Workers' Compensation - CalHR

Benefits Administration Manual - Workers' Compensation

 

Content

1401. General Information

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).

1402. Employee's Responsibility

Reporting the Injury or illness

If an employee is injured or becomes ill as a result of their employment, they must report the injury to their employer as soon as possible. The employer will provide the injured employee a Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) form to describe how, when, and where the injury or illness occurred.
 

Obtaining Treatment

The department is responsible for arranging treatment with the employer selected physician or medical facility within the Medical Provider Network (MPN), or with the employee's pre-designated personal physician or medical group. The Guide to Workers' Compensation for New State of California Employees (e13546) includes a pre-designation form. The employee must have provided the department written notification of the name of the physician or medical group prior to the date of injury, and the physician must have indicated a willingness to provide treatment in the event of an industrial injury or illness.
It is important to inform the treating physician that the employee's injury or illness is (or may be) work related.
 

Absence Reporting

After receiving treatment, the injured employee must inform their employer of the physician's advice concerning their ability to resume work responsibilities. All time off related to the work injury must be reported on the Absence and Additional Time Worked Report form (STD 634) or equivalent form. Although no time is charged against leave credits on the day of injury, a notation must be made to show the date of injury on the STD 634. A statement from the attending physician is required each time the injured employee is seen regarding the work-related injury or illness. All physician statements must be attached to the STD 634 and forwarded to the attendance clerk or Personnel Office.

1403. Return to Work Coordinator's or Employer's Responsibility

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.

 

Reporting the Injury or Illness

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.

1404. Personnel Office's Responsibility

Ensure Legal Requirements Are Met

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.

 

Notify Employee of Benefit Options

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.

1405. State Compensation Insurance Fund (State Fund) Responsibility

Case Management and Legal Representation

State Fund makes all liability determinations based on medical documentation and relevant facts. State Fund ensures the injured employee receives all benefits to which they are legally entitled including medical care, temporary disability, permanent disability, supplemental job displacement and death benefits. In addition, State Fund provides legal representation for issues that fall under the jurisdiction of the Workers' Compensation Appeals Board.

1406. Benefits

Medical Treatment

Medical treatment is provided to the employee to cure or relieve the effects of the injury. This includes medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches and apparatus, including orthotic and prosthetic devices and services (Labor Code, Section 4600). Medical treatment is subject to Utilization Review (UR).
 

Temporary Disability Benefits

Temporary disability benefits are payments for lost wages paid to the injured employee while they are recovering from an injury or illness and are unable to return to work. Payments must begin within 14 days of the employer's knowledge that a work-related injury or illness occurred, unless the employer contests the claim for workers' compensation benefits (Labor Code, Section 4656).
 
No payments are due for the first 3 days unless the disability continues for more than 14 calendar days, the employee is hospitalized, (LC, Section4652) or is the victim of a criminal assault (Labor Code, Section 4650.5).
 
Administrative Time Off (ATO) is granted for any time lost on the day of injury. See the State Controller's Office Payroll Procedures Manual Sections E300 through E700 for details on processing payroll for employees receiving temporary disability benefits.
 

Temporary Disability (TD)

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.

 

Industrial Disability Leave (IDL)

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.

 

Enhanced Industrial Disability Leave (EIDL)

EIDL was established in 1984 through memoranda of understaning between the state and exclusive representatives for rank-and-file employees in specific bargaining units. Government Code 19871.2 provides the authority for excluded employees to also receive this benefit.  Eligible excluded employees are those in a classification responsible for the supervision of represented employees who are eligible for enhanced benefits.
 
To qualify for EIDL benefits, there must be a provision in the employee's memorandum of understanding (MOU) and the employee must be temporarily disabled as a result of a physical injury incurred in the official performance of their duties.  See the appropriate MOU for information on qualifying physical injuries.
 
The department's appointing power or their designee has the final decision regarding an injured employee's eligibility for EIDL based on the specific circumstances of each case. EIDL is an extension of IDL and has most of the same requirements.
 
However, permanent intermittent employees in Bargaining Unit 6 may be entitled to EIDL even if they are not members of CalPERS or CalSTRS. 
 
For additional information on the provision of EIDL, see PML 2014-025.
 

Labor Code Section 4800 (4800 Time)

Labor Code Section 4800 is a special benefit available only to Department of Justice peace officers falling within the "state peace officer/firefighter" classification and Department of Fish and Wildlife law enforcement officers. It provides for up to one year of full salary in lieu of other benefits for injuries that occur in the line of duty.
 
This section does not apply to periods of disability, which occur subsequent to termination of employment by resignation, retirement, or dismissal. When this section does not apply, the officer is eligible for those benefits which would apply if this section had not been enacted.
 
 

Labor Code 4800.5 (4800.5 Time)

Labor Code Section 4800.5 is a special benefit available to any sworn member of the Department of the California Highway Patrol. It provides for up to one year of full salary for disabled officers in lieu of disability payments.
 
If the disability is solely the result of cumulative trauma or injury, this benefit shall be limited to the actual period of temporary disability, or for one year, whichever is less.
 

Permanent Disability (PD)

Permanent Disability (PD) payments are made to compensate an injured employee for their permanent impairment or limitation as a result of their work related injury (LC Section 4061). An injured employee can receive PD payments and return to work full duty.
 
For dates of injury 1/1/05 through 12/31/12, the PD payments will be reduced by 15% if the employer offers the injured employee regular, modified, or alternative work within 60 days of his or her permanent and stationary date. If the employer does not offer regular, modified, or alternative work then future PD payments are increased by 15% after the 60 day period has expired.
 
The plus or minus 15% adjustment is eliminated for dates of injury on or after 1/1/13.
 

Supplemental Job Displacement Benefit (SJDB)

An injured employee who has a permanent partial disability and has not returned to work may be eligible to receive a Supplemental Job Displacement Benefit (SJDB) voucher.
 
For dates of injury 1/1/04 through 12/31/12, the amount of the voucher depends on the level of permanent disability and is provided at claim settlement. It ranges from $4,000 to $10,000 and can be used to pay for retraining or skill enhancement at a state approved or accredited school, related educational expenses, and fees for a vocational rehabilitation counselor.
 
For dates of injury after 12/31/12, the amount of the voucher is set at $6000.00 and is provided at the time the employee reaches maximum medical improvement.
 

Death Benefit

Death Benefit payments are made to surviving total and partial dependents of the deceased. The benefit is paid out in installments at the decedent's TD rate, until the total benefit is paid or a minor child turns 18-years old (Labor Code, Section 4700). Additionally, the employer is responsible for providing reasonable burial expenses not to exceed $10,000 (Labor Code, Section 4701).

1407. Forms and Brochures

Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility (e3301)

An employee uses the Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) to formally report a work-related injury or illness to his or her employer and to open a workers' compensation claim file. It must be provided to the injured employee within one working day of knowledge of any injury or illness that requires medical treatment beyond first aid or causes lost time beyond the work shift.
 
You can obtain the Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301) through State Fund's website: State Contract Forms
 

Guide to Workers' Compensation for New State of California Employees (e13546)

This pamphlet provides workers' compensation information to new employees, answers frequently asked questions regarding workers' compensation, and has an attached Employee's Predesignation of Personal Physician Form. Employees must be given the opportunity to predesignate their treating physician or medical group within 30 days of hire. You can obtain the Guide to Workers' Compensation for New State of California Employees (e13546) through State Fund's Web site: State Contract Forms
 

I've Just Been Injured on the Job, What Happens Now? Brochure

This brochure provides answers to the most common questions asked by an injured employee at the onset of the claims process. It is recommended that this brochure be provided along with the Workers' Compensation Claim Form(DWC 1) & Notice of Potential Eligibility (e3301). You can obtain this brochure by visiting the Workers' Compensation Program (WCP) Web site: CalHR's Workers' Compensation Page.
 

Employer's Report of Occupational Injury or Illness (e3067s)

This form must be promptly completed by the employer when an injured employee requires medical treatment beyond first aid or has lost time beyond the date of injury or files a claim for a work-related injury or illness. The completed 3067 must be received by State Fund within five calendar days of the employer's knowledge that an injury or illness has occurred. You can obtain the Employer's Report of Occupational Injury or Illness (e3067s) through State Fund's Web site: State Contract Forms
 
The preferred method of completing and submitting the Employer's First Report of Occupational Injury or Illness is electronically via State Fund Online (SFO). For access to SFO, contact your RTWC.
 

STD 634 - Absence and Additional Time Work Report

This form is used to document all time off used by an injured employee. In cases of work-related injuries or illnesses, all time used must be recorded on the STD 634 or equivalent attendance form. This serves as a tracking document when an injured employee's leave time is restored after an injury or illness has been verified by State Fund. You can obtain the STD 634 through the Office of Statewide Publishing (OSP) Web site: DGS STD 634
 

STD. 618S - Industrial Disability Leave with Supplementation Benefits Information and Option Selection

This form provides an injured employee with information regarding the basic IDL and IDL/S benefits. The injured employee is also provided with a comparison of the amount of IDL they would receive with or without supplementation, and is given the opportunity to select IDL or IDL/S. You can obtain the STD 618s through the OSP Web site: DGS STD 618
 

Temporary Disability Verification of State Employee (3290)

This form states the dates and hours State Fund has verified as disability periods related to an employee's injury or illness. Without the State Fund 3290 the Personnel Office is unable to request and release the IDL benefit.

1408. Step by Step Instructions

Please refer to the Workers' Compensation Claims Kit for detailed instructions to complete all the forms necessary to report a work related injury or illness. You can obtain this publication by visiting the Workers' Compensation Program web site: CalHR's Workers' Compensation Page.
 

Updated 10/20/2014