Workplace Injuries and Workers' Compensation
Workers' Compensation is an employee benefit program mandated and regulated by the State of California and the California Labor Code. As an employee of California State University, you are covered by Workers' Compensation Insurance.
Notice of workers' compensation carrier
Benefits include medical treatment, death benefits to eligible dependents, temporary disability or industrial disability leave payments, and vocational rehabilitation.
CSUMB pays the full cost of all benefits. Our workers' compensation program is administered by Sedgwick CMS in coordination with CSUMB University Personnel.
Sedgwick CMSCSU Unit
PO Box 14629
Lexington, KY 40512-4629
Phone: (800) 225-2998
Fax: (916) 851-8089
Call your supervisor and University Personnel within 24 hours to report a work-related injury, illness, or accident and for referral authorization to the appropriate medical treatment facility.
If you are unable to work due to a work related injury, report the absence immediately to your supervisor and University Personnel. A work status from the treating physician is required.
CSUMB has a strong interest in the timely and effective treatment of injured employees, prompt payment of benefits, and the exploration of an early return to work through temporary modified duty or alternate work.
University Personnel will assist in obtaining quality medical treatment, explaining benefits and options, and in exploring other measures to facilitate recovery from the effects of work-related injuries or illnesses to resume productive work as soon as feasible. Call the UP Analyst for ADA, Leaves, and Workers' Compensation at (831) 582-3584 or the UP front desk at (831) 582-3389 to request assistance.
In the event of serious bodily injury or life-threatening illness, call 911.
CSUMB has designated the following Medical Provider Network for the treatment of work-related injuries:
- CSUMB Health Center: Bldg. 80 (831) 582-3965.
- Doctors on Duty: Monterey (831) 899-1910, N. Salinas (831) 757-1100, S. Salinas (831) 422-7777, when the Campus Health Center is closed.
- Community Hospital of the Monterey Peninsula (CHOMP): for life-threatening emergencies only, 23625 Holman Highway, Monterey, (831) 624-5311.
- Doctors on Duty, Seaside, (831) 899-1910
- Doctors on Duty, Monterey, (831) 649-0770
Pre-Designation of Physician
If you have a pre-designation of physician on file with University Personnel prior to the injury, you may treat with that physician. University Personnel can verify whether one is on file. Please call (831) 582-3584 for assistance.
What to expect When You File a Workers' Compensation Claim
As required by law and CSU policy, workers’ compensation insurance coverage is provided for work-related injuries. Injuries should be reported immediately to the supervisor and UP (ext. 3389). For emergencies -- call 911. Student Assistants, registered volunteers, staff, and faculty are covered by workers’ compensation insurance. For assistance, call the UP Analyst for ADA, Leaves, and Workers' Compensation at (831) 582-3584.
Refer to the Workers' Compensation FAQ for guidance on seeking medical treatment and reporting requirements. A referral to the designated Medical Provider Network for treatment is provided by UP or the supervisor. If a Physician Pre-designation form is on file with UP, the employee may choose to be seen by the designated physician instead of CSUMB's Medical Provider Network (CSUMB Health Center or Doctors on Duty). UP also provides a Pharmacy Network Script to cover prescription drugs on the approved formulary for work-related injuries.
Injured employees must complete and promptly submit the Accident, Illness, and Incident Report within 24 hours to UP. The employee's direct supervisor submits a Supervisor's Report within 24 hours to UP.
Employees are encouraged to submit the Workers' Compensation Claim Form (DWC-1) to UP within 24 hours after a work-related injury or illness. Injured employees have the right to file a Workers' Compensation Claim Form within one year from the date of injury.
The claims examiner at Sedgwick CMS, CSUMB's workers' compensation carrier, contacts the employee to confirm the claim has been filed and facilitates the claim process. The Sedgwick claims examiner and the UP workers' compensation analyst supports employees and supervisors with the reporting and treatment process.
Employees are expected to keep medical and treatment appointments and to contact the provider 24 hours in advance if rescheduling is necessary. A work status is required of the employee from the treating physician at the end of each appointment that should be provided to University Personnel or the manager after each medical visit. Work restrictions should be provided in writing to UP (ext. 3584) or manager prior to beginning work so temporary job accommodations can be facilitated, as applicable.
A medical history is obtained by Sedgwick and a representative may interview the employee and any witnesses. If deemed necessary, the employee is referred to a physician evaluator to determine if the injury or illness arose out of or in the course of employment and should be deemed industrially related. The physician receives past medical records and other information relevant to injury/illness, treatment, and a to reach a claim determination.
Sedgwick has up to 90 days from the date the claim is filed to accept or deny a claim. The employee will receive a written notification of this decision.
According to CSU policy, if an employee has returned to work and remains under the care of a physician, and "an employee loses work time for doctor's appointments, physical therapy, etc., such absences shall be charged to the employee's leave credits."
Labor laws protect against retaliation for filing a workers' compensation claim. Claim information is handled in a confidential manner.
Workers' Compensation Pay
If the claim is accepted, full regular pay is paid on the day of injury. The first three calendar days of lost time (after date of injury) are considered as the waiting period and will be charged to leave credits. Any time off must be authorized by the doctor in order for the lost time to be covered under workers' compensation benefits. Once returned to work, any visits to the doctor or therapy treatments are charged to leave credits.
Contributing members of the Public Employees Retirement System (PERS) or the State Teachers Retirement System are entitled to Industrial Disability Leave Benefits, which provide 22 days of your net salary (not charged to sick leave credits). If the industrial disability continues beyond 22 work days, the payment will be two-thirds of the gross monthly salary. Industrial Disability Leave Benefits commence after the third day of absence. State employees who are active members of CalPERS are eligible to receive Industrial Disability Leave in lieu of Temporary Disability.
Depending on the nature of injury, once completely recovered, an employee may be entitled to permanent disability benefits. The Sedgwick claims administrator refers the employee to a physician for disability rating purposes. If found by the Disability Ratings Bureau to have any permanent disability, the CSUMB claims administrator will prepare and forward necessary documents to the employee.
If injured such that one can no longer perform their profession, entitlement to supplemental job displacement will be evaluated, as determined from the medical reports, and the Sedgwick claims examiner promptly contacts the employee to facilitate this process.
Return to Work
CSUMB has a comprehensive return-to-work program including temporary modified duty. Once the physician releases the employee, the workers' compensation analyst will work with both manager and employee to facilitate the development of a return-to-work plan. The return-to-work process includes the following steps:
- A facilitated job analysis between the manager and employee. An interactive meeting is scheduled to review the job description and discuss the employee's ability to perform essential and/or non-essential functions if there are any work restrictions.
- The work schedule and temporary modified work duties are finalized.
- Job accommodations, including equipment and/or training, are identified.
- Time reporting procedures are reviewed.
- Notes that summarize the return-to-work plan are then forwarded to both the manager and the employee for future reference.
- The workers' compensation analyst checks-in with the manager and employee to ensure a successful return-to-work and provides advice on new issues or concerns.