Workers' Compensation

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					Workers’ Compensation
    UCLA Healthcare




                      June 6, 2003
                                     1
What Is the Purpose of Workers’
        Compensation?

To provide legally mandated benefits
to workers who are injured at work
or who develop a job-related illness as a
result of their employment
Benefits may include payment for medical
bills, mileage, lost wages and vocational
rehabilitation
                                            2
Who Administers and Pays for
 Workers’ Compensation?
UC is self-insured and has selected Octagon Risk
Services, an independent contractor, to administer our
workers’ compensation claims.
Octagon Risk Services may discuss the claim with the
department and the employee, investigate the
injury/illness, and determine what workers’ compensation
benefits the employee will receive.
Funding for the Workers’ Comp program is provided by
the UC locations as a group. Each UC location is charged
a premium amount per $100 of payroll
based on the location’s overall claim
performance.
                                                           3
    When an Employee Is Injured
          on the Job . . .
Provide the employee with:


1. A completed EMPLOYEE’S CLAIM FORM FOR WORKERS’
   COMPENSATION BENEFITS
   This form must be provided within 24 hours of receipt of notice
   that an injury or illness has occurred as mandated by California
   state law. (Exception: first aid incidents)

2. A completed EMPLOYEE’S REFERRAL SLIP FOR
   INDUSTRIAL INJURY AND REPORT OF ACCIDENT

3. UCLA WORKERS’ COMPENSATION BOOKLET WHEN AN
   INJURY OCCURS & Workers’ Compensation Instruction Sheet
                                                                      4
 Employee’s Claim For Workers’
    Compensation Benefits
Instructions on how to complete the Employee’s Claim
   Form for Workers’ Compensation Benefits
1a. If the employee notifies you in person, the supervisor or
    department personnel representative must fill out lines 1, 9, 10, 11,
    12, 13, 16, 17, 18
    Have employee sign on line 8. Continue to step 2
    –   The employee may fill out the “employee” section of the claim form in your
        presence and return the form to you
    –   If the employee chooses to fill out the “employee” section on their own,
        instruct them to mail the completed form to Healthcare HR
1b. If you receive notice of the employee’s injury by phone:
    supervisor fills out lines 1, 9, 10, 11, 12, 16, 17, 18. On line 11, fill
    in the date supervisor received phone report of injury. On line 12,
    fill in the date form was mailed to the employee
    – Certified mail is advisable as proof of mailing
                                                                                     5
    – Continue to step 2
Employee’s Claim For Workers’
Compensation Benefits (Cont’d)
2.   Make a copy of the Claim Form and proof of mailing form for the
     department’s records. Department keeps the 5th copy
     “Employers’ Temporary Receipt” for department records.

3.   Immediately FAX a copy of the completed form
     to the WC FAX line x 40530.

4    Employee keeps the 4th copy “Employee’s Temporary Receipt.”

5.   Send all other copies of the form immediately to Healthcare HR
     for further distribution.

       6.   Notify Healthcare HR Workers’ Comp x40522 or via
            email to Cynthia Vazquez as soon as you are aware
            that an employee has been taken off work.                  6
 Employee’s Referral Slip For Industrial
    Injury And Report Of Accident
Instructions on how to complete the Employee’s Referral
    Slip for Industrial Injury and Report of Accident.
1.   Supervisor is responsible to complete this form describing how the injury
     occurred and where. Note the date the injury was reported.
2.   Send the employee to the Occupational Health Facility with the Referral
     Slip. If OHF is closed, direct the employee to the Emergency Medicine
     Center for treatment.
3.   Keep a copy of the Referral Slip for the department’s records.
4.   Immediately FAX a copy of the completed form to
     the WC FAX line x 40535.
         5. Notify Healthcare HR Workers’ Comp x 40522 or via email to
            Cynthia Vazquez as soon as you are aware that an employee
            has been taken off work.
                                                                                 7
Employee’s Referral Slip For Industrial
   Injury And Report Of Accident
SPECIAL CIRCUMSTANCE #1: PRE-DESIGNATED DOCTOR
If the employee reports he/she has pre-designated MD –
•   Advise the employee to obtain medical care with the pre-designated MD as soon as
    possible. He/She may go to Occupational Health or the Emergency Medicine Center
    for immediate treatment, if the employee desires. Pre-designation of a private MD
    does not bar the employee from getting treatment at OHF or the EMC.
•   Give and complete the WC Claim Form, Referral Slip. Provide When an Injury
    Occurs brochure and WC Checklist per previous instruction.

SPECIAL CIRCUMSTANCE #2: : EMPLOYEE HAS BEEN
    RECEIVING OUTSIDE TREATMENT
If the employee reports that he/she is being treated by a private MD –
•   Give and complete the WC Claim Form, Referral Slip. Provide When an Injury
    Occurs brochure and WC Checklist per previous instruction.
•   Send the employee to Occupational Health with any medical records/MD notes they
    have been given.
•   Advise the employee to contact Octagon Risk Services and give ORS the physician’s
    information.                                                                      8
Workers’ Compensation Process
 Octagon Risk Services reviews the claim and determines what
 benefits the employee should receive. ORS notifies the employee
 by mail and by phone whether claim is accepted, delayed, or
 denied.

 If the injury is delayed or denied, employee should file for
 disability benefits. Contact the employee’s supervisor or dept
 personnel rep to begin leave notification process. HR WC will
 direct inquiries to the department per the Benefits leave process.

             If the injury is approved as work related and the
             employee receives a temporary disability check from
             ORS, HR WC will immediately notify the department.
             HR WC mails out Options letter to the employee.
             Department receives a copy.
                                                                      9
Workers’ Compensation Process
           (Cont’d)
Workers’ Compensation payments for Temporary Disability or
Vocational Rehabilitation will effect the employee’s pay.
   The employee must use his/her sick leave for first three
   calendar days of the leave.
   Follow the PTR instructions outlined in the next pages to pay
   the employee appropriately.

The employee needs to immediately choose how he/she would like
us to treat his/her pay and notify Cynthia Vazquez in Human
Resources, and the department:
   Option 1 -- Employee elects to receive only the workers’
    comp payments.
   Option 2-- Employee elects to use sick leave only to
    supplement the workers’ comp payment.
   Option 3-- Employee elects to use sick leave and vacation time
    to supplement the workers’ comp payment.                        10
                    OPTION 1

Employee elects to receive only the workers’
 comp temporary disability payments.
  Revise the LOA Notification as Approved WC Option 1
  and email to Human Resources Benefits Team and
  update the leave in EDB.
    Immediately place the employee, if eligible,
    on FMLA leave without pay.
    If not eligible for FMLA, place the employee on
    Workers’ Comp Leave Without Pay.
       Use 09 for Workers’ Comp Code & clarify action on comments.

              Do not report any time on WPS or EPRs.
                Employee should receive no pay from payroll while
                                                                     11
                receiving temporary disability.
             OPTION 1 (Cont’d)
Employee is fully responsible for Benefits contribution
according to the FMLA guidelines.
      Employee must make employee contribution for health.
      HR Benefits will notify the employee directly regarding all
      benefits which are not paid for by FMLA.
      Employee will also need to pay directly for health, dental, and
      vision once the 12 weeks of FMLA exhaust.


Review the IDER and timesheet to determine
if there was any payment of sick leave/vacation time.
       Sick leave and vacation paid are considered “overpayment”.
       Enter a reduction transaction “RX” for the overpayment amount.
       When the employee repays the amount, the sick leave and
              vacation hours will be returned to balance by Hospital
              Payroll.                                                  12
                      OPTION 2
Employee elects to use sick leave only to supplement
  the temporary disability payment.
  Employee uses only a few hours SICK LEAVE each pay period to
  supplement temporary disability to equal 100% of his/her regular
  salary.

  You will need to know:
  1. The employee’s SICK LEAVE balance as of the date of
       injury/date when employee first began losing time. Refer to
       Accrual slips/Hospital Payroll/Timesheet.
  2. The regular hours the employee would have worked for the dates
       listed on the WC worksheet. Dates are inclusive.
  3. Any pay that the employee may have already received for the
       dates listed on the WC worksheet. Refer to the IDER screen.
                                                                      13
            OPTION 2 (Cont’d)
Complete the Option 2 worksheet sent by HR WC.
  IF the Balance is enough to cover the “Difference” then the
  employee remains at 100% pay for the WC Worksheet period.
  Forward a completed copy of the worksheet via email to the
  Hospital Payroll representative for your department.
      Hospital Payroll will update the sick leave balance and award full
      accruals to the employee. Sick leave may be used as accrued while
      @ 100% salary.
Enter the transactions on PTR per the PTR Manual and
Payroll instruction.
  Per University Policy, employee should receive shift
  differentials in addition to base pay.
  Use DOS code REG for base pay.
  Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
  Use DOS code WCR for WC check deduction.                                14
  PROCESS BY PAY COMPUTE DEADLINES!                                       14
            OPTION 2 (Cont’d)
Revise the LOA Notification as Approved WC Option 2
and email to Human Resources Benefits Team and
update the leave in EDB.
   Place employee, if eligible, on FMLA Leave With Pay.
   If not eligible for FMLA, place the employee on
   Workers’ Comp Leave With Pay.
      Use 09 for Workers’ Comp Code & clarify action on comments

Once the employee’s own sick leave exhausts, the
employee is eligible to receive 80% Extended Sick Leave
benefit.
      Reduce employee time on EDB to 80%.

           Do not report any time on WPS or EPR’s
               Department will process the pay on PTR              15
                       OPTION 3
Employee elects to use sick leave and vacation to
  supplement the temporary disability payment.
  Employee uses only a few hours SICK LEAVE and VACATION
  each pay period to supplement temporary disability to equal 100%
  of his/her regular salary. Exhaust sick leave first, then vacation.


  You will need to know:
  1. The employee’s SICK LEAVE and VACATION balance as of
       the date of injury/date when employee first began losing
       time. Refer to Accrual slips/Hospital Payroll/Timesheet.
  2. The regular hours the employee would have worked for the dates
       listed on the WC worksheet. Dates are inclusive.
  3. Any pay that the employee may have already received for the
       dates listed on the WC worksheet. Refer to the IDER screen.      16
             OPTION 3 (Cont’d)
Complete the Option 3 worksheet sent by HR WC.
  IF the Balance is enough to cover the “Difference” then the
  employee remains at 100% pay for the WC Worksheet period.
  Forward a completed copy of the worksheet via email to Hospital
  Payroll.
      Hospital Payroll will update the sick leave/ vacation balance and
      award full accruals to the employee. Sick leave and vacation may
      be used as accrued while @ 100% salary.
Enter the transactions on PTR per the PTR Manual and
Payroll instruction.
  Per University Policy, employee should receive shift
  differentials in addition to base pay.
  Use DOS code REG for base pay.
  Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
  Use DOS code WCR for WC check deduction.                              17
                                                                        17
  PROCESS BY PAY COMPUTE DEADLINES!
           OPTION 3 (Cont’d)
Revise the LOA Notification as Approved WC Option 3
and email to Human Resources Benefits Team and
update the leave in EDB.
   Place employee, if eligible, on FMLA Leave With Pay.
   If not eligible for FMLA, place the employee on
   Workers’ Comp Leave With Pay.
      Use 09 for Workers’ Comp Code & clarify action on comments

Once the employee’s own sick leave and vacation
exhausts, the employee is eligible to receive 80%
Extended Sick Leave benefit.
      Reduce employee time on EDB to 80%.

           Do not report any time on WPS or EPRs
               Department will process the pay on PTR              18
      80% Extended Sick Leave
Employee elected Option 2 or 3 and accrual bank has
  exhausted.
  When an employee elects Options 2 or 3, the employee
  is eligible for this benefit once the SL or SL/VA in the
  employee’s bank is exhausted.

  Department pays the employee the difference between [80% of
  regular salary based on appt] and the [WC temporary disability
  payment.]
      80% ESL does not come out of employee’s individual bank.
      Benefit is paid for 26 weeks from the date employee exhausted
      his/her own SL or SL/VAC time on the WC worksheet and
      continues to receive WC temporary disability.
      Employee continues to accrue SL/VAC @ 100 % but cannot          19
      use accruals until return to work or separation.
80% Extended Sick Leave (Cont’d)
 Calculate 80% of the employee’s regular hours based on
 appt for the dates listed on the 80% ESL Worksheet sent
 by HR WC. Dates are inclusive.
    Forward a completed copy of the worksheet via email to Hospital
    Payroll.
        Hospital Payroll will update the sick leave/ vacation balance and
        award full accruals to the employee upon return to work or
        separation.
 Enter the transactions on PTR per the PTR Manual and
 Payroll instruction.
    Per University Policy, employee should receive shift
    differentials in addition to base pay.
    Use DOS code ESL for base pay.
    Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.
    Use DOS code WCR for WC check deduction.                                20
    PROCESS BY PAY COMPUTE DEADLINES!
80% Extended Sick Leave (Cont’d)
 Confirm the LOA Notification to Human Resources
 Benefits Team and confirm the leave is current.
   Place employee, if eligible, on FMLA Leave With Pay.
   If not eligible for FMLA, place the employee on
   Workers’ Comp Leave With Pay.
      Use 09 for Workers’ Comp Code & clarify action on comments

 Reduce employee time on EDB to 80%.
   Begin and end date of 80% reduction in time can be found on
   80% ESL worksheet.

            Do not report any time on WPS or EPRs
               Department will process the pay on PTR
                                                                   21
              AFTER 80% ESL
HR WC will notify the department rep to update the
LOA Notification for the Human Resources Benefits
Team and update the leave in EDB.
   Email the LOA Notification promptly so HR Benefits
   can mail a disability packet to the employee.
   Place the employee on Workers’ Comp Leave Without Pay.
      Use 09 for Workers’ Comp Code & clarify action on comments

Correct employee time on EDB from 80% to original
appt.
            Do not report any time on WPS or EPR’s
          NOTIFY the HR Benefits Team via email on the
          Return to Work Notice form if the employee returns
          to work or pay status
                                                                   22
   AFTER 80% ESL (Cont’d)
Health Insurance coverage may continue --
    UC Regents will continue to pay the employee’s full health
   benefits (Employee and University contribution) via the Health
   Contingency Fund while the employee continues to receive
   temporary disability payments AND has not been separated
   from UCLA Medical Center.

Employee must make payment for all other insurances
and Benefits that he/she wishes to keep current
   HR Benefits will coordinate direct payment of premiums for
   all other benefits with employee.




                                                                    23
        General guidelines . . .
TIMESHEETS (EPRs/WPS)
WAITING PERIOD --
   Fill out the WPS/EPR with first 3 calendar days of sick leave.
   If the employee does not have enough sick leave to cover the first 3 days, the
   employee is entitled to receive 80% of his/her regular salary. Notify Human
   Resources, Cynthia Vazquez, if the employee does not have enough sick leave.
   Record no sick leave/vacation on timesheet after waiting period.
TO AVOID OVERPAYMENTS ONLY RECORD WAITING
PERIOD AS SL:
   Individual situations may be considered. Advise employees about potential
   overpayments if the employee requests sick leave/vacation pay while waiting
   for the WC paycheck.

UPDATE the LOA NOTIFICATION form as needed.

UPDATE the leave in EDB.
                                                                                    24
What else should you do?
FMLA
  Provide the employee with a FMLA packet.
  All workers’ compensation leaves are FMLA leaves if leave is more than 3 days.

TIMELINESS
  Complete the worksheets and process in EDB and PTR as they are provided to you.
  If they are not processed, the employee does not receive pay, and benefits may be
  discontinued.

HOLIDAYS
  Employees should receive FULL holiday pay while at 100% or 80% pay. Do not
  include holidays when calculating the hours worked for the worksheets.

PTO
  If the employee on workers’ comp is eligible for PTO, immediately notify
  Enterprise Payroll. Send notification by e-mail to the department’s payroll
  representative and copy Lillian Wilson, Hospital Payroll.
  While on Workers’ Comp, the PTO rules no longer apply and the employee’s         25
  accrual bank reverts back to vacation and sick time.
                                                                                   25
           New Employee Pamphlet/
          Pre-designation of Physician
NEW EMPLOYEE PAMPHLET
 For employees hired on or after 01/01/03
    New employees must be given written notice of workers’ compensation
    rights
    Includes a tear-off form to pre-designate their personal physician to treat
    them in the event of a work-related injury.
    Written notice must be provided to an employee no later than the end of his
    first pay period.
    Pamphlet with approved language available in Healthcare HR.
PRE-DESIGNATION OF PHYSICIAN
 Current form is available on the HR website
 Current employees may utilize that form – only new employees must receive
    the whole pamphlet including the tear off form.
   Employee must designate PRIOR TO AN INJURY the name and address
    of the MD or DO in writing. The doctor must be someone who had treated
    the employee before and who has the employee’s medical records.               26
          PRE-DESIGNATION OF
               PHYSICIAN
IF employee chooses to complete the form,
   HE/SHE must return the form to Human Resources as soon as
   he/she fills it out.
   HR will clock in date of receipt.
   HR must add the information to our database.
   HR will return the original form to the department to be retained
   in the employee’s personnel file.

If department receives form from the employee,
    Clock in date of receipt.
    Forward copy of the form to HR immediately.
    Retain the original form in the employee’s personnel file.
    HR must add the information to our database.
                                                                       27
                                   Types of Injuries

Types of Injuries
Indemnity
– Examples: Repetitive motion, fracture, or sprain
– Claims with lost time more than 3 days or anticipated permanent
  disability
– Temporary disability, permanent disability, vocational rehabilitation,
  partial replacement of lost wages

Medical
– Claims with lost time of 3 days or less
– May receive medical care and follow-up by Occupational Health or
  Workers’ Compensation medical provider

First Aid
– No medical treatment needed                                              28
                           Types of compensation

•   Medical coverage
     – Medical examinations, therapy, co-pays, prescriptions, mileage, equipment,
       vocational rehabilitation
•   Temporary disability
     – Represents 2/3 of the employee’s regular salary, up to the current maximum of
       $602.00 per week for injuries occurring on or after 01/01/03.
     – Starts with the fourth calendar day the employee is unable to work. The three-
       day waiting period is waived if the employee is hospitalized or disabled for 14
       days or more
     – Can also be WAGE LOSS which represents 2/3 of the employee’s lost
       earnings from the total average weekly earnings, up to maximum, when return
       to work on a part-time/modified basis
• Vocational Rehabilitation
     – Training when employee’s injury prevents return to usual and customary job
•   Permanent disability
     – Long-term effects on ability to work are calculated, or “rated”, taking into
       account the body part affected, the occupation, the age and rate of pay at the
       time of the injury/illness.                                                       29
              Assistance Directory
OCTAGON RISK SERVICES               UCLA HEALTHCARE HUMAN
                                        RESOURCES
10880 Wilshire Blvd, Suite 850
                                    10920 Wilshire Blvd, Suite 400
Los Angeles, CA 90024-6914
                                    MC 167648
Mail code 691448
                                    Phone      310 794 0500
Phone       310 794 8247
                                    Fax        310 794 0530
Fax         310 794 8268

OCCUPATIONAL HEALTH FACILITY(OHF)   EMERGENCY MEDICINE CENTER (EMC)
200 UCLA Medical Plaza, Suite 224   BE-144 CHS Center for Health Sciences
Monday through Friday               Open 24 hours a day
7:30 a.m. to 4:30 p.m.              Phone      310 825 2111
Mail Code 172524                    Fax 310 794 0599
Phone        310 825 6771
Fax 310 206 4585                    ENTERPRISE PAYROLL
                                    UCLA Wilshire Center, Suite 1700
CAMPUS PAYROLL                      MC 167646
UCLA Wilshire Center, Suite 620     Phone     310 794 0127
MC 141648                           Fax       310 794 8049
Phone     310 794 8706
Fax       310 794 8751                                                 30
                      INFORMATION
INJURY REPORTING             CLAIM STATUS
PROGRAM INFORMATION          INJURY INVESTIGATION
INJURY ANALYSIS/TRENDS          ASSISTANCE
                             Claims Account Executive
SUPPLEMENTAL PAYROLL
                             Octagon Risk Services (ORS)
   WORKSHEETS
                             x 48247 phone
Cynthia Vazquez
Med Center Human Resources
                             ACCIDENT PREVENTION
x 40522
                             SAFETY INSPECTIONS/TRAINING
                             ACCIDENT INVESTIGATION
DISABILITY MANAGEMENT           COORDINATION
RETURN TO WORK               ERGONOMIC EVALUATION
VOCATIONAL REHABILITATION    Victor Kennedy x 54012
LOSS CONTROL ASSISTANCE      200 Medical Plaza, Suite 202
                             692624
Mark Briskie
                             Daniel Phillips x 53389
Med Center Human Resources
                             Derick Nguyen x 45170
x 40525                      Building and Safety
                             MC 694116                      31
• Review a Workers’ Compensation
  Worksheet
• Calculate Sick Leave and Pay Adjustments
• Process a Leave of Absence in EDB
• Process Pay Adjustments and a Workers’
  Compensation Check in PTR
                                           32
SAMPLE # 1 (OPTION 2)
    IMA EXAMPLE - OPTION 2

Title: Hospital __ Asst. I - 9252
Appointment: 100% (40 hr/wk, evening shift)
Salary: $13.50 hr/ + $.85 SDF
Injured: March 18, 2002
Sick Leave: 25.5 on date of injury
         Note: Accrual date on March 30, 2002
ORS Check: $720.00 (March 19-Apr 1, 2002)
Returned to Work: April 2, 2002



                                                33
                                  WORKERS’ COMPENSATION INSTRUCTION SHEET
                                             OPTION 2 – Sick Leave
                                                                                                                  REVISION       DATE
 DATE:
 04/03/02
 EMPLOYEE:                                  EMPLOYEE ID:                                  EMPLOYEE’S HOURLY RATE:
 IMA EXAMPLE                                987654321                                     $13.50
 DEPARTMENT:                                DEPARTMENT REP:                               EXTENSION:
 MODEL DEPARTMENT                           POLLY PROCESSOR                               52003
 DATE OF INJURY:                            NATURE OF INJURY:                             ORS CASE #:
 03/18/02                                   STRAIN, LOW BACK                              200212345

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 720.00, for the
period 03/19/02 to and including 04/01/02.
                                                                                                                                                 ADD in full
The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the
                                                                                                                                                 accruals of
amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The         SICK
                                                                                                                                                   LEAVE
employee continues to accrue sick leave and vacation benefits while disabled.

The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay.
The following must be done:                                                                                                                       while on
Adjust the employee’s sick leave:                                                                                                                 Option 2
a)      Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
        sick leave accruals to the employee’s balance.
b)      Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
        include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
        hours represented by the ORS check (53.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The
        “difference” represents the number of sick leave hours required to keep the employee at 100% pay status.

                                                                                                                
 Sick leave hours available on 03/19/02 =     Total Normal Working Hours =        72       Total Sick Leave Balance =           32.89
 25.5

                                                                                                                                                    This
 Accruals (if applicable) +                   Hours represented by ORS check = 53.3        Difference from column #2 =          18.7
 7.39
                                             “DIFFERENCE” =
                                                                                                                                                 balance is
 TOTAL Sick Leave balance =                                                              18.7   Balance sick leave left for next worksheet
 32.89                                       (deduct this “difference” from sick leave records) =                                 14.19

                                                                                                                                                   left in
If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the
employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay.

Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
                                                                                                                                                 employee’s
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours           bank.
used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX”
transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the
ORS check in the “Pay Period End Date” field.

Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.

Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.

Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.
 Distribution:     Department POLLY PROCESSR
                                                                                                                                                           34
                   Medical Center Payroll Office MED CTR PAYROLL REP 1
                   Campus Payroll Office GTAYLOR
          MARCH 2002
                                                                                                     APRIL 2002
S    M    T   W    T       F
                           1
                                  S
                                   2
                                        WORKSHEET                                         S    M    T    W     T    F   S
                                                                                                1    2   3     4    5    6
 3    4    5   6      7    8       9
                                                                                           7    8    9   10   11   12   13
10   11   12   13    14   15      16
17
24
     18
     25
          19
          26
               20
               27
                     21
                     28
                          22
                          29
                                  23
                                  30
                                             SAMPLE 1                                     14
                                                                                          21
                                                                                               15
                                                                                               22
                                                                                                    16   17
                                                                                                    23 24 25
                                                                                                              18   19
                                                                                                                   26
                                                                                                                        20
                                                                                                                        27
31                                           IMA EXAMPLE                $13.50/hr
                                                                                          28   29   30
                                             100% BW                    $.85 SDF


                    WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)
                                                                AMOUNT OPTION
                    For the period 3/19/02 through    4/1/02    $720.00    Option 2


                    SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)
                                             HRS/%     DOS CODE
                    Payperiod:  3/30/02        32          REG     8 worked hours + 24 SL hours
                                                                   Was paid on 04/10/02 payday


                    PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)
                                              HRS/%   DOS CODE
                    Payperiod:  3/30/02          8         REG     1 day worked, 03/18/02
                                                 8         REG     1 holiday @100%, 03/25/02
                                                64         REG     8 days @ 100% pay,
                                                                   03/19-03/22/02, 03/26-03/29/02
                                4/13/02          8         REG     1 day @100% pay, 04/01/02


                    PTR TRANSACTIONS:
                                  TC         PER. END DATE   TIME        RATE       DOS
                                  LX              3/30/02      48 hrs    $13.50     REG
                                  LX              4/13/02       8 hrs    $13.50     REG

                    Inst. Sheet        TC    PER. END DATE              RATE/Amt    DOS
                                       RX        04/01/02                $720.00    WCR

                    Note:
                    Any other payments such as NSD, SDF etc. due employee (refer to EDB                                      35
                    appointment) should also be calculated and paid based on the above.
                                                        IDER SCREEN

PPIDER0-I1214                Departmental Inquiry      04/15/02 13:50:17
                            Earnings Distributions     Userid: HPJRV
Pay Cycle:   B2 Processed In: 03/30/02 Check Date: 04/10/02
       ID:   xxxxxxxxx  Name: EXAMPLE, IMA                      SSN: XXX-XX-XXXX
  Hm Dept:   280300     MC-HUM RES                 Disp: 8   Emplmt Status: A
 Check No:              Type: CUR-ACTIVITY           PAR Control No: 697

 01 TC: AP FAU: 4-427705-    -63000-      -2             Title: 9252 Gross:    432.00
 Rate:    13.5000 Time H: 32.00      Time %:            .0000 Period: 03/30/02-B- - -N
  ERC: E    Typ: 2    TUC: EX SHC:      DUC:              Cov: C Ret: 0    DOS: REG

 02 TC: AP FAU: 4-427705-             -63000-      -2   Title: 9252 Gross:        6.80
 Rate:    0.85000 Time H:            32.00    Time %:         Period: 03/30/02-B- - -N
  ERC:      Typ:      TUC:              SHC:     DUC:    Cov:     Ret:      DOS:

    TC:      FAU:                                        Title:       Gross:
 Rate:                     Time H:           Time %:          Period:
  ERC:        Typ:            TUC:      SHC:    DUC:     Cov:    Ret:        DOS:

Next Func:           ID:              Name:                              SSN:
Pay Cycle:                      Check Date:




 Review IDER screen to verify if any hours have been paid
 during the pay period for which the adjustments are being made. 36
       EXAMPLE, IMA                                                                             9252 HOSP__ASST II
                                      987654321



                 031702-
033002-
                                                                              0.00
                                             0.00


                                      8.00                 32.00




03/29/02


      03/17/02             03/18/02             03/19/02           03/20/02          03/21/02       03/22/02




                                                                                                                     37
 EXAMPLE, IMA




03/17/02   03/30/02




                      38
  Logging on to OASIS for PTR
Log on to Oasis
Oasis Menu Screen will appear, enter PPP
Online Application
       Main Menu
Go to Next Function field, enter EDAT, enter Employee ID#, then the Enter key/
       Dept Adjustment Transaction menu will appear
Go to Next Function field:
     Enter EDLR
     Enter Employee ID#
     Refer to “Schedule for Updating PPS ON-Line” and enter the Pay Cycle, I.e., B1 or B2 as
       appropriate
     Enter the Pay Period End Date for the pay day on which the transaction(s) will be
     processed and then the Enter key
 The (EDLR) Dept. Adj. Trans screen will appear
     Process LX and RX transactions from the Worker’s Comp Instruction Sheet
          LX: REG 80.00 hours or ESL , and all other data, I.e., Title Code, Full Account
          Number, Rate, enter “H” in AH field
          RX: WCR (worker’s comp payment) enter “A” in AH field
Go to F10 and enter comments, Go to F6 to add Payroll Notification and appropriate HR
       Benefits Team members as carbon copy recipients of the ASAP notification, Go to F3 to
       return to list of ASAP recipients, then F9 to Update transaction                     39
Refer to PTR User Guide, Section E13, Special Processes for additional help
                    EDB - Leave of Absence
                                                                                               OPTION 2
PPELVE0-E0875                        EDB Entry/Update              LOAB 11/08/01
17:03:11
10/23/01 22:18:37                Leave of Absence Data                  Userid: HPJRV
ID: 987654321     Name:      example, ima                         SSN: 987-65-4321
                                                                               Leave of Absence Action Codes
                                                                               07           Leave with Pay
Leave of Absence Action Code                :07                                08          Leave without Pay
Leave of Absence Begin Date                 :031902   Return:   040202   Type:16


                 Type of Leave of Absence
  01    Sabbatical at full salary
  02    Sabbatical at partial salary
                                                                    Leaves of absence due to a work incurred
  03    Sabbatical in residence at full salary
                                                                    injury run concurrent with Family &
  04    Pregnancy Disability
                                                                    Medical Leave.
  05    Extended Illness
  06    Government/Public Service                                   The leave should first be processed as a
  07    Professional Development                                    Family & Medical Leave, either with or
  08    Personal                                                    without pay as appropriate.
  09    Worker’s compensation
  10    Furlough                                                    The comments on the ASAP notification
  11    Military                                                    should state that the employee is on
  12    Special Research                                            worker’s comp and the time period.
  13    Administration                                              Once the employee has exhausted the
  14    Sabbatical in Residence at partial Salary                   Family & Medical Leave period and is still
  15    Family and Medical Leave Without Pay
                                                                    on worker’s comp, the leave type would 40
  16    Family and Medical Leave With Pay
                                                                    then be 09 - Worker’s Comp.
  99    Other (as specified in Personnel File)
             MARCH 2002
 S      M    T   W    T          F   S
                                 1    2
  3
 10
 17
        4
       11
       18
              5
             12
             19
                   6
                   13
                   20
                           7
                          14
                          21
                                 8
                                15
                                22
                                      9
                                     16
                                     23
                                             PTR – Pay Adjustments
 24    25    26    27     28    29   30
 31
 PPETLR-E1064                  Dept. Adj Trans           11/08/01 19:45:38
 11/05/01 23:40:13          Late/Reduce Pay (EDLR)           Userid: HPJRV
 ID: 700486135 Name: EXAMPLE, IMA       SSN: 987-65-4321       Emp Status: A                         OPTION 2
 Pay End: 04/13/02 Check Date: 04/24/02 Pay Cycle: B2          Page 1 of 1
 C
   Seq:    Tr:LX   Per End:033002 Pay Cy:B Dst:11 E: E T: D:    Ttl:9252
      LACFPS: 4 427705 63000                 2            Rate: 13.5000           AH: H
      DOS:REG       Time: 48.00            H%:   H DOS:        Hr:      DOS:    Hr:     WSP:
                                                                                                 Worker’s comp check
      Seq:        Tr:LX        Per End:033002 Pay Cy:B Dst:12      E:   T: D:     Ttl:9252
                                                                                                 amount & end date of
      LACFPS: 4 427705 63000                              Rate: .8500            AH: H
      DOS: SDF     Time: 48.00             H%:   H   DOS:      Hr:      DOS:      Hr:    WSP:       period covered

      Seq:    Tr: RX Per End:040102 Pay Cy:B Dst: E: T: D:                      Ttl: 9252         Injured: 3/18/02
      LACFPS: 4 427705 63000 2            Rate: 00720.00                         AH: A
                                                                                                  ORS Check: 0319 -
      DOS: WCR    Time:       H%:    DOS:      Hr:      DOS:                      Hr:    WSP:
                                                                                                  040102
                                                                                                  NEED TO ENTER
                                                                                                  THE LX FOR PPE
 Payroll pay period
                                                                                                  04/1302 8 HOURS
 end date & hours              EDB preparer must take two (2) separate actions                    ON NEXT PAGE
covered by worker’s
                                      adjust the employee’s sick leave accruals (Coordinate w/Hospital Payroll))
      Comp check
                                      adjust the employee’s pay
  LX Transaction = Hours employee would have worked during the period covered by the Worker’s Comp check
  RX Transaction = Credit for the Worker’s Comp check
                                                                                                                      41
  WCR = DOS code used to report the amount of the Worker’s Comp check as a credit for the period of the check
                Transaction Codes
                 and Notifications
Screen Label     Data Name           Data Values/Comments                          PTR Screen
 Tr       Transaction Type Code   Code indicating the nature of the transaction      EDLR
                                  LX - Late Pay
                                  Used to report the sick leave and/or 80% ESL to be paid


                                  RX - Reduction in pay or leave
                                  Used to report the ORS check as a by-agreement credit


Carbon Copy Recipients of ASAP:

          Payroll Notification and HR Benefits Team
          HR WC Cynthia Vazquez OPTIONAL

Comments on the ASAP notification:
EXAMPLES: “Employee on approved WC leave, Option 2 use of Sick Leave”
           “Employee has filed WC claim pending Approval. Extended Illness.”
           “Employee on 80% Extended Sick Leave under workers’ comp”
                                                                                            42
           “Extend WC LWOP. 80%ESL exhausted 05/30/03.”
                SAMPLE #1 (OPTION 2)
PPETLR-E1064                             Dept. Adj Trans                                               11/08/01 08:45:02
11/05/01 23:51:40                                     Late/Reduce Pay (EDLR)                           Userid: MFLWO
ID: 700486135       NAME:     EXAMPLE, IMA                         SSN: 987-65-4321                Emp Status: A
Pay End: 041302            Check Date: 042402            Pay Cycle: B2                                 Page        1 of 2

Seq: Tr: LX     Per End: 033002                     Pay Cy: B      Dst: 11          E: E     T:   D:         Ttl: 9252
LACFPS:    4 427980 63000           2                           Rate: 13.5000                                 AH: H
DOS: REG        Time:   48.00      H%: H              DOS:           Hr:               DOS:                  Hr:         WSP:

Seq:              Tr: LX          Per End: 033002       Pay Cy: B Dst: 12           E: E     T:   D:          Ttl: 9252
LACFPS:    4 427980 63000           2                              Rate: .8500                                        AH: H
DOS: SDF        Time: 48.00       H%: H               DOS:           Hr:               DOS:            Hr:           WSP:

Seq:              Tr: RX          Per End: 040102       Pay Cy: B Dst:              E: E     T:   D:          Ttl: 9252
LACFPS:    4 427980 63000          2                               Rate: 00720.00                      AH: A
DOS: WCR        Time:                   H%:           DOS:           Hr:                   DOS:        Hr:                      WSP:




  Payroll pay period end
  date & hours covered                                              Worker’s Comp check
  by worker’s comp
                                                                    amount and end date of
  Check
                                                                    period covered
                                                                                                                                       43
             SAMPLE #1 (OPTION 2)
PPETLR-E1064                               Dept. Adj Trans                                                11/08/01 08:45:02
11/05/01 23:51:40                                       Late/Reduce Pay (EDLR)                            Userid: MFLWO
ID: 700486135       NAME:        EXAMPLE, IMA                           SSN: 987-65-4321                 Emp Status: A
Pay End: 041302               Check Date: 042402               Pay Cycle: B2                              Page 2      of 2

Seq:            Tr: LX               Per End: 041302          Pay Cy: B Dst: 11       E: E     T:    D:         Ttl: 9252
LACFPS:      4 427980 63000            2                             Rate: 13.5000                               AH: H
DOS: REG        Time:    8.00        H%: H               DOS:             Hr:               DOS:                Hr:         WSP:

Seq:              Tr: LX             Per End: 041302          Pay Cy: B Dst: 12       E: E     T:    D:          Ttl: 9252
LACFPS:      4 427980 63000            2                                Rate: .8500                                     AH: H
DOS: SDF        Time: 8.00         H%: H                 DOS:             Hr:               DOS:          Hr:         WSP:

Seq:              Tr:                Per End               Pay Cy:      Dst:          E:      T:    D:      Ttl:
LACFPS:                                                                 Rate:                             AH:

DOS: Time:              H%:             DOS:            Hr:                    DOS:   Hr:                   WSP:




                                               Payroll pay period end
                                               date & hours covered
                                               by worker’s comp
                                               Check
                                                                                                                                   44
   SAMPLE #2 (OPTION 3)
            MISTER JONES - OPTION 3

Title: CN II (9139)
Appointment: 90% (36 hr/wk, night shift)
Salary: $29.51 hr/ + $4.00 NSD
Injured: February 1, 2001 @ 3a.m. (sent to ER, taken off work)
Sick Leave: 18 s/l and 24 v/l on date of injury
ORS Check: $980.00 (February 2-15, 2001)
             $980.00 (February 16-March 1, 2001)
Returned to Work: March 2, 2001




                                                                 45
                                  WORKERS’ COMPENSATION INSTRUCTION SHEET
                                       OPTION 3 – Sick Leave and Vacation
                                                                                                                REVISION        DATE
 DATE:
 03/04/01
 EMPLOYEE:                                     EMPLOYEE ID:                              EMPLOYEE’S HOURLY RATE:
 MISTER JONES                                  123456789                                 29.51
 DEPARTMENT:                                   DEPARTMENT REP:                           EXTENSION:
 MODEL DEPARTMENT B                            INGRID INPUTTER                           98765
 DATE OF INJURY:                               NATURE OF INJURY:                         ORS CASE #:
 02/01/01                                      STRAIN, R ARM                             200112345

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 980.00, for the
period 02/02/01 to and including 02/15/01.

The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.

The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:

Adjust the employee’s sick leave:
a)      Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
        sick leave and vacation accruals to the employee’s balance.
b)      Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
        include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
        hours represented by the ORS check (33.2), which is calculated by dividing the ORS check by the employee’s hourly rate. The
        “difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.
                                                                                                                                                Add in the
                                                                                                                                               appropriate
                                                                                                              
     Sick Leave and Vacation hours available on Total Normal Working Hours =            72         Total Sick Leave and Vacation Balance =

                                                                                                                                                 accruals
                       02/01/01 = 18 + 24                                                                                            56.96
                      Accruals (if applicable) = Hours represented by ORS check = 33.2            Difference from column #2 =        38.79

                                                                                                                                                 based on
                                   6.65 + 8.31
     TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =                             38.79 Balance sick leave/vacation left for next

                                                                                                                                               Option 2 or
                                         56.96 (deduct this “difference” from SL/VA records)  worksheet =                       18.17
If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.

Adjust the employee’s pay:
                                                                                                                                                    3!!!
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
                                                                                                                                                 While at
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.      100% pay,
Enter the actual last date of the ORS check in the “Pay Period End Date” field.
                                                                                                                                               add in 100%
                                                                                                                                                 accruals.
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.

Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.                                                                                                                      46
Distribution:    Department ingridi inputter
                 Medical Center Payroll Office med center payroll rep 2
                 Campus Payroll Office g taylor
                                  WORKERS’ COMPENSATION INSTRUCTION SHEET
                                       OPTION 3 – Sick Leave and Vacation
                                                                                                                REVISION        DATE
 DATE:
 03/04/01
 EMPLOYEE:                                       EMPLOYEE ID:                            EMPLOYEE’S HOURLY RATE:
 MISTER JONES                                    123456789                               29.51
 DEPARTMENT:                                     DEPARTMENT REP:                         EXTENSION:
 MODEL DEPARTMENT B                              INGRID INPUTTER                         98765
 DATE OF INJURY:                                 NATURE OF INJURY:                       ORS CASE #:
 02/01/01                                        STRAIN, R ARM                           200112345

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 980.00, for the
period 02/16/01 to and including 03/01/01.

The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.

The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:

Adjust the employee’s sick leave:
a)      Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
        sick leave and vacation accruals to the employee’s balance.
b)      Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
        include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
        hours represented by the ORS check (33.2), which is calculated by dividing the ORS check by the employee’s hourly rate. The
        “difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.

                                                                                                                                            Not enough
     Sick Leave and Vacation hours available on Total Normal Working Hours =
                          02/01/01 = 18.17
                                                                                       64.8       Total Sick Leave and Vacation Balance =
                                                                                                                                    18.17      SL/VAC to
                      Accruals (if applicable) = Hours represented by ORS check = 33.2
                                        NONE
                                                                                                  Difference from column #2 =        31.6
                                                                                                                                                complete
     TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =                             31.6
                                         18.17 (deduct this “difference” from SL/VA records)
                                                                                             Balance sick leave/vacation left for next
                                                                                             worksheet =                                      worksheet!
If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.
                                                                                                                                                 Contact
                                                                                                                                               Healthcare
Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation
                                                                                                                                                  HR to
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.
Enter the actual last date of the ORS check in the “Pay Period End Date” field.
                                                                                                                                               change to
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the      80%ESL.
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.

Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.                                                                                                                     47
Distribution:    Department
                 Medical Center Payroll Office
                 Campus Payroll Office
                                WORKERS’ COMPENSATION INSTRUCTION SHEET
                                     OPTION 3 – Sick Leave and Vacation
                                                                                                               REVISION X DATE 03/06/01
 DATE:
 03/04/01
 EMPLOYEE:                                 EMPLOYEE ID:                                  EMPLOYEE’S HOURLY RATE:
 MISTER JONES                              123456789                                     29.51
 DEPARTMENT:                               DEPARTMENT REP:                               EXTENSION:
 MODEL DEPARTMENT B                        INGRID INPUTTER                               98765
 DATE OF INJURY:
 02/01/01
                                           NATURE OF INJURY:
                                           STRAIN, R ARM
                                                                                         ORS CASE #:
                                                                                         200112345
                                                                                                                                                  NOTE
                                                                                                                                                REVISION
The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 490.00, for the
period 02/16/01 to and including 02/22/01.                                                                                                        DATE
The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings
minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave
benefit. The employee continues to accrue sick leave and vacation benefits while disabled.

The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the
employee’s pay. The following must be done:

Adjust the employee’s sick leave:
a)      Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
        sick leave and vacation accruals to the employee’s balance.
b)      Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
        include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of
        hours represented by the ORS check (16.6), which is calculated by dividing the ORS check by the employee’s hourly rate. The
        “difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.

                                                                                                              
                                                                                                                                               This balance
     Sick Leave and Vacation hours available on Total Normal Working Hours =
                          02/01/01 = 18.17
                                                                                       28.8      Total Sick Leave and Vacation Balance =
                                                                                                                                   18.17
                                                                                                                                                 is left in
                      Accruals (if applicable) = Hours represented by ORS check = 16.6
                                        NONE
                                                                                                 Difference from column #2 =        12.2        employee’s
     TOTAL Sick Leave and Vacation balance = “DIFFERENCE” =                             12.2
                                         18.17 (deduct this “difference” from SL/VA records)
                                                                                              Balance sick leave/vacation left for next
                                                                                                worksheet =                        5.97
                                                                                                                                                   bank.
If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If
the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.
                                                                                                                                                 Accruals
Adjust the employee’s pay:
                                                                                                                                                 while on
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to      80%ESL will
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and
vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation         be added to
balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period.
Enter the actual last date of the ORS check in the “Pay Period End Date” field.                                                                     this
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the       balance.
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the
Instruction Sheet.

Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation
Representative at extension 40500.                                                                                                                       48
Distribution:    Department      INGRID INPUTTER
                 Medical Center Payroll Office MED CTR REP 2
                 Campus Payroll Office G TAYLOR
                            WORKERS’ COMPENSATION INSTRUCTION SHEET
                                   80% Extended Sick Leave Benefit
                                                                   REVISION X DATE 03/04/01
DATE:
03/04/01
EMPLOYEE:                                  EMPLOYEE ID:                                   EMPLOYEE’S HOURLY RATE:
MISTER JONES                               123456789                                      29.51
DEPARTMENT:                                DEPARTMENT REP:                                EXTENSION:
MODEL DEPARTMENT B                         INGRID INPUTTER                                98765
DATE OF INJURY:                            NATURE OF INJURY:                              ORS CASE #:
02/01/01                                   STRAIN, R ARM                                  200112345

80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or
vacation, depending on which option was selected.

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 490.00, for
the period 02/23/01 to and including 03/01/01.

This employee, who previously selected OPTION 2        OPTION 3 X, has exhausted all sick leave (and vacation, if applicable), and is
now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from
02/23/01 through 08/22/01, or until he/she is released to return to work, which occurs first.

The department must adjust the employee’s pay as follows:

Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.


                                                                                                                                        BEGIN and
If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the
Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual

                                                                                                                                        END dates
number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the
amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date”

                                                                                                                                          of the
field.

Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the

                                                                                                                                        80% ESL
comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to
their copy of the Instruction Sheet.

Vacation and Sick Leave Accruals                                                                                                        benefit.
Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’
compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation
and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate
adjustment.

Holiday Hours
Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full
holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll
Office at extension 40127.

Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’
Compensation Representative at extension 40500.


Distribution:    Department INGRID INPUTTER                                                                                                    49
                 Medical Center Payroll Office MED CENTER PAYROLL REP 2
                 Campus Payroll Office G TAYLOR
EDB Transaction for Employee on
  80% Extended Sick Leave
                                                                                   Page 1 of 2

   PPEAPP0-E1287                    EDB Entry/Update           11/13/01 18:25:38
   11/05/01 23:40:13           Appointments/Distributions     Userid: HPJRV
   ID: 123456789 Name: JONES, MISTER               SSN: XXX-XX-XXXX Pri Pay: BW
           PAF Gen No:   48                                          Pg 01 of 02
   Appt    Actions Pgm Typ Bas Pd Ovr      Appt Begin Appt End Dur Dept FLSA
    40               1   2                   091597       999999    I 280300 0
   Title                          Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv
   9139 CLINICAL NURSE II                0.90    F     29.5100    H BW    N   N
   Dist Actions L Acct      CC    Fund PC      S                 FTE Dis %
    42            4 427705        63000        2 MEDCTR-HUMAN RESOURCES
   0.9000
          Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP
          093001     022201                 29.5100       REG

   Dist Actions L Acct   CC  Fund PC     S                                 FTE
   Dis %
    41   16      4 427705     63000 2 MEDCTR-HUMAN RESOURCES             0.8000
         Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC              WSP
         022301    082201             29.5100     ESL




   ESL = DOS code for the 80% Extended Sick Leave period


                                                                                             50
EDB Transaction for Employee on
80% Extended Sick Leave (Cont’d)
                                                                                           Page 2 of 2
        PPEAPP0-E1287                 EDB Entry/Update        11/13/01 18:25:38
        11/05/01 23:40:13        Appointments/Distributions     Userid: HPJRV
        ID: 123456789 Name: JONES, MISTER          SSN: XXX-XX-XXXX Pri Pay: BW
               PAF Gen No:   48                                      Pg 02 of 02
        Appt   Actions Pgm Typ Bas Pd Ovr ppt Begin Appt End Dur ept        FLSA
         40              1   2              091597     999999    I 280300 0
        Title                     Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv
        9139 CLINICAL NURSE II          0.90   F    29.5100     H BW    N   N

        Dist   Actions L Acct   CC Fund PC    S                  FTE              Dis %
         43            4 427705    63000 2 MEDCTR-HUMAN RESOURCES                 0.9000
               Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC                 WSP
               082301     999999           29.5100     REG

        Dist   Actions L Acct   CC    Fund PC        S                      FTE   Dis %

               Pay Begin   Pay End   Step   O/A   Rate/Amount   DOS   PRQ   DUC   WSP




Comments on the ASAP notification: “Employee on 80% extended
        sick leave under workers’ comp”
Carbon Copy Recipients of ASAP: Payroll Notification and HR
       Benefits Team                                                                                51
                    SAMPLE #2 (OPTION 3)
PPETLR-E1064                                    Dept. Adj Trans                                    11/08/01
     08:45:02
11/05/01 23:51:40                         Late/Reduce Pay (EDLR)                     Userid: MFLWO
ID: 000345789       NAME: JONES, MISTER                                SSN: 239-00-2367                 Emp Status: A
Pay End: 020301          Check Date: 11/21/01             Pay Cycle: B2                            Page     1 of 4

Seq:        Tr: LX         Per End: 020301        Pay Cy: B            Dst: 11       E: E     T:   D:        Ttl: 9139
LACFPS:    4 427980 63000         2                   Rate: 29.5100                                AH: H
DOS: REG Time: 7.20           H%: H        DOS:           Hr:             DOS:          Hr:        WSP:

Seq:        Tr: LX         Per End: 020301        Pay Cy: B            Dst: 12       E: E     T:   D:        Ttl: 9139
LACFPS:    4 427980 63000         2                     Rate: 4.0000                                AH: H
DOS: NSD    Time: 7.20        H%: H        DOS:           Hr:                 DOS:     Hr:          WSP:

Seq:            Tr: RX     Per End: 021501        Pay Cy: B            Dst:          E: E     T:   D:        Ttl: 9139
LACFPS:    4 427980 63000        2                      Rate: 980.00                                AH: A
DOS: WCR Time:                H%:          DOS:           Hr:                 DOS:     Hr:
    WSP:



                                                                                                                     52
                  SAMPLE #2 (OPTION 3)
PPETLR-E1064                         Dept. Adj Trans                             11/08/01 08:45:02
11/05/01 23:51:40                 Late/Reduce Pay (EDLR)              Userid: MFLWO
ID: 000345789     NAME: JONES, MISTER                    SSN: 239-00-2367          Emp Status: A
Pay End: 021701       Check Date: 11/21/01            Pay Cycle: B2                            Page 2 of      4

Seq:        Tr: LX        Per End: 021701      Pay Cy: B          Dst:          E: E     T:    D:       Ttl: 9139
LACFPS:    4 427980 63000       2                 Rate: 29.5100                                AH: H
DOS: REG Time: 72.00         H%: H      DOS:         Hr:              DOS:         Hr:         WSP:

Seq:        Tr: LX        Per End: 021701      Pay Cy: B          Dst:          E: E     T:    D:       Ttl: 9139
LACFPS:    4 427980 63000       2                  Rate: 04.0000                                AH: H
DOS: NSD    Time: 72.00       H%: H     DOS:         Hr:                 DOS:     Hr:           WSP:

Seq:         Tr: RX       Per End: 030101      Pay Cy: B          Dst:          E: E     T:    D:       Ttl: 9139
LACFPS:    4 427980 63000       2                  Rate: 490.00                        AH: A
DOS: WCR Time:               H%:        DOS:         Hr:                 DOS:     Hr:                        WSP:




                                                                                                                  53
                  SAMPLE #2 (OPTION 3)
PPETLR-E1064                         Dept. Adj Trans                             11/08/01 08:45:02
11/05/01 23:51:40                 Late/Reduce Pay (EDLR)              Userid: MFLWO
ID: 000345789     NAME: JONES, MISTER                    SSN: 239-00-2367          Emp Status: A
Pay End: 030301          Check Date: 11/21/01            Pay Cycle: B2                            Page   3 of 4

Seq:        Tr: LX         Per End: 030301        Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000         2                  Rate: 29.5100                               AH: H
DOS: REG Time: 7.20           H%: H        DOS:         Hr:              DOS:         Hr:         WSP:

Seq:        Tr: LX         Per End: 030301        Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000         2                   Rate: 04.0000                                   AH: H
DOS: NSD    Time: 7.20        H%: H        DOS:         Hr:                 DOS:     Hr:          WSP:

Seq:         Tr: RX        Per End: 022201        Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000        2                    Rate: 490.00                   AH: A
DOS: WCR Time:                 H%:         DOS:         Hr:                 DOS:     Hr:                       WSP:




                                                                                                                  54
                  SAMPLE #2 (OPTION 3)
PPETLR-E1064                         Dept. Adj Trans                             11/08/01 08:45:02
11/05/01 23:51:40                 Late/Reduce Pay (EDLR)              Userid: MFLWO
ID: 000345789     NAME: JONES, MISTER                    SSN: 239-00-2367          Emp Status: A
Pay End: 030301       Check Date: 11/21/01               Pay Cycle: B2                            Page   4 of 4

Seq:        Tr: LX        Per End: 030301         Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000       2                    Rate: 29.5100                               AH: H
DOS: REG Time: 21.60        H%: H          DOS:          Hr:             DOS:         Hr:         WSP:

Seq:        Tr: LX        Per End: 030301         Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000       2                     Rate: 04.0000                                   AH: H
DOS: NSD    Time: 21.60      H%: H         DOS:          Hr:                DOS:     Hr:          WSP:

Seq:         Tr: LX       Per End 030301          Pay Cy: B          Dst:          E: E     T:   D:       Ttl: 9139
LACFPS:    4 427980 63000       2                     Rate: 29.5100                                   AH: H
DOS: ESL    Time: 28.80      H%: H         DOS:          Hr:                DOS:     Hr:                       WSP:




                                                                                                                      55
 SAMPLE # 3 (Option 1)
      HOURLY01, STUDENT - OPTION 1

Title: Admin Specialist (7646)
Appointment: 100% (5 days/week, day shift)
Salary: $19.25/hr
Injured: May 12, 2003 @ 9 a.m. (sent to OHF, taken off work)
Sick Leave: 110 s/l and 24 v/l on date of injury
ORS Check: $513.30 (May 12-18, 2003)
Returned to Work: May 19, 2003




                                                               56
57
                                                          IDER SCREEN

PPIDER0-I1214                Departmental Inquiry      05/30/03 13:50:17
                            Earnings Distributions     Userid: HPJRV
Pay Cycle:   B2 Processed In: 05/24/03 Check Date: 06/04/03
       ID:   xxxxxxxxx  Name: HOURLY01, STUDENT             SSN: XXX-XX-XXXX
  Hm Dept:   280300     MC-HUM RES                 Disp: 8   Emplmt Status: A
 Check No:              Type: CUR-ACTIVITY           PAR Control No: 697

 01 TC: AP FAU: 4-427705-    -63000-      -2             Title: 7646  Gross:    770.00
 Rate:    19.2500 Time H: 40.00      Time %:            .0000 Period: 05/24/03-B- - -N
  ERC: E    Typ: 2    TUC: EX SHC:      DUC:              Cov: C Ret: 0    DOS: REG

 02 TC: AP FAU: 4-427705-                                Title: 7646 Gross:
 Rate:            Time H:                     Time %:         Period: 03/30/02-B- - -N
  ERC:      Typ:      TUC:             SHC:     DUC:     Cov:    Ret:      DOS:

    TC:      FAU:                                        Title:       Gross:
 Rate:                     Time H:          Time %:           Period:
  ERC:        Typ:            TUC:     SHC:    DUC:      Cov:    Ret:        DOS:

Next Func:           ID:              Name:                              SSN:
Pay Cycle:                      Check Date:




    Review IDER screen to verify if any hours have been paid
    during the pay period for which the adjustments are being made. 58
                   SAMPLE #3 (OPTION 1)
PPETLR-E1064                               Dept. Adj Trans                                             11/08/01
      08:45:02
11/05/01 23:51:40                       Late/Reduce Pay (EDLR)                          Userid: MFLWO
ID: 700486135     NAME: HOURLY01,STUDENT            SSN: XXX-XX-XXXX                          Emp Status: A
Pay End: 052403      Check Date: 061803         Pay Cycle: B2                           Page 1 of 1

Seq:      r: RX        Per End: 052403     Pay Cy: BDst: 11       E: E     T:      D:        Ttl: 7646
LACFPS: 4 427980 63000      2                     Rate: 19.2500                                 AH: H
DOS: REG  Time: 40.00    H%: H           DOS:          Hr:             DOS:                Hr:       WSP:

Seq:        Tr:          Per End:          Pay Cy:   Dst:         E:       T:      D:          Ttl:
LACFPS:                                              Rate:                                     AH:
DOS:        Time:         H%:            DOS:          Hr:             DOS:              Hr:           WSP:

Seq:         Tr:         Per End:        Pay Cy:     Dst:         E:          T:    D:          Ttl:
LACFPS:                                              Rate:                                                 AH:
DOS:        Time:            H%:         DOS:          Hr:               DOS:            Hr:           WSP:


                                                        UNDER OPTION 1
                                                        Reverse SL hours
                                                        paid during same
                                                        period as Workers’
                                                        Comp check
                                                                                                                  59
  SAMPLE # 4 (Wage Loss)
WORKER, WANDA – OPTION 2/80% ESL/WAGE LOSS

   Title: ASST I (4724)
   Appointment: 100% (5 days/week, day shift)
   Salary: $13.60/hr
   Injured: February 28, 2003
            Saw OHF, given restrictions which department
            can accommodate 20 hours/week
   Sick Leave: 7.39 s/l and 0 v/l on date of injury
   Returned to Work: March 3, 2003 for 20 hours/week
                       on modified duty
   ORS Check: $181.33 wage loss check March 2-March 8, 2003
               $181.33 wage loss check March 9-March 15, 2003   60
                                                                                      MARCH 2003
           WORKSHEET                                                     S     M      T    W    T    F    S
                                                                                                     x    1
                                                                           2   3      4    5    6    7    8
SAMPLE 4 (WAGE LOSS)                                                       9   10     11   12   13   14   15
                                                                         16    17     18   19   20   21   22
               WANDA WORKER              $13.60/hr                      23     24     25   26   27   28   29
               100% BW


 WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)
                                             AMOUNT OPTION
 For the period 3/2/03 through     3/8/03    $181.33 Option 2 WAGE LOSS
                3/9/03             3/15/03    181.33 80 % ESL WAGE LOSS

 SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)
                          HRS/%     DOS CODE
 Payperiod:  3/15/03        20          REG     WORKED 4 HOURS/DAY
                            20          REG     WORKED 4 HOURS/DAY

 PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)
                           HRS/%   DOS CODE
 Payperiod:  3/15/03         20         REG     5       days   @4 hours/day worked
                             20         REG     5       days   @ 4 hrs/day @100%
             3/15/03         20         REG     5       days   @ 4 hours/day worked
                             16         ESL     5       days   @ 4 hrs/day @ 80%

 PTR TRANSACTIONS:
               TC        PER. END DATE     TIME         RATE         DOS
               LX           3/15/03               20    $13.60       REG
               LX           3/15/03               16    $13.60       ESL

 Inst. Sheet      TC     PER. END DATE                 RATE/Amt     DOS
                  RX        3/8/03                      $181.33     WCR
                  RX        3/15/03                      181.33     WCR

 Note:
 Any other payments such as NSD, SDF etc. due employee (refer to EDB
 appointment) should also be calculated and paid based on the above.
                                                                                                           61
                                 WORKERS’ COMPENSATION INSTRUCTION SHEET
                                            OPTION 2 – Sick Leave
                                                                                                                  REVISION       DATE
 DATE:           WAGE LOSS:
 03/10/03        YES
 EMPLOYEE:                                    EMPLOYEE ID:                                EMPLOYEE’S HOURLY RATE:
 WANDA WORKER                                 XXXXXXXXX                                   13.60
 DEPARTMENT:                                  DEPARTMENT REP:                             EXTENSION:
 MODEL DEPARTMENT 4                           ELMO ENTRY                                  XXXXX
 DATE OF INJURY:                              NATURE OF INJURY:                           ORS CASE #:
 02/21/03                                     SPRAIN                                      XXXX55555

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for the
period 03/02/03 to and including 03/08/03.

The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the
amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The
employee continues to accrue sick leave and vacation benefits while disabled.                                                                             NOTE:
The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay.
The following must be done:                                                                                                                           WORKSHEET
Adjust the employee’s sick leave:                                                                                                                         WILL
a)      Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct
        sick leave accruals to the employee’s balance.                                                                                                 INDICATE
b)      Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not
        include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of          THIS IS WAGE
        hours represented by the ORS check (13.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The
        “difference” represents the number of sick leave hours required to keep the employee at 100% pay status.                                          LOSS
                                                                                                                
 Sick leave hours available on 02/22/03 =    Total Normal Working Hours =               20      Total Sick Leave Balance =         7.39
 7.39
 Accruals (if applicable) +                  Hours represented by ORS check = 13.3              Difference from column #2 =        6.7
 NONE
 TOTAL Sick Leave balance =                  “DIFFERENCE” =                              6.7    Balance sick leave left for next worksheet
 7.39                                        (deduct this “difference” from sick leave records) =                                 0.7
If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the
employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay.

Adjust the employee’s pay:
Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.
                                                                                                                                                    WAGE LOSS
For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to
report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours            Use only the
used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX”
transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the     remaining hours
ORS check in the “Pay Period End Date” field.
                                                                                                                                                   needed to reach
Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the
transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the                    100%.
Instruction Sheet.

Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those
                                                                                                                                                 Worked hours will be
accruals will be deducted after the employee returns to work or upon separation from the University.                                                 submitted
The department must notify the Workers’ Compensation Representative on the date the employee returns to work.                                         regularly
Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at                         through
                                                                                                                                                        WPS
extension 40127.
Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation                                  62
Representative at extension 40500.

Distribution:    Department           ELMO ENTRY
                 Medical Center Payroll Office R POTTS
                 Campus Payroll Office R CRUZ
                              WORKERS’ COMPENSATION INSTRUCTION SHEET
                                     80% Extended Sick Leave Benefit
                                                                     REVISION                                            DATE
DATE:         WAGE LOSS:
03/10/03      YES
EMPLOYEE:                                         EMPLOYEE ID:                              EMPLOYEE’S HOURLY RATE:
WANDA WORKER                                      XXXXX XXXX                                13.60
DEPARTMENT:                                       DEPARTMENT REP:                           EXTENSION:
MODEL DEPARTMENT 4                                ELMO ENTRY                                XXXXX
DATE OF INJURY:                                   NATURE OF INJURY:                         ORS CASE #:
02/21/03                                          SPRAIN                                    XXXX55555

80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or
vacation, depending on which option was selected.

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for
the period 03/09/03 to and including 03/15/03.

This employee, who previously selected OPTION 2 X OPTION 3           , has exhausted all sick leave (and vacation, if applicable), and is
now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from
03/09/03 through 09/13/03, or until he/she is released to return to work, which occurs first.

The department must adjust the employee’s pay as follows:

Refer to the PTR User Guide, Section E13.0 Workers’ Compensation.

If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the
Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual
number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the
amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date”
field.

Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the
comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to
their copy of the Instruction Sheet.

Vacation and Sick Leave Accruals
Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’
compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation
and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate
adjustment.

Holiday Hours
Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full
holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll
Office at extension 40127.

Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’
Compensation Representative at extension 40500.
                                                                                                                                            63
Distribution:     Department ELMO ENTRY
                  Medical Center Payroll Office   R POTTS
                  Campus Payroll Office           R CRUZ
             SAMPLE #4 (WAGE LOSS)
PPETLR-E1064                               Dept. Adj Trans                                                11/08/01 08:45:02
11/05/01 23:51:40                       Late/Reduce Pay (EDLR)                             Userid: MFLWO
ID: 700486135     NAME: WORKER, WANDA               SSN: XXX-XX-XXXX                             Emp Status: A
Pay End: 031503      Check Date: 032603          Pay Cycle: B2                             Page 1 of 2

Seq:      r: LX        Per End: 031503       Pay Cy: B Dst: 11       E: E       T:    D:          Ttl: 4726
LACFPS: 4 427980 63000      2                        Rate: 13.6000                                   AH: H
DOS: REG  Time: 20.00    H%: H              DOS:          Hr:             DOS:                  Hr:       WSP:

Seq:        Tr: LX        Per End: 031503     Pay Cy: B Dst: 11      E:     E    T:       D:        Ttl: 4724
LACFPS: 4 427980 63000      2                      Rate: 13.6000                                   AH: H
DOS: ESL    Time: 16.00    H%: H            DOS:         Hr:              DOS:              Hr:         WSP:

Seq:      Tr: RX    Per End: 030803     Pay Cy: B Dst:    E:                E        T:    D:        Ttl: 4724
LACFPS: 4 427980 63000     2                 Rate: 181.33                                        AH: A
DOS: WCR Time:          H%:         DOS:        Hr:                         DOS:               Hr:             WSP:



                                                    UNDER WAGE LOSS
          WC check
        amount and end                              Only need to LX the remaining hours
        date of period                              needed to reach 100% or 80%
           covered                                  Worked hours will be submitted
                                                    regularly through WPS                                                 64
             SAMPLE #4 (WAGE LOSS)
PPETLR-E1064                               Dept. Adj Trans                                      11/08/01 08:45:02
11/05/01 23:51:40                       Late/Reduce Pay (EDLR)                   Userid: MFLWO
ID: 700486135     NAME: WORKER, WANDA               SSN: XXX-XX-XXXX                   Emp Status: A
Pay End: 031503      Check Date: 032603          Pay Cycle: B2                   Page 1 of 2

Seq:      Tr: RX    Per End: 031503     Pay Cy: B Dst:    E:      E         T:   D:         Ttl: 4724
LACFPS: 4 427980 63000     2                 Rate: 181.33                               AH: A
DOS: WCR Time:          H%:         DOS:        Hr:               DOS:                Hr:             WSP:

Seq:        Tr:         Per End:         Pay Cy:     Dst:    E:        T:        D:          Ttl:
LACFPS:                                             Rate:                                   AH:
DOS:        Time:        H%:           DOS:           Hr:         DOS:            Hr:           WSP:

Seq:         Tr:        Per End:          Pay Cy:     Dst:   E:     T:           D:           Ttl:
LACFPS:                              Rate:                        AH:
DOS:        Time:           H%:        DOS:           Hr:         DOS:                Hr:              WSP:




                                                                                                                65

				
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