Frequently Asked Questions - Supervisors
Q. Why is the Employer’s Report of Occupational Injury or Illness form so important?A. The Employer’s Report is required by the state. It begins the Workers’ Compensation claim process, which provides the employee’s medical coverage as well as temporary or permanent disability benefit payments. Remember, it is your responsibility as a supervisor to complete and give or send the Incident Report form to the injured employee and to send the Employer’s Report form (5020) to the Benefit's Office within one working day of your knowledge of the injury. Completing the form is not an admission of liability.
Q. Why is it necessary to fill out the Incident Report form?
A. University of California’s mission is to provide a safe working environment for all employees and to minimize the adverse impact of work-related injuries. Our goal in requiring the reporting of incidents it to promote prompt notification of unsafe conditions so the prompt and appropriate remediation can take place.
Q. What if I don’t have all the information for completing the Employer’s Report of Occupational Injury or Illness?
A. The Employer’s Report of Occupational Injury or Illness form must be sent to the Benefit Services Offices whether or not you have all the information requested on the form. Delaying the form seriously jeopardizes the employee’s disability payments or medical care, as well as the claims and accident investigations. When describing the injury or accident, you may leave lines 15-18 blank if no information is available at the time.
Q. If an employee is injured elsewhere (i.e., while in another department on official business), which departmental supervisor is responsible for reporting the injury?
A. Employees should inform their own supervisors of the injury so that the supervisor can complete the Employer’s Report of Occupational Injury or Illness and provide the Incident Report form to the injured employee.
Q. What if an employee tells me an injury is job-related but does not wish to file a claim for the injury?
A. It is the employee’s right not to file. State law requires, however, that the Employer’s Report of Occupational Injury or Illness form be completed by the employer any time an occupational injury is reported. To aid in the claims process, attach a statement indicating the employee does not wish to pursue the claim at this time.
Q. If an employee is hospitalized for an occupational injury/illness, should I mail the Incident Report form to his/her home?
A. Yes, you must give or mail the claim form to the employee’s home address within one working day of the date you’ve been notified of the injury. You may fax or take a copy of the Incident Report form and the Employer’s Report form (5020) to the Benefit Services Offices at UCOP.
Q. What is the supervisors’ responsibility for administering first aid to an injured employee?
A. You can administer first aid if you have a first aid kit or send the employee to the Occupational Health Facilities designated by UCOP for medical attention.
Q. Can I or my employee come to the Occupational Health Facilities even if the employee’s injury is not work-related?
A. No. For personal health care problems, the employee should seek his/her own health care provider. The designated Occupational Health Facilities are only available to employees with work-related injuries.
Q. If my employee calls in to report “back problems,” are they considered work-related injuries?
A. Ask the employee what happened. If the employee states that the back problems are work-related, give or mail the Incident Report form to the employee. You must also complete the Employer’s Report of Occupational Injury or Illness form. Medical examinations and claims investigation will determine the nature and extent of the employee’s injury.
Q. Who determines what benefits an employee is eligible for and whether or not the injury is work-related?
A. The type and amount of benefits are established by law. Sedgwick CMS, the third-party administrator, determines whether the injury is work-related or not, after talking with the employee and supervisor, reviewing the medical reports, and sometimes requiring additional medical evaluations.
Q. Am I required to give the Incident Report form to an employee who claims to be out because of work-related stress?
A. Yes, if the employee claims to be out because of stress caused by work (or if work restrictions from the physician indicate this), you are required to send the Incident Report form to your employee by mail. Sedgwick CMS will conduct an investigation to determine work-related stress factors with any stress claim.
Q.What is a stress claim?
A. A psychiatric injury is compensable if it is a mental disorder that caused a disability or the need for medical treatment, based on a diagnosis using language and criteria accepted nationally by practitioners in the field of psychiatric medicine. For a psychiatric injury claim to be compensable, however, the following must apply:
The employee must have been employed for at least six months (need not be continuous) unless the psychiatric injury is caused by a sudden and extraordinary employment condition.
The employee must demonstrate by a preponderance of evidence that actual events of employment were predominant (not less than 51%) as to all contributory causes.
For employees whose injuries resulted from being a victim of a violent act or from direct exposure to a significant violent act, the employee must demonstrate by a preponderance of evidence that actual events of employment were a substantial cause (35-40%) of the injury.
No compensation is due in the following situations:
Claim is filed after notice of termination or layoff unless special conditions exist.
Psychiatric injury was substantially caused by a lawful, nondiscriminatory, good faith personnel action.
Q. What is a Delay in Decision?
A. A Delay in Decision is a notice sent by Sedgwick CMS to an injured worker when there is a question related to the compensability of the injury.
Q. Can I, as a department supervisor, be personally sued?
A. As a general rule, no, unless you act outside your scope of employment with “serious and willful misconduct” or discrimination. In such cases, you may be held personally liable. In addition to seeking an increase in benefits, an employee may pursue civil remedies.
If an employer knowingly violates a safety order and the violation is the cause of the injury, it will constitute serious and willful misconduct. Also, if the employer fails to provide a safe place to work as required by law, the intent required for serious and willful misconduct may be inferred.
The term “willful” means that the conduct was intended. “Misconduct” is defined as “inappropriate behavior.” An employee seeking an increase in benefits must prove that the employer’s conduct involved an intent to injure or showed a reckless disregard for employee safety.
If an employer discharges, threatens to discharge, or discriminates against an employee because he or she has filed or made known an intention to file an application for adjudication, or because the employee has received a rating, award, or settlement, the employer is guilty of a misdemeanor.
If you are found to have caused an injury by serious and willful misconduct or to have discriminated against an employee, the department will be responsible for the payment of any award or increase in benefits that results.
Q. Does an employee lose employment service credits for the time lost because of a work injury?
A. No, provided the injury is accepted by Sedgwick CMS and the employee remains on the payroll.
Q. What is my reporting responsibility regarding employees with recurring injuries who lose time off and on or who re-injure themselves at work?
A. Any time an employee loses one day or more from work because of a work injury, call the Benefit Services Office to report the lost time. The Benefit Services Office will relay this information to Sedgwick CMS to avoid delays in claims processing or in providing disability payments.
Q. How should I report my employee’s time off on Workers’ Compensation?
A. Note“WC” for time claimed for the injury. You will receive an Employee Profile from the Benefit Services Office for each temporary disability check sent to the injured employee so that your department knows which time period is being covered by Workers’ Compensation.
Q. When can I replace an employee who is out on Workers’ Compensation?
A. You can temporarily replace an injured employee according to personnel policies and collective bargaining agreements. An injured employee who is on pay status (full pay or Extended Sick Leave) cannot be medically separated. If you wish to replace an employee who is out on Workers’ Compensation, contact the UCOP Employee and Labor Relations Manager, Rene Jackson at (510) 987-0879.