What guidelines govern work-incurred injuries?

Resources

Guide to Workers' Compensation Program

Workers' Compensation Portal

California Division of Workers' Compensation

Sedgwick Claims Management Services

ANSWER

California Workers’ Compensation law requires the University to provide workers’ compensation benefits to employees free from retaliation when work-related injuries, illnesses, or accidents are reported.

  • Allows the employee the right to medical and disability benefits, but in return, the employee gives up the right to sue in civil court
  • Allows employers to gain relief from the expense of civil litigation
  • It is an “exclusive remedy/no fault system”
  • Injury must have “Arisen Out of Employment and in the Course of Employment” aka AOE/COE

KEYS TO PREVENTING LIABILITY

Workers compensation claims that involve disciplinary action or termination, need to be handled with care as these are two separate and distinct items.

Common Workers' Compensation Questions

Definitions

Workers’ Compensation Benefits Structure defines what injured workers are entitled to receive when they sustain an injury “arising out of and in the course of” employment. Exclusive remedy/ no fault workers’ compensation system mandates employers accept responsibility for workplace injuries or illnesses and workers give up their right to sue their employer under civil suit in exchange for the entitlement of benefits including medical treatment.

AOE/COE (Arising out of and occurring in the course of employment): The injury must be caused by and happen on the job.

Sedgwick UCOP contracts with Sedgwick to administer claims for the University.  Sedgwick is referred to as a “third party administrator” (TPA). Sedgwick:

  • Investigates claims for AOE/COE
  • Pays all workers’ compensation benefits
  • Sends benefit notices and letters
  • Monitors medical treatment
  • Settles claims