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California State University, Fullerton

Workers' Compensation

workers compCalifornia Workers' Compensation (WC) laws require CSUF to provide workers' compensation benefits to employees who are injured or who develop an illness as a direct result of their employment.
The University is required to report all work related injuries or illnesses. Serious injuries must be reported to Cal/OSHA within 8 hours from the time of the incident.
For additional information, please call the Risk Management Office at (657)278-7346. Office hours are Monday - Friday, 8 am to 5 pm.

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Injuries and Illnesses covered under Workers' Comp

 A primary issue in Workers’ Compensation is determining whether an injury or illness is work-related. Workers’ Comp covers injuries and illnesses "arising out of and in the course of" employment.


Arising out of and in the course of employment

“Arising out of employment” means that the claimant must have been performing an obligation or condition of his/her employment that exposed him/her to the danger causing the injury. If one falls as a result of a previous medical condition which is not related to a danger of the job, it probably will not be considered to have arisen out of the employment.


“In the course of employment” deals with the time and place that the injury occurred. If an injury occurs on the employer’s premises, such as in the parking lot or in the lobby of a building within a reasonable time before or after working hours, then workers’ compensation is likely to be accepted. Under the “personal comfort doctrine” an injury is in the course of employment, for example, when going on a coffee break, going to the restroom, etc.


Specific Injury or Illness

A specific injury or illness occurs as the result of or is caused by a specific event or one-time exposure. The time, place and circumstances surrounding the injury or illness are specific and identifiable.


Cumulative or Repetitive Trauma Injury

A Cumulative or repetitive trauma is a gradual onset of injury or illness caused by repetitive acts or traumas. The most common cumulative trauma claims are back, wrist, hearing loss or psychological claims.

Benefits Available to Injured or Ill Employees

There are five primary Workers' Compensation benefits available to injured or ill employees. Those benefits are:

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Medical Care

Employees who suffer a work-related injury or illness will receive, at no cost to them, medical care that is required to cure or relieve the effects of the injury or illness. The medical care will be consistent with the appropriate evidence-based medical treatment guidelines.

 

Pharmacy Benefit Program

The University participates in a pharmacy benefit program with ScripNet. Therefore, at the onset of medical treatment the employee will receive a ScripNet form to take to their pharmacist to fill prescriptions at no cost.  Once they have used this form, a ScripNet card will be mailed to them for future prescriptions for that particular injury/illness.  Each injury/illness requires a separate card.Under Development

Temporary Disability Benefits

Temporary disability is a benefit paid to an injured or ill employee unable to work while recovering from a work-related injury or illness. If the injured or ill employee is a PERS member, he or she may be eligible to select from the following temporary disability plans. In each case, the benefit is available after serving a 3-day waiting period. The waiting period will be waived if time lost exceeds 14 calendar days, the injury or illness is caused by a criminal act of violence or the employee is hospitalized.

Industrial Disability Leave (IDL)

IDL is a benefit that pays the first 22 work days of disability at an amount equal to the employee's net pay (full pay less an amount equal to Social Security and Medicare and withholding taxes based on your exemptions). If disability continues beyond 22 work days, IDL pays 2/3 of the employee's gross pay.

The injured or ill employee may be eligible to supplement the 2/3 IDL benefit with accrued sick leave available as of the first day of lost time. This option is referred to as IDL with Supplementation.

IDL is available for a maximum of 52 weeks within a 2-year period beginning with the employee's first date of lost time. While on IDL, the employee continues to accrue their full PERS service credit and their health benefits remain in force.

Should the period of temporary disability exceed the maximum IDL benefit eligibility, the employee may be eligible to receive Temporary Disability benefits with supplementation of accrued sick and vacation leave credits.

For more information, please refer to the CSU Guide Industrial Disability Leave.

Temporary Disability (TD)

TD is a benefit that pays a flat rate for each calendar day of lost time. The rate is based upon 2/3 of the employee's average weekly wages with a minimum and maximum set by state law.

The employee may be eligible to supplement the TD benefit with accrued sick and vacation leave credits. This option is referred to as TD with Supplementation. While on TD with Supplementation, the employee accrues partial PERS services credit based upon the supplementation portion only. The employee's health benefits remain in force.

Application for Catastrophic Leave

The purpose of the catastrophic leave program is to supplement any disability for which an employee is eligible. If the employee is interested in applying, he/she must contact Human Resources for further information regarding the program. If the employee decides to apply for catastrophic leave, his/her choice is limited to Temporary Disability with Leave Credit Supplementation. All leave credits must be used before using leave credits donated from other employees

Non-Industrial Disability Leave (NDI)

Employees who are unable to work due to a non-industrial injury or illness may receive non-industrial disability leave (NDI). The State Employment Development Department authorizes NDI benefits. Employees desiring NDI must complete a Formal Leave form and NDI questionnaire. Both forms are available in Payroll.

Permanent Disability Benefits

Employees who have a permanent impairment as a result of a work-related injury or illness may be entitled to receive permanent disability benefits. These benefits address the nature of the injury and the employee's occupation, age and diminished future earning capacity.

The amount of permanent disability is based upon the treating doctor's description of the employee's medical problems and limits on the work he or she can perform. The doctor's description is based on guidelines published by the American Medical Association (AMA) and outlined in a written permanent and stationary report.

If the employee does not agree with the medical report written by his or her treating doctor, he or she may contact the Department of Workers' Compensation (DWC) to request a panel (list) of 3 Qualified Medical Examiners (QME's). All of the above information and instructions on how to request a QME panel will be provided to the employee when the University receives doctor's permanent and stationary report.

IDL/TD Comparison Chart

Supplemental Job Displacement Benefits

Employees injured on or after January 1, 2004, who have a permanent disability caused by their injury may be eligible to receive "supplemental job displacement benefits" (vouchers) for retaining or skill enhancement.

Employees may be eligible if they do not return to work within 60 days after Temporary Disability (TD) benefits end, unless the employer offers modified or alternative work within 30 days after TD benefits end.

Vouchers may be used for education-related retraining or skill enhancement at state approved or accredited schools. The amount of the vouchers is determined by the rating of permanent disability.

Death Benefits

If an employee is fatally injured, reasonable burial expenses up to $5,000, are paid. In addition, the employee’s dependents may receive support payments for a period of time. These payments are generally payable in the same manner and amount as temporary disability benefits.

The total aggregate amount of support payments depends on the number of dependents and the extent of their dependency. Generally, the maximum (where three or more total dependents are eligible) is $320,000, though additional benefits are payable if there continues to be any dependent children after the basic death benefit has been paid.

 

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Reporting a student injury during a class, lab, or field trip.

Students
Students that are injured in your class or on a field trip must be reported using the Student/Visitor Injury form.

Send the original to Risk Management, CP700; send a copy of the report to Environmental Health and Safety, T1475.  Keep a copy in your department files.

Student Assistants
If the student was working as a volunteer or student assistant during the incident, an Employee or Volunteer Injury form must be filled out; do not fill out the Student Injury form. 

Students Working on Grants
Contact the Workers' Comp Administrator at 657-278-7346.

Manager and supervisor responsibility for an injured employee?

 

Supervisors and managers should report all employee or volunteer work-related injuries or illnesses to the Office of University Risk Management within one working day of notice or knowledge. Don't wait until the Employee Injuryform has been completed to report the injury; it's better to call Risk Management as soon as possible at 657-278-7346.  Some injuries require notification to governmental agencies and a delay could put the University at risk. 

An Employee Injury formmust be filled out for every injured employee, volunteer, and student assistant. You do not need to report first aid injuries. (see the section on first aid injuries)

Please encourage all employees, including student assistants and volunteers, to report any work-related accidents and/or near miss incidents when they occur.  Early reporting assists in identifying campus and safety issues and in determining eligibility for benefits.

If you believe that the employee would pose a risk to himself/herself or to others if he/she drove, tell the employee not to drive. Risk Management will arrange transportation for the injured/ill employee to the nearest medical provider. An employee who needs medical attention may not be transported by another University employee, supervisor or manager.

First aid injuries 

 First aid is medical care that all employers must provide to their employees. The difference between first aid and medical treatment is based on the type of treatment an employee receives. It does not depend on whether the treatment is provided by a physician or another licensed health-care professional.

The California Labor Code, Section 5401(a) defines first aid as "any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel."

Treatment is not considered first aid in either of the following circumstances:

  • Medical care goes beyond a one-time treatment and follow-up visit.

  • The injury causes an employee to lose time from work beyond his or her work shift.

Employer/Employees are not Required to Report First Aid Injuries

Another difference between first aid and medical treatment is the employer's and employee's reporting responsibilities. Specifically:

  • If treatment is considered first aid, the employer is not required to submit a Report of Employee Injury/Illness.
  • If additional care is needed beyond first aid, both the injury report and claim form must be submitted.

Doctor’s Report Required if Physician Provides First Aid

Physicians who provide first aid treatment must comply with Section 6409(a) of the California Labor Code regarding first aid injury treatment reporting. The physician is required to submit a Doctor’s First Report of Injury or Illness.  A DFR is not required if a physician is not involved in the first aid treatment.

Driving an Injured Worker to the Hospital or Doctor

If you cannot drive or arrange timely transportation, your manager or supervisor will contact Risk Management to arrange transportation. An employee who needs medical attention may not be transported by another University employee, supervisor or manager

Contacting Employees Off Work Due to Work Related Injuries

The University’s Return-to-Work Program assists employees temporarily or permanently unable to perform the essential functions of their regular work due to either a work related or non-work related injury or illness. This Program is designed to review prescribed work restrictions and determine whether the University can provide temporary or permanent modified or alternate work.  

Some employees might be temporarily unable to return to work due to their injury or illness. When this occurs, the employee’s supervisor should regularly contact the employee until he/she is able to return to work. When contacting an employee, supervisors should follow the following guidelines.

 

When to Call: Twice a month, or more often if important information needs to be communicated. Calls should be made during regular work hours.

 

What to discuss: The purpose of regular contact is to show concern and support for the injured or ill employee, and to help answer any questions they may have. Typical remarks/questions may include: 

  • “We miss you at work and want you to know that we are thinking about you.”
  • “How are you doing?”
  • “Do you have any questions or concerns? I’ll help if I can, or if not, I’ll put you in touch with someone who can.”

 

When Not to Call: Sometimes it is not helpful to call an injured or ill employee. Inappropriate circumstances might include the following:

  •  The employee specifically asks you not to call.
  •  The employee seems to be angered by your calls.
  •  You have a history of conflict with this employee and believe they may view your calls as a form of harassment, discrimination or retaliation.

 

In the cases above, call the University’s Workers’ Compensation Program Manager at extension 2824. The Program Manager will maintain contact with the injured or ill employee on your behalf.

 

What Not to Discuss: The goal of contact is not to interrogate the employee, investigate their injury, or do anything that can be interpreted negatively. Therefore, remember:

 

  • Do not ask questions directly or indirectly designed to “check up on” the employee or to “catch them in a lie”. If the employee’s injury seems suspect to you, let the Program Manager deal with that issue.

  • Do not ask for medical information such as diagnoses, treatment or prognosis.

 

Workers' Compensation Fraud

Although the vast majority of Workers’ Compensation claims are legitimately work-related injuries, 20% to 25% of all Workers’ Compensation claims are estimated to be inappropriate. The National Insurance Crime Bureau estimates the annual value for fraudulent claims to be $5 billion.

Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony punishable by up to 5 years in prison and/or up to $50,000 in fines. If you have knowledge, information or evidence of fraud, please contact the Office of University Risk Management or the Office of University Counsel.  Please see the State of California's Workers' Comp Fraud Warning.

Forms

Resources

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