Frequently Asked Questions - Supervisors
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.