Workers’ Compensation
May 2015
1
Management Training Class
• Workers’ Comp Overview for Managers
• Quarterly
• June
at SMUCLA and RRUMC
16 RRUMC
• Covers
processes and procedures related to Workers’
Compensation
• Reviews
Disability Management and the Interactive Process
2
Who is eligible?
• Career, casual, Per Diem employees are covered from
the first date of employment
• Vanpool injuries
• Non-UCLA employees are covered by their respective
employers, e.g. Traveler’s, Registry, other temporary
workers
• Volunteers
3
Initial Employee Contact
Was this injury work related?
• If the employee believes it was work-related or is
unsure, provide Workers’ Compensation forms and
direct the employee to seek immediate medical
treatment at either Occupational Health Facility or the
UCLA Emergency Department
• Employee
should tell the UCLA Emergency Department that
they are a UCLAMC employee and that they are being
treated for a work-related injury
• Follow
all procedures for a leave of absence
4
Medical Treatment
Where to send the employee for treatment?
Employee should be seen by Occupational Health Facility or the
UCLA Emergency Department for the first 30 days
IF EMPLOYEE WAS SEEN AT THE EMERGENCY ROOM, direct
employee to follow-up at UCLA Occupational Health.
Medical Control:
UC directs the employee’s medical care for an initial 30 days.
UCLAMC’s designated providers are Occupational Health Facility
(OHF), RRUMC Emergency Medicine, and SMUCLA Nethercutt
Emergency Medicine
Exception: Employee pre-designates personal Medical Doctor in
writing prior to the injury. Contact WC HR for more information.
5
New Pharmacy Network
• The University of California (UC) has partnered with Helios to
establish a Pharmacy Benefit Network (PBN) for workers’
compensation illness and injury related medications as part of the
overall pharmacy program.
• Injured workers within the PBN will only be able to fill prescriptions
from a pharmacy within the network after 4/1/2015.
• Posters
should be posted next to the state mandated WC
posters.
• Pamphlets
will be given to all new hires with other statemandated WC pamphlet
6
Cal-OSHA
FOR SERIOUS INJURIES,
page UCLA Health Safety at pager #90248 within EIGHT hours
or call the Campus 24-hour call-in phone number
EH&S Hotline: 310-825-9797
Serious injury includes:
Amputation
Concussion
Injury resulting in serious degree of permanent disfigurement such
as crushing injury or severe burn
In-patient hospitalization >24 hours for other than medical
observation
OSHA requires notice within 8 hours of Serious Injury
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When an Employee is injured on the job . . .
Provide the employee with:
1. A completed Workers’ Compensation Claim Form (DWC-1)
and Notice of Potential Eligibility
This form must be provided within 1 working day of notice that an
injury or illness has occurred as mandated by California state law.
(Exception: First Aid incidents)
2. A completed UCLA Incident Report and Referral for Medical
Treatment
3. Workers’ Compensation Information Sheet
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Paperwork
1. Please review and complete all lines. Sign where appropriate.
Supervisor should sign all forms where indicated
2. Department keeps one copy for department records.
If notification was by phone, send the form to employee via Certified
Mail
3. Immediately:
1.FAX
a copy to the WC FAX line Health System HR 310 794
3337 or
2.EMAIL
to hrworkerscomp@mednet.ucla.edu or
3.CALL
877-6UC-RPRT (877-682-7778) with the information on
the form (see Step #5)
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Paperwork
4. Employee keeps one copy of completed form
5. Send all other copies of the form immediately to Health System HR
for distribution
6. Notify Health System HR Workers’ Comp x40500 if employee
has been taken off work.
Follow all procedures for a leave of absence
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Important Information
Employees should be paid for the time at OHF and/or the EMC (to
complete the work shift.)
Charge hours to Home Cost Center
Employees must use SL for any time at off-site (non-OHF or EMC)
appointments, and for time taken for therapy, diagnostic appts
Charge hours to Home Cost Center
Employee may return to temporary work on a modified work schedule
or modified duties at any time.
Charge actual Modified duty hours worked as ‘Modified Duty
Workers’ Comp’ and to the Return to Work Cost Center.
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Disability Management
Mark Briskie
UCLA Health System Human Resources
(310) 794-0525
Legal Responsibilities
Workers’ Compensation
Family Medical Leave
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Contacts for Return to Work Program
Contact UCLA Health HR Workers’ Compensation/
Return to Work coordinators to confirm employee meets
eligibility criteria
UCLA Health Human Resources WC
310 794 0500
Mark Briskie
mbriskie@mednet.ucla.edu
310 794 0525
Cynthia Vazquez
cvazquez@mednet.ucla.edu 310 794 0522
Ingrid Garcia
igarcia@mednet.ucla.edu
310 794 3036
Return to Work Coordinators
Mark Briskie
mbriskie@mednet.ucla.edu
310 794 0525
Suzanne Bleibtreu sbleibtreu@mednet.ucla.edu
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Injury Prevention resources
UCLA Health Safety
SAFETY INSPECTIONS/TRAINING
ACCIDENT INVESTIGATIONS
Jennifer Mempin
310-267-9886 phone
PAGER 99828
ERGONOMIC EVAL
jmempin@mednet.ucla.edu
310 267 9887 fax
SAFE PATIENT-HANDLING COORDINATOR
Larona Taylor
lataylor@mednet.ucla.edu
310-267-9897 phone
PAGER 91136
310 267 9890 fax
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Injury Prevention resources
Ergonomic Evaluation Request Form
• Bruin Ergo - UCLA UCLA Health Online Ergonomics Program
(Cardinus)
User ID = Employee ID Number (link on HR website)
• To request onsite eval: UCLA Health Support Services Center
Bruin Break
Jeri Simpson 310 794 0500
jasimpson@mednet.ucla.edu
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Directory
SEDGWICK CMS
P.O. Box 14533
Lexington KY 40512-4533
Mail code 691448
Phone
310 253 7500
Fax
310 253 7569
CAMPUS PAYROLL
UCLA Wilshire Center, Suite 620
MC 141648
Phone
310 794 8706
Fax
310 794 8751
UCLA HEALTHCARE PAYROLL
UCLA Wilshire Center, Suite 1700
MC 167646
Phone
310 794 0127
Fax
310 794 8049
OCCUPATIONAL HEALTH FACILITY
(OHF)
67-120 Center for Health Sciences
Monday through Friday
7:00 a.m. to 4:30 p.m.
Mail Code 172524
Phone
310 825 6771
Fax
310 206 4585
www.ohs.uclahealth.org
EMERGENCY DEPARTMENT
757 Westwood Plaza
(ER entrance Gayley Ave, N of Le Conte)
Phone 310 267 8406
Open 24 hours a day
SMH Nethercutt Emergency Room
1255 15th Street, Santa Monica
Phone
424 259 8400
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Policy
Health System Policy
HS 7318
Employee Work-Related Illness and/or Injury
http://www.mednet.ucla.edu/Policies/pdf/enterprise/HS7318.pdf
Health System Policy
HS 7324
Employee Transitional Return to Work(TRTW) Policy
http://www.mednet.ucla.edu/Policies/pdf/enterprise/HS7324.pdf
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Other Required forms
Required Workplace postings
• DWC 7 Notice to Employees – Injuries Caused By Work
• Workers’ Compensation Pharmacy Benefit Network
HR Website http://hr.uclahealth.org
New Employee Pamphlets
• Notice to Employees – Injuries Caused by Work
• Helios/Pharmacy Benefit Network
Distributed at time of Hire by HR Rep
Pre-designation of Physician form
HR Website http://hr.uclahealth.org
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