Workers' Compensation FAQs

Workers' Compensation is a mandatory benefit that an employer is required by law to carry, to cover medical and lost time benefits of their employees in case they are injured or become ill as a direct result of their employment.

For the purposes of administering Workers Compensation benefits the word "employee" represents those noted below.

• Faculty, FERP and rehired annuitants
• Staff
• Student assistants
• Graduate assistants
• Volunteers – authorized and approved

Any injury or illness that occurs due to employment is considered a workers' compensation injury or illness. Under workers' compensation law, an employee will receive help if they are injured no matter who was at fault.

If an employee is injured or ill, they do not have to report a claim, however, if they require medical attention, it is highly advisable. A Workers Compensation Claim form(DWC-1) is necessary when an employee requires medical treatment for a work related incident. If the employee fills out the DWC-1 Workers Compensation Claim form, they will be provided with a medical authorization form to receive medical treatment at one of CSUDH’s approved occupational clinics, unless a personal physician has been predesignated prior to the injury/illness.

However, an Employee Report of Injury/Illness form should be completed as soon as possible after a work-related injury, illness, incident, or near-miss incident occurs. Human Resources Management and the respective manager must be informed of the work-related incident as soon as possible. The employee’s manager will immediately direct them to Human Resources Management to complete an Employee Report of Injury/Illness and a DWC-1 Workers Compensation Claim form, if necessary. There should be a date of injury and how, when, and where it occurred. Their claim will be reported to Sedgwick CMS and a representative will contact them to explain the benefits an employee may receive.

At CSUDH, employees are strongly encouraged to report work-related injuries, illnesses, incidents, and/or near-miss incidents to their manager and Human Resources Management immediately after they occur. Early reporting assists the University in identifying and addressing safety hazards, prevents delays in treatment and potential workers' compensation benefits to the injured employee. Additionally, if treatment is not immediately sought but found to be needed at a later date, it is best to have a report on file in the Human Resources Management office to expedite the medical treatment authorization.

If an injury or illness requires only First Aid treatment, such as minor papercuts or abrasions, the First Aid kit located in the employee’s department may be used, when available.

The University has designated Concentra Medical Group and Kaiser On-the-Job to treat all employees for work-related injuries or illnesses which require one or more visits. The employee must receive medical authorization from Human Resources Management prior to visiting one of the designated occupational clinics.

If an injury or illness requires medical treatment beyond first aid, and an employee is unable to drive or cannot arrange for timely transportation, Human Resources Management may only arrange transportation to the approved occupational clinics (Concentra and Kaiser On-the-Job). This service is only provided on the first day of treatment. All subsequent transportation needs must be arranged by the employee.

Any suspected work-related injury, illness, incident, and/or near-miss incident must be reported within 24 hours to the employee’s manager and Human Resources Management.

In most circumstances, an injured or ill employee has one year from the date of injury or five years from the date the last workers’ compensation benefit was provided to pursue a claim. However, early and timely reporting is encouraged.

No. Workers' Compensation is only for injuries or illnesses that occur due to employment. State Disability is for injuries or illnesses that are not work-related and is handled by the Employment Development Department (EDD).

After filing a claim, the Human Resources Management Workers’ Compensation (WC) Coordinator will contact the employee to review the benefits provided by workers’ compensation and respond to any questions or concerns. If the injured or ill employee requires medical treatment, they will be sent to one of the University’s approved occupational clinics for a medical examination, unless a personal physician has been pre-designated prior to the injury/illness occurring. If the treating medical provider takes the employee off work because of their injury or illness, the WC Program will review loss time compensation benefits with the employee. If the employee is able to work modified or light duty, the WC Program will review the employee’s work restrictions with their manager to determine if a temporary modified or transitional work assignment is available.

Please remember the University investigates all claims. The injured or ill employee may also be contacted by the CSU third-party claims administrator, Sedgwick CMS and Environmental Health and Safety (EHS), at any point in time after filing a claim. At times, the Environmental Health and Safety manager will conduct the investigation. At other times, an investigator may be acquired to take an employee’s statement. The results of the investigation not only help determine whether an injury or illness is work-related but also determine whether a need exists to adjust any applicable safety procedures.

Sedgwick CMS is the third-party administrator that administers all the Workers’ Compensation claims in the California State University system. Sedgwick CMS is responsible for determining whether to accept, delay, or deny a claim, coordinating the provision of medical treatment, and payment of the medical and disability benefits related to the Workers' Compensation claim.

To ensure that only appropriate claims are accepted, the University investigates all claims of a work-related injury or illness. Some of these investigations are conducted in-house and some are conducted by off-campus personnel. Early reporting of work-related injuries and illnesses makes it more likely that complete information about the circumstances surrounding the injury or illness can be gathered.

When an employee’s claim is accepted, Sedgwick CMS will work with the employee to provide the workers’ compensation benefits they are qualified to receive.

When an employee’s claim is delayed, Sedgwick CMS has determined that it needs to obtain additional information to aid in the evaluation of their claim. If there is a question of medical causation, Sedgwick CMS will notify the employee of their need to obtain medical verification that the injury or illness occurred and that it is work-related.

Please note that once the employee has completed, signed, and returned a claim form to Human Resources Management, they may be provided with up to $10,000 in employer-paid medical care until the claim is accepted or denied. Only medical treatment consistent with established guidelines will be authorized. All treatment is subject to the utilization review process.

Cooperation is needed in the workers’ compensation process. Failure to return the forms or communicate with Sedgwick CMS can result in further delay or possible denial of the claim.

Sedgwick CMS has 90 days from the time the claim is filed to notify the employee of their decision concerning acceptance or denial of the claim.

When the employee is off work, they can use their accrued sick or vacation leave credits. They can also apply for non-industrial disability to account for any lost wages. If an employee’s claim is accepted, depending on the disability plan that they select, their sick and vacation leave credits will be restored.

If your claim is denied, Sedgwick CMS has determined, based on available information, that your injury or illness is not work-related. You have a right to challenge this decision.

You have one year from the date of the denial notice to pursue your claim. You must act by filing an Application for Adjudication before the Workers' Compensation Appeals Board within this time period.

When the employee’s claim is denied, Sedgwick CMS has determined based on available information that the injury or illness is not work-related. The employee has a right to challenge this decision.

The employee has one year from the date of the denial notice to pursue their claim.

Industrial Disability Leave (IDL) and Temporary Disability (TD) are two different types of partial wage continuation benefits employees/volunteers may be eligible to receive if they are unable to return to work after sustaining a work-related injury or illness. These benefits are intended to help the employee recover from any lost wages. IDL benefits are paid for by the University and TD benefits are paid for by Sedgwick CMS.

At the onset of loss time due to an injury or illness, the University's WC Program Manager may conduct a meeting with the employee to explain IDL/TD benefits.