Workers' Compensation Benefits

Workers' compensation offers the following benefits:

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 medications. Your claims administrator will pay the costs directly, so you should never see a bill. 

Steps to take in getting medical care

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. 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.

Temporary Disability payments 

If your claim is accepted and 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 directly from Sedgwick.

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.

Temporary Disability payments stop when your doctor says you can return to work, or your condition has reached Maximum Medical Improvement (MMI), meaning your medical recovery has reached maximum foreseeable improvement. Temporary Disability 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 are 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 Temporary Disability payments stopped. If you did not receive Temporary Disability 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. 

You have the right to disagree with any decision affecting your claim. Call your claims examiner first to see if you can resolve any disagreement.  You may also contact your local Workers' Compensation office at UCSF for assistance.

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"). This is part of the California Department of Industrial Relations (DIR). 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 may find information here: DIR Injured Worker Guide Book

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 visit the State Bar of California website.