sedgwick . Once employee’s sick leave balances are depleted, they have the option of using vacation leave and/or comp time to continue receiving a 100% paycheck. For more detailed information on leave options and usage, refer to the Risk Management Office’s Employee Guide link in Critical Concepts above.

Sedgwick will notify employee of the status of their claim within 14 days after they receive it for processing.

Three possibilities exist:

  1. Accepted
  2. Denied
  3. A letter of delay is issued if more time is required to investigate the claim

For claims that are denied, Sedgwick will mail a letter to employee’s home explaining why the claim has been denied. A copy of this letter will also be mailed to the employee's supervisor and department timekeeper. Any time lost on the day of the injury will no longer be considered Administrative Leave. Employee’s accrued leave balances would be used to cover time lost on that day.

Additional Information


If you still have questions or need additional assistance, please submit a ticket.