Workers' Compensation Benefits

Home / Campus / ( Published on 2014-09-11 )

Medical Care 

Your claims administrator will pay all reasonable and necessary medical care for your work injury or illness. Medical benefits may include treatment by your doctor, hospital services, physical therapy, lab tests, x-rays, and medicines. Your claims administrator will pay the costs directly, so you should never see a bill. For injuries occurring on or after Jan. 1, 2004, there is a limit on some medical services. 

How to Obtain Medical Care

First Aid: Seek first-aid immediately.

Emergency Care: Get help immediately. Dial 9-911 to call an ambulance or go to the nearest emergency room.

Acute and Follow-up Care: 

If you pre-designated your personal M.D. or D.O.: Contact your physician as soon as possible and make arrangements for treatment. (Information on pre-designation is on the Medical Provider Information page.)

If you did not pre-designate your personal M.D. or D.O.: Seek follow up care at the clinic designated by your employer.  

Campus employees may seek treatment at any of the following locations:

  • Occupational Health Services 415/885-7580 
  • St. Francis Memorial Health Center at SBC Park 415/972-2249 
  • Kaiser on the Job 415/833-9600

Pharmacy Benefit Network: The University of California and Sedgwick have selected Helios as their workers’ compensation pharmacy benefit network (PBN) to provide medications for work-related injuries through their pharmacy network, Tmesys. This plan provides that drugs (and other services) prescribed for treating your work injury can be obtained only from providers specified in your plan network. If you have any questions about how to obtain prescribed medications, call the toll-free number 866/599-5426. View the brochure here.

Temporary Disability Payments 

If you are disabled for more than three calendar days, temporary disability payments will partially replace your lost wages. The first three calendar days are not paid unless you are disabled for more than 14 days, or are hospitalized overnight. You should receive your first payment within two weeks of reporting your injury. Every two weeks after that, you will receive another payment.

Temporary Disability pays two-thirds of your average wage, subject to minimum and maximum amounts set by state law. The payments are tax-free and there are no deductions.

TD payments stop when your doctor says you can return to work, or your condition has become Permanent and Stationary (your medical recovery has reached maximum foreseeable improvement). Also, for injuries occurring on or after April 19, 2004, TD payments stop after 104 payable weeks within two years from the date of the first TD payment; or after 240 payable weeks within five years from the date of injury for specific long-term conditions such as amputations, severe burns, and certain chronic diseases. 

Workers’ Compensation Temporary Disability payments are made to employees with accepted claims who are kept off work or who have work restrictions that cannot be accommodated. Time taken off from work for medical appointments, follow-ups or other treatments such as physical therapy is not paid through this program.  

Permanent Disability Payments 

If a doctor says your injury or illness will always leave you somewhat limited in your ability to work, you may be eligible for permanent disability payments. The amount will depend on the type of injury, your age, occupation, date of injury, and how much of the permanent disability was caused by the work injury. There are minimum and maximum amounts set by state law. Payments are made at a regular rate and are spread out over a fixed number of weeks until the total amount has been paid. 

If you received temporary disability payments, the first permanent disability payment is due within 14 days after the TD payments stopped. If you did not receive TD payments (many people with permanent disability keep working), the first permanent disability payment is due within 14 days after your doctor says your condition is permanent and stationary (your medical recovery has reached maximum foreseeable improvement). Subsequent payments are made every 14 days until the total amount is paid.

Death Benefits 

If the injury or illness causes death, payments may be made to relatives or household members who are financially dependent on you. The amount is set by state law and depends on the number of your financial dependents. Payments are made at the same rate as temporary disability. A burial allowance is also provided.

Supplemental Job Displacement Benefits (SJDB)

If you have permanent disability and you do not return to work within 60 days after your temporary disability ends, and the University does not offer modified or alternative work, you may qualify for a non-transferable voucher payable to a school for retraining and/or skill enhancement. If you qualify, the claims administrator will pay the costs up to the maximum set by state law based on your percentage of permanent disability. SJDB is a benefit for injuries occurring on or after Jan. 1, 2004.

If Benefits Are Denied 

You have the right to disagree with any decision affecting your claim. Call your claims administrator first to see if you can resolve any disagreement. For free assistance, you can contact an information and assistance officer at the Division of Workers’ Compensation (see the section of this pamphlet captioned "If You Have Other Questions"). You can also file with the Workers’ Compensation Appeals Board (WCAB). There are deadlines for filing the necessary WCAB paperwork, so you should not delay. You can also consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee will be taken out of your benefits. For names of W/C attorneys, call the State Bar of California at 415/538-2120 or go to their website.