UC SAN DIEGO HEALTH SYSTEM
SUPERVISOR’S GUIDE TO WORKERS’ COMPENSATION
These guidelines were prepared by the UC San Diego Health System Workers’ Compensation Unit to help supervisors understand
the Workers' Compensation Program and the procedures that are activated when an employee experiences a work-related injury or
If you have questions or need assistance, please call or e-mail the Workers’ Compensation Unit (WCU)
Cynthia Rowe, Workers Compensation Manager (firstname.lastname@example.org) 619-543-7691
Linda Morgan, Disability & Accommodation Manager (email@example.com) 619-543-7709
Miriam Poletti, Workers’ Compensation Claims Specialist (firstname.lastname@example.org ) 619-543-7823
Janice Fletcher, Safety & Ergonomic Specialist (email@example.com) 619-543-7783
Cherry Vergara, DM & WC Admin. Assistant (firstname.lastname@example.org) 619-471-0283
WHAT IS WORKERS' COMPENSATION?
Designed to be a "no-fault" system, Workers' Compensation is a state-mandated benefit. The purpose of Workers' Compensation is
to provide benefits and assistance to all workers who are either injured or develop a job-related illness as a result of their
employment. Benefits may include:
The objective of the UC San Diego Health System Workers' Compensation Program is to bring about expedient recovery and
return to productive work.
WHAT IS A WORK-RELATED INJURY?
The California Labor Code's definition of the term "injury" includes "any injury or disease arising out of employment AND occurring
in the course of employment." The injury may result from either trauma or disease. Injuries are categorized in three ways:
1. SPECIFIC - Injury to one or more parts of the body resulting from a specific incident.
2. CUMULATIVE - Injury from repetitive traumatic activities over a period of time, such as exposure to chemicals or fumes
which are injurious to an employee.
3. AGGRAVATION - A preexisting condition or non-work-related condition aggravated by an occupational injury or disease.
The employer provides medical treatment until the employee returns to the pre-injury status of the preexisting condition.
Funding the University’s Workers Compensation Program
The University of California is self-insured for Workers’ Compensation. Costs associated with claims and management of the program
are paid out of a trust fund into which each campus contributes a premium. Premium payments are made into the trust based on the
amount of payroll, loss experience, and future loss projections associated with each campus.
Funding for this program is a departmental expense. Department managers and supervisors play a key role in controlling departmental
costs by providing a safe work environment, responding promptly when injuries occur, and providing transitional work for injured
employees during the healing process.
WHEN AN INJURY OR ILLNESS WHO IS COVERED BY THE UCSD
OCCURS WORKERS' COMPENSATION
Injured employees should call and set up an appointment to seek PROGRAM AND WHEN?
UCSD Center for Occupational & Environmental Medicine WHO – UC San Diego Health System employees and
(COEM) volunteers with paperwork on file.
300 Lewis Street, Suite 100 8899 University Center Lane, Suite 160
San Diego, CA 92103 San Diego, CA 92122 WHEN - Workers' Compensation coverage begins the first
Phone (619) 471-9210 Phone (619) 657-1600 minute an employee is on the job and continues any time
an employee is officially on the job. The only requirement
In the event the incident occurs after normal business hours have is that the individual is officially working as an employee
the injured employee report to a UC San Diego Health System providing a service to the university at the time of the
Emergency Department (Hillcrest or Thornton), and must follow up injury.
with COEM on the next business day.
Employees choosing to receive initial treatment from their personal Students-other than student employees-and employees of
doctor must have a Designation of Physician Form on file with their outside agencies are not covered, even though the injury
department before an injury or illness occurs. This form is may have occurred at UC San Diego Health System.
available from the New Employees Orientation packet.
When an injury occurs
The employee should report the injury or illness to his/her supervisor immediately.
Supervisor will instruct employee to call COEM to set up an appointment. In the event the incident occurs
after normal business hours have injured employees report to the ER, and to follow up with COEM on the
next business day. The employee is responsible for keeping you informed as to her/his work status. You
should be provided with a written work status report after each physician visit.
The supervisor/employee must report the injury in one of three ways: the WC Hot Line at (619)-5437-877; the
toll free hotline (877) 682-7778 available through our claims administrator, Sedgwick CMS; or complete an
On Line Injury Reporting form at http://ucsdhealthcare.ucsd.edu/safetyoffice. The information needed for
each injury is:
Name of injured employee
SS of injured employee
Injured employees department
Brief description of accident or reported injury
Date and time of accident or injury
Date when it was reported to supervisor/manager
The information gathered will be forwarded to Sedgwick CMS, our Third Party Administrator, for processing
the claim and administering benefits.
A representative from Sedgwick CMS, our claims administrator, will call you to gather additional information
about the employee and the circumstance of the incident. Please be honest and forthright about the employee
with regard to any personnel issues pending, “rumors” regarding the circumstances of the injury and similar
information. Sedgwick CMS work for the University and wants to make sure any employee who may not
actually have been injured as reported is given the opportunity to obtain care through her/his health insurance.
Keep in touch; maintain contact with your injured employee. As a supervisor you play an important role in an
employee’s recovery and return to work. Try to answer the employee’s questions or find the answers for
them. Let the employee know transitional work may be available.
Departments involved in the Workers’ Compensation program
Department Address and phone # Responsibility Additional duties
1. First point of contact for 1. Instructing injured
Workers Compensation Unit 330 Dickinson injured employees employee to see COEM
(WCU) San Diego, CA 92103-8235 2. Completion of first for treatment.
Phone # 619-543-7823 report claims reporting 2. Advising supervisor of
system. restricted or out of work
3. Contacting supervisor to status ASAP.
WCU Ergonomics 1. COEM physician 1. Assists with obtaining
If injury is from cumulative 330 Dickinson recommends evaluation. recommended equipment.
stress/repetitive activites an San Diego, CA 92103-8235 2. Ergonomic specialist 2. Evaluates area to
ergonomic evaluation is Phone # 619-543-7783 conducts evaluation, determine if other
makes recommendations. employees are at risk.
conducted. Preventive ergo 3. Provides training as
evals are also available. necessary.
1. Works with department to 1. Consults with departments
implement transitional about reasonable
Disability & Accommodation 330 Dickinson return to work program.. accommodations for
Services San Diego, CA 92103-8235 2. Assesses modified or employees with a
Phone # 619-543-7709 alternative work for disability.
employees precluded from
3. Treatment of all 4. Will provide work
UCSD Center for 330 Lewis Street, Suite 100 UCSDMC work related restrictions where
Occupational & San Diego, CA 92103 injuries and illnesses possible to allow
Environmental Medicine Phone # 619-294-6206 4. Will notify WCU and departments to find work
********************* PRM of injured workers in area.
(COEM) 8899 University Center status ASAP
Lane, Suite 160
San Diego, CA 92122
1. Interview injured 1. Provide WCU with reports
Sedgwick CMS employee and supervisor. and updates to monitor
42815 Camino Del Rio 2. Contact WCU with process of Workers
Is the Third Party Administrator South, Suite 300 information regarding compensation claim cost,
(TPA) for the University of San Diego, CA 92108 employee’s injury status. 5. Provide all sites with
California, reporting to the Office Phone 619-321-1440 5. Provide estimated date statistical data for tracking
of Risk Management employee to return to W/C programs.
6. Advise Workers’
Compensation Unit of
work restrictions for
1. Administers the various 1. Provides consultation and
UC Employee Benefit information regarding the
Benefits and Personnel 200 West Arbor Drive Plans and Programs UC Retirement and
Services San Diego, CA 92103-8912 2. Administers the Disability Income Plan
Phone # 619-220-5007 University-sponsored (UCRP)
Human Resources Disability Plans 2. Process direct premium
(Employer and payments from
Employee- Paid) employees to continue
health and welfare
1 Ensures UCSD complies 1. Provides the following
with all health and safety services:
and environmental Safety engineering, sanitation,
Employee Health and Safety UCSD Medical Center regulations radiation safety,
Employee Health & Safety 2. Coordinates and assists biological/chemical
330 Dickson Street other departments safety, fire safety,
San Diego, CA 92103-8912 involved in similar industrial hygiene,
Phone 619-543-7575 activities. Emergency planning and
3. Provides consultation on training.
4. Responds to Hazardous
Frequently asked questions by supervisors.
Q. What happens when an employee is returned to work with restrictions?
A. The supervisor should try to find work within the area to accommodate the restrictions. In some cases we
realize this is not possible. At that time the vocational councilor (Linda Morgan) will try to find another
department with work that will accommodate the restrictions. In the event work is not available within the
restrictions the employee will remain out of work and is eligible for TD payments.
Q. When will I know the status of an employee out on WC?
A. WCU or PRM will be in contact with the supervisor by e-mail as soon as information is available. Under
the law there is only certain information we can discuss with the supervisors. This information is Date of
injury, date of last treatment, date of next physician visit, and return to work status.
Q. What if I suspect the alleged injury/illness did not happen at work?
A. The supervisor needs to document any observations or information related to the alleged injury/illness.
This information needs to be reported to the WCU who will report it to PRM. PRM is responsible for
investigating all our WC claims.
Q. What is the difference between an illness and an injury?
A. Good question, under OSHA regulations an illness is defined as any abnormal condition or disorder caused
by exposure to environmental factors associated with employment. OSHA also defines an injury as any injury
that results from a work accident or from a single instantaneous exposure in the work environment.
Important OSHA Requirement: Supervisors must immediately report all work-related deaths, catastrophes,
and serious injuries or illnesses to the UC San Diego Health System Workers’ Compensation Office at (619)
543-7823. The UC San Diego Health System Workers’ Compensation Office is required to report the above
described injury or illness to Cal/OSHA within 8 hours from the time of the incident. Delays in reporting
such injuries or illnesses to the Workers’ Compensation Office in a timely manner could result in Cal/OSHA
fines for your department. A serious injury or illness is one that requires inpatient hospitalization, or in which
an employee suffers a loss of any member of the body or suffers any serious degree of permanent
TIMEKEEPING: REPORTING TIME LOST
University policy states that the day of injury will be counted as a normal workday and no time shall be charged against
the employee if there is lost time on that day. (PPM 200-20) .
Sick time must be used to attend physical therapy, Dr.’s appointments or diagnostic testing during scheduled time at
work. If sick time is not available it will be considered a leave without pay.
Any time missing from work as a result of this injury will be counted towards the Family and Medical Leave Act
(FMLA) annual allotment.
Employees on TRTW should be coded as Light Duty in the time keeping system, and WKC when the department is
unable to accommodate the restrictions.
If you have work available within the work restrictions and the employee calls in sick or does not work the entire shift
due to the effects of the injury, they must contact the physician and obtain documentation indicating they are not
medically able to work. If not, the time off will be counted as sick time.