Workers' Compensation Benefits

Benefits Available to Injured or ill Employees

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.

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

It is the CSU’s policy that the first visit to a MD following an injury is not counted against sick leave.

Temporary Disability Benefits

A partial wage replacement benefit paid to the injured worker if the injury prevents the employee from returning to work while recovering from the effects of an industrial injury. These payments are subject to minimum and maximum rates as well as aggregate maximums.

• 2/3 of the Average Weekly wage is subject to statutory maximums.
• 3-day waiting period If lost time is > 14 days or the employee is hospitalized overnight, the WP is waived.
• For Dates of injury from 4/19/2004 through 12/21/2007 the aggregate limit for TD benefits is 104 weeks in a 2-year window from the date of the first TD payment.
• For injuries on or after 1/1/2008 the 104-week aggregate maximum is limited to a 5-year window from the date of injury.
• Date of injury controls the benefit rate.
• Paid every two weeks.
• LC 4453(a)(10) controls the TD rate increase based upon the percentage increase in the state average weekly wage (SAWW) as compared to the prior year.

Industrial Disability Leave (IDL)

Pursuant to the Education Codes 89529-89529.11 many CSU employees qualify for Industrial Disability Leave in lieu of Temporary Disability. The employee must be a PERS or STRS member. If the employee qualifies for IDL and chooses this benefit instead of TD, the IDL benefit pays as follows:

• IDL is a benefit that pays the first 22 workdays of disability at an amount equal to the employee's net pay (full pay less than an amount equal to Social Security and Medicare and withholding taxes based on an employee’s exemptions). If disability continues beyond 22 workdays, 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 or without supplementation of accrued sick and vacation leave credits.

Enhanced Industrial Disability Leave (EIDL) [Employees in Unit 8]

The employee must be an active member of CalPERS and a member of CSU bargaining unit 8 to be eligible to receive EIDL. EIDL pays the injured or ill bargaining unit 8 employees their full net pay for up to 1 year of disability, as long as their absences occur within 1 year of their date of injury. While the employee is paid EIDL, their normal CalPERS retirement contributions and voluntary deductions such as health, dental, and vision plans continue. During EIDL, the employee continues to accrue sick leave and vacation credits. EIDL is paid to the employee monthly by the University.

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 Management 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 and whose injury or illness has been denied under workers' compensation may qualify for 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 Human Resources Management.

Permanent Disability Benefits (PD)

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, the employee's age and occupation, and other factors.

The amount of permanent disability will be outlined in a final written medical report by the treating doctor after the employee’s condition has stabilized and is determined unlikely to change. In the final report, the doctor will indicate the employee has reached their maximum medical improvement (MMI) or permanent and stationary (P&S) status. The doctor's finding is based on guidelines published by the American Medical Association (AMA).

If the employee or Sedgwick CMS disagrees with the final report, he or she may contact Sedgwick CMS or the Administrative Director for the Department of Workers' Compensation (DWC) Medical Unit to request a panel (list) of 3 Qualified Medical Examiners (QME's). Once the list is received, the employee has 10 days to make a selection. All the above information and instructions on how to request a QME panel will be provided to the employee by Sedgwick CMS once a final (MMI or P&S) report is received.

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. For all vouchers issued for dates of injuries on or after January 1, 2013, the vouchers expire two years after issuance or five years from the date of injury whichever is later.

Death Benefits

Death benefits are payments to a spouse, children or other dependents if an employee dies from a work-related injury or illness. This includes reasonable burial expenses, not exceeding $5,000 for injuries before Jan. 1, 2013, and $10,000 for injuries on or after Jan. 1, 2013. 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.