All California employers, including the State, must provide workers' compensation benefits to employees who sustain a work-related injury or illness. An essential requirement for departments is that they establish, implement, and maintain written policies for an injury and illness prevention program (IIPP) (Labor Code 6401.7) and establish a reporting system for job-related injuries, illnesses or death.
The State Compensation Insurance Fund (State Fund) is the adjusting agent/insurance carrier, who provides adjusting and legal services for the State's workers' compensation claims and provides benefits services to injured employees.
A worker's compensation injury is any injury or illness that arises out of and in the course of employment (AOE/COE)(Labor Code 3600).
The RTWC much ensure employees receive prompt medical care, if such care is believed necessary by either the employer or the employee, by arranging for treatment by either the employer selected physician or the employee's pre-designated physician or medical group. The employer selected physician is listed on the Posting Notice (e13913/13914) or equivalent form.
If your injured employee is referred to the employer selected physician, they must be given the Guide to the State Fund Medical Provider Network for State of California Employees (e13174). For information regarding your department's MPN process, contact your department's RTWC.
A supervisor or designee can accompany the injured employee to the doctor, and find out from the doctor if the injured employee will be able to return to work. If the employee is not able to return to work immediately, attempt to find out how long the employee will be off work. A description of the employee's normal duties, or of alternate "light duty" work that may be available, may help the doctor make a decision.
Provide the injured employee with the Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) within one working day of knowledge of the injury or illness. The injured employee may also be provided with the I've Just Been Injured on the Job, What Happens Now? brochure.
When the Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) is returned, complete the employer's section. Give the employee a copy of the completed form and forward to State Fund within five calendar days of receipt.
Once a completed Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) has been received from the employee, authorization for medical treatment must be given within one working day. Employers are responsible for paying up to $10,000 in medical treatment until a claim is denied. If the claim is accepted, medical treatment will continue to be paid by the employer. The Employer's Report of Occupational Injury or Illness (e3067s) must also be completed. This form must be received by State Fund within five days of your department's knowledge of an injury or illness.
The Employer's Report is required if the employee has completed a Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301), or has lost time beyond the date of injury or illness, or requires medical treatment beyond first aid.
First aid is defined as any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, and so forth, which do not ordinarily require medical care. Such one-time treatment and a follow-up visit for the purpose of observation are considered first aid, even if provided by a physician or registered medical personnel.
The RTWC or Personnel Office will ensure timely delivery of all forms to State Fund and will also ensure that the injured employee has received the appropriate forms and notifications.
The Personnel Office is required to give the injured employee an Industrial Disability Leave with Supplementation Information and Benefits Option Selection (STD. 618S) once State Fund notifies the department that a claim is accepted and worker' compensation benefits are approved.
The Temporary Disability Verification of State Employees (3290) or a letter from State Fund is used to notify the departments of claim acceptance. The 3290 lists the dates of lost time verified by State Fund. This form states the dates and/or hours State Fund has verified as disability periods and authorizes the Personnel Office to request and the release of Industrial Disability Leave (IDL) benefits.
TD payments are based on 2/3 of the employee's average weekly earnings and paid by State Fund every 14 days. Minimum and maximum TD rates are set by the legislature.
Injured employees who have sufficient leave credits can supplement their TD payments, but their TD payments plus supplemental check cannot be more than their net salary.
TD payments are issued by State Fund, sent directly to the injured employee and have no mandatory or voluntary deductions withheld. The supplementation payments, which are paychecks issued by the State Controller's Office, are paid by the employer and are subject to all mandatory deductions including taxes, retirement contributions, garnishments, and union dues. Voluntary deductions, such as health, dental, and vision benefits or life insurance, can also be withheld. Deductions can only be made as long as there are sufficient leave credits. Mandatory deductions will have priority over voluntary deductions.
An injured employee is entitled to a continuation of health, dental, and vision benefits even if they choose not to supplement their TD payments. If an employee contribution is due, arrangements must be made by the department to collect that portion directly from the injured employee (see Personnel Management Liaison 2000-035).
For additional information regarding the provision of TD and supplementing TD benefits, see PML 2004-026.
Established by the Berryhill Total Compensation Act of 1975, IDL is a salary continuation program specifically designed as an alternative benefit program to TD. The legal authority for this program is found in Government Code Sections 19869 - 19877.1. To qualify for IDL benefits, an injured employee must be an active member of the California Public Employees' Retirement System (CalPERS) or the California State Teachers' Retirement System (CalSTRS).
IDL benefits are paid in lieu of TD and are based on the injured employee's current wages. For the first 22 work days or maximum of 176 hours(22 days x 8 hours/day = 176 work hours for full-time employees and prorate for different time bases), an injured employee receives full net salary. Thereafter, the payments are based on two-thirds of the injured employee's normal gross salary without any reduction for taxes. Even though IDL is not taxable, the gross amount for IDL during the first 22 work days (maximum of 176 hours for full-time employees and prorated for other time bases) is reduced by the amount that would have been taken for taxes (federal, Social Security, Medicare, and state taxes). This is called the "reduced gross" and is the amount reflected on the warrant register, as well as on the earnings statement.
The only mandatory deduction taken from an IDL payment is the retirement contribution, which is based on the employee's actual gross income.
In addition, IDL payments may be subject to the following deductions: survivor's benefits, accounts receivable, child support, spousal support, conservatee support, and CalPERS arrears contributions. All voluntary deductions continue unless the injured employee cancels them. Pre-tax deductions (e.g., deferred compensation, tax-sheltered annuities, and health/dental premium co-pays) revert to regular deductions from IDL or can be deducted from IDL supplementation provided the supplementation payment is sufficient.
IDL benefits are payable for a maximum of 52 weeks, or 2080 work hours (40 hours/week x 52 weeks = 2080 hours for a full-time employee), within a two-year period, from the first day of disability (first time lost) due to the injury or illness. Any time paid as IDL, whether one hour or eight hours, constitutes one date of IDL applied to the maximum time limits.
Injured employees who have sufficient leave credits can supplement their IDL payments up to their full net pay. Income received from supplementation is taxable and will be reported on the employee's W-2 Form at the end of the year. Federal and state taxes will be based on the current flat tax rate.
For additional information on the provision of IDL or IDL/S, see PML 2014-025. For further information on IDL for time lost before July 1, 2014, see PML 2002-060.