Workers' Compensation FAQs

• What is workers' compensation?

  If you, as an employee for the University of California have a work-related injury or illness, UCR is required by law to pay for workers' compensation benefits. You could get hurt by:
  One event at work, such as hurting your back in a fall, getting burned by a chemical that splashes on your skin or getting hurt in a car accident while making deliveries.

  Or

  Repeated exposures at work, such as hurting your wrist from doing the same motion over and over or losing your hearing because of constant loud noise.
   

• What happens if I wait too long to report a job injury or file a claim form?

  Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need. If UCR does not learn about your injury within a few days and this prevents UCR from fully investigating the injury and how you were injured, you could lose your right to receive workers' compensation benefits.

  
  Worst case scenario is that if our claims administrator, Sedgwick CMS, neither gets a timely injury report or claim form, you could be ultimately responsible for medical and other associated out-of-pocket expenses.
   

• Will get in trouble if I report a claim or file a claim form?

  No.  It is illegal in California for an employer to retaliate against its employees that file Workers’ Compensation claims (see California Labor Code section 132a).  You cannot be disciplined or terminated solely for exercising your rights in filing a Workers’ Compensation claim.

• What benefits am I entitled to?

  UCR Workers' compensation insurance provides five basic benefits:
  •    Medical care: Paid for by your employer to help you recover from an injury or illness caused by work
  •    Temporary disability benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering
  •    Permanent disability benefits: Payments if you don't recover completely
  •    Supplemental job displacement benefits (if your date of injury is in 2004 or later): Vouchers to help pay for retraining or skill enhancement if you don't recover completely and don't return to work for your employer
  •    Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.
   

• What resources are available to me?

  If you have any questions, please contact the Workers’ Compensation Office: workerscomp@ucr.edu

  Workers’ Compensation Manager

  Ariel Caluag | (951) 827-4207 
  Email: ariel.caluag@ucr.edu

  Return to Work Consultant

  Kathy Mosley | (951) 827-3206
  Email: kathy.mosley@ucr.edu

  UCR WorkStrong Coordinator

  Ed Marchall, ATC | (951) 827-5106
  Email: Edward.marchall@ucr.edu

  Address:
  Environmental Health & Safety
  900 University Ave.  Riverside, CA 92521
   

• I know that independent contractors aren't covered under workers' compensation. How do I know if I really am an independent contractor?

  There is no set definition of this term. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or an independent contractor. Some employers misclassify employees as an independent contractor to avoid workers' compensation and other payroll responsibilities. Just because an employer says you are an independent contractor and doesn't need to cover you under a workers' compensation policy, doesn't make it true. A true independent contractor has control over how their work is done.

  You probably are not an independent contractor when the person paying you:
  •    Controls the details or manner of your work
  •    Has the right to terminate you
  •    Pays you an hourly wage or salary
  •    Makes deductions for unemployment or social security
  •    Supplies materials or tools
  •    Requires you to work specific days or hours.
   

• What happens to an injured worker's personal information that is requested on various DWC forms? Is it kept confidential?

  UCR and the CA Department of Workers’ Compensation (DWC) uses this information solely to administer its duties in workers' compensation claims. For example, if an injured worker provides their Social Security number (in whole or in part), the DWC will use it as an identifier to ensure that documents are matched to the correct workers' comp case. Unless authorized by law to do so, UCR or the DWC cannot disclose the residence addresses of injured workers or their Social Security number.

• What kind of medical care will I receive for my injury?

  Doctors in California's workers' compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve work-related injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.

  
  To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body regions guidelines adopted from the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain and therapy after surgery. The DWC has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
   

• Are there limits on certain kinds of treatment?

  Yes. If your date of injury is in 2004 or later, you are limited to a total of 24 chiropractic visits, 24 physical therapy visits, and 24 occupational therapy visits, unless the claims administrator authorizes additional visits or you have recently had surgery and need postsurgical physical medicine.

• How long can I continue to receive treatment?

  For as long as it's medically necessary. However, some treatments are limited by law and the medical treatment you receive must be evidence-based.

  The MTUS lays out treatments scientifically proven to cure or relieve work-related injuries and illnesses. It also deals with how often the treatment is given and for how long, among other things.

  If the treatment your doctor wants to provide goes beyond what is recommended by the MTUS, your doctor must use other evidence to show the treatment is necessary and will be effective.

  Additionally, your doctor's treatment plan may be reviewed by a third party hired by the claims administrator. This process is called utilization review (UR). All claims administrators are required by law to have a UR program. They use UR to decide whether or not to approve treatment recommended by your doctor.
   

• What is a primary treating physician (PTP)?

  Your primary treating physician (PTP) is the physician with the overall responsibility for treatment of your injury or illness.

• What does predesignating a personal doctor involve?

  This is a process you can use to tell your employer you want your personal physician to treat you for a work injury. You can predesignate your personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) only if the following conditions are met:

  1. A written notice predesignating the employee's personal physician or medical group is given in writing to the employee's employer prior to the date of injury for which treatment is sought and the notice includes the physician's name and business address;
  2. The employee has healthcare coverage for non-occupational injuries or illnesses on the date of injury in a plan, policy or fund; and
  3. The employee's personal physician or medical group agrees to be predesignated prior to the dates of injury.

  Form for predesignating a personal physician: https://risk.ucr.edu/docs#predesignation_of_personal_physician
   

• Can I work while I am recovering?

  Soon after your injury, the treating doctor examines you and sends a report to the claims administrator about your medical condition. If the treating doctor says you are able to work, he or she should describe:
  •    Clear and specific limits, if any, on your job tasks while recovering. These are called work restrictions. They are intended to protect you from further injury (example: no work that requires repetitive bending or stooping)
  •    Changes needed, if any, in your schedule, assignments, equipment or other working conditions while recovering (example: provide headset to avoid awkward positions of the head and neck)
  •    If the treating doctor reports that you cannot work at all while recovering you cannot be required to work.
   

• What are temporary disability benefits?

  Temporary disability (TD) benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering. TD Benefits can also be paid if your manager or department refuses to provide modified or alternative work.

• Are there different types of TD benefits?

  There are two types of TD benefits. If you cannot work at all while recovering, you receive temporary total disability (TTD) benefits. If you can't work your full schedule while recovering, you receive temporary partial disability benefit (TPD) payments.

• How much will I receive in TD payments?

  As a general rule, TD pays two-thirds of the gross (pre-tax) wages you lose while you are recovering from a job injury. However, you cannot receive more than the maximum weekly amount set by law. Your wages are figured out by using all forms of income you receive from work: wages, food, lodging, tips, commissions, overtime and bonuses. Wages can also include earnings from work you did at other jobs at the time you were injured. Give proof of these earnings to the claims administrator. The claims administrator will consider all forms of income when calculating your TD benefits.

  The minimum and maximum rates are adjusted annually.
   

• Can my first temporary disability payment be delayed?

  Sometimes. If the claims administrator can't determine whether your injury is covered by workers' compensation, he or she may delay your first TD payment while investigating. A delay is usually not longer than 90 days. If there is a delay, the claims administrator must send you a delay letter. It must explain why you won't receive payments, what additional information the claim administrator needs and when a decision will be made. If there are further delays, the claims administrator must send you additional delay letters.

  If the claims administrator doesn't send you a letter denying your claim within 90 days after you filed the claim form, your claim is considered accepted in most cases
   

• Why am I receiving so many letters?

  The claims administrator must keep you up to date by sending letters that explain how payments were determined, why TD will be delayed, reasons for changing TD payment amounts and why the TD benefits are ending.

• What are permanent disability benefits?

  Most workers fully recover from job injuries but some continue to have medical problems. Permanent disability (PD) is any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work.

  PD benefits are limited. If you lose income, PD benefits may not cover all the income lost. If you experience losses unrelated to your ability to work, PD benefits may not cover those losses.
   

• How is PD identified?

  A doctor determines if your injury or illness caused PD. After your doctor decides your injury or illness has stabilized and no change is likely, PD is evaluated. At that time, your condition has become permanent and stationary (P&S). Your doctor might use the term maximal medical improvement (MMI) instead of P&S.

  Once you are P&S or have reached MMI, your doctor will send a report to the claims administrator telling them you have PD. The doctor also determines if any of your disability was caused by something other than your work injury. For example, a previous injury or other condition. Assigning a percentage of your disability to factors other than your work injury is called apportionment.