Workers' Compensation

Workers' Compensation is an employer-paid benefit program that provides compensation and medical benefits if you are injured or become ill due to a work-related condition. The California State University (CSU) program is administered by Sedgwick Claims Management Services.

Any injury or illness is covered if it is caused by your job. This includes serious injuries as well as first aid type injuries. Under workers' compensation law, you will receive help if you are injured, no matter who was at fault. The main question is whether or not the injury or illness was caused by your job. Final determination of eligibility for benefits is made by Sedgwick Claims Management Services.

There is no waiting period for coverage by workers' compensation. Coverage begins the first minute you are on the job and continues any time you are working. Payment for medical treatment begins immediately. There is a three-day waiting period before the disability income benefit payments begin.

The program will pay all approved medical and hospital bills associated with your work-related injury or illness. If you are disabled, you may be eligible for Industrial Disability Leave (IDL) payments or choose Temporary Disability (TD) payments. Temporary Disability payments are equal to two-thirds of your salary up to a maximum set by law. If you cannot return to your usual occupation due to the injury or illness, you may be eligible for permanent disability benefits. In addition, you may be entitled to Vocational Rehabilitation (VR) benefits if you are unable to return to your usual job duties. While you are enrolled in a VR plan, the benefits are paid by your employer.

In case of death, qualified surviving dependents are eligible to receive benefits as set by law.

Immediately report the job-related injury/illness to your supervisor. You will receive an Employee Claim for Workers' Compensation Benefits on which you should describe your injury and how, when, and where it occurred. Return the completed form to your supervisor or Human Resources Office. The Human Resources Office will send a copy to Sedgwick Claims Management Services and submit a claim on your behalf. Sedgwick Claims Management Services will then get in touch with you to explain the benefits you will be receiving.

Your supervisor or Human Resources Office will arrange for authorized medical treatment and complete the necessary reports. You must furnish your supervisor or Human Resources Office with a doctor's written "return to work" release prior to resuming your duties. INSURE YOUR RIGHT TO BENEFITS BY IMMEDIATELY REPORTING EVERY WORK-RELATED INJURY OR ILLNESS.

Emergency or After Hours: In an emergency, contact University Police at x3114 or dial 911 from a campus phone. University Police will dispatch emergency services to assess and/or transport the injured employee. For injuries after hours, dial 911.

Non-Emergency Incidents: Notify your supervisor immediately. It is important to report injuries as soon as possible in order to receive the best medical care possible. The designated workers' compensation facility can examine and treat your work-related injury unless you have a pre-designated Physician Form on file with the WCC. Then, you can visit the pre-designated physician of your choice. In accordance with the law, after 30 days from the date of injury, you may be treated by a physician of your choice or at a facility of your choice within a reasonable geographic area.

If you are a member of the California Public Employees' Retirement System (PERS), you may be eligible for IDL benefits in lieu of Temporary Disability (TD) benefits. IDL has a three-day waiting period before paid benefits begin. The waiting period is waived if you are hospitalized or off work more than 14 calendar days. For the first 22 work days of disability, IDL provides an amount equal to your net pay (full pay minus an amount equal to OASDI and withholding taxes based on your exemptions). If disability continues beyond the 22 work days, IDL provides two-thirds of your gross pay for the balance of 52 weeks. While you are receiving IDL, your normal retirement contributions and voluntary deductions continue. If you are disabled beyond the expiration of IDL benefits, you may be eligible to receive Temporary Disability (TD) benefits. All qualified medical bills will be paid whether you receive IDL or TD.

If you are a member of PERS, you may be eligible to supplement IDL with accrued leave credits. Your credits must be sufficient to provide with IDL an amount to equal your regular salary.

If a work-related injury or illness prevents you from working, you are eligible for TD payments. The amount of TD is generally two-thirds of your salary not to exceed the maximum as set by law. There is a three-day waiting period before paid benefits begin. This waiting period is waived if you are off work more than 14 calendar days or are hospitalized. TD stops when the treating physician released you to return to work or says your condition is stabilized (permanent and stationary).

PD payments are different from TD payments and compensate you for any permanent disability you may suffer from an accepted workers' compensation claim. The amount you will receive depends on the extent of your disability and the workers' compensation law, regardless of whether or not you are able to return to your work.

CSU employees are paid on a monthly basis. If you are eligible for IDL or supplementation to TD, you will remain on the normal monthly pay cycle.

If you receive TD without supplementation or PD payments, you will receive payments approximately every two weeks. The TD and PD payments from Sedgwick Claims Management Services will normally be sent directly to your home.

The law prohibits your employer from discharging or discriminating against you because of a workers' compensation injury/illness. If you believe you have been discriminated against because of your injury, you should discuss your rights with an Information and Assistance Officer or with an attorney.

If you have questions about your claim, seek assistance immediately from either the Human Resources Office or Sedgwick Claims Management Services which is processing your claim. If you are dissatisfied with the information provided, you may contact an Information Assistance Officer with the California Division of Workers' Compensation or an attorney.