HR - Workers' Compensation - CA

Policy Statement and Reason

For the purposes of this policy, employees include California faculty and staff unless otherwise indicated in the sections below. All provisions of this policy apply, except that for employees covered by a collective bargaining agreement, this policy does not create any benefits not expressly provided by that collective bargaining agreement and if there are inconsistencies between this policy and the collective bargaining agreement, the terms of the collective bargaining agreement will govern. 

The College provides a comprehensive Workers’ Compensation insurance program (Temporary Disability Benefits) to all employees. This program covers injuries and illnesses that are sustained in the course of employment and that require medical, surgical or hospital treatment.  Subject to applicable legal requirements, workers’ compensation insurance provides benefits after a short waiting period or immediately in the event of hospitalization. This policy provides information about work-related incidents, medical assistance, reporting requirements, Workers’ Compensation benefits (also referred to as temporary disability benefits), and return to work following work-related illnesses or injuries.

Policy Guidelines

Eligibility

Regular full-time, part-time and temporary faculty and staff.

Injuries or illnesses resulting from voluntary participation in non-mandatory College-sponsored recreation or athletic events during non-working hours generally do not qualify for Workers’ Compensation benefits.  

Prevention

The College is concerned about the safety and well-being of its employees and strives to provide a healthy work environment free of hazards. To prevent accidents, injury or illness the College expects all employees to practice safe working habits and to report any unsafe conditions to their supervisors and/or responsible departments (i.e., Facilities Management, Campus Police, etc.). 

Medical Assistance and Work-Related Illnesses or Injuries

Personal Physician Pre-Designation: If employees would like to use their personal physicians or medical groups in the event of work-related illnesses or injuries, they must “predesignate” their personal physicians or medical groups in writing to the College’s Human Resources department before they incur work-related illnesses or injuries. Designated doctors must serve as employees’ primary care providers and be one of the following:

  • general practitioner
  • internist
  • pediatrician
  • obstetrician-gynecologist
  • family practitioner

Employees may predesignate medical groups if they meet the following criteria:

  • composed of licensed doctors of medicine (MD)
  • composed of doctors of osteopathy (DO)
  • offers and coordinates both primary care and care in other medical specialties

Medical Assistance – Urgent and Non-emergencies

  • Employees who sustain work-related injuries or illnesses should immediately inform their supervisors and the Human Resources Department. No matter how minor an on-the-job injury may appear, it is important that it be reported immediately. This will enable eligible employees to qualify for coverage as quickly as possible
  • Medical Documentation: Appropriate medical documentation will be required for employees to qualify for approved time away from work, medical leaves, and Workers’ Compensation. Employees should inform their healthcare providers that the illness or injury is work-related.

Important Process and Reporting Requirements

Workers' Compensation is intended to protect employees against loss of income and/or medical expenses when they are absent from work because of on-the-job injuries or illness. Consequently, it is critical that work-related incidents are reported as follows:  

  • Report incidents to Supervisors and Human Resources immediately
  • If employees report incidents to their supervisors, supervisors must ensure that the incident is reported to Human Resources by employees and/or supervisors immediately
  • Injuries or illnesses that develop gradually (like tendinitis or hearing loss) must be reported as soon employees learn or believe it is work-related
  • Human Resources must immediately report serious occupational injury, illness or death to the Division of Occupational Safety and Health by telephone or through an online mechanism established by the division for that purpose.
  • Within one working day of learning about the work-related illness or injury, Human Resources will provide employees or their supervisors, as appropriate, with the Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (e3301) for them to complete
  • Employees or supervisors must complete and return DWC1 Forms and e3301 Forms to Human Resources within one (1) working day of incidents
  • Within one working day of receiving the completed forms, employees will receive authorization to seek medical treatment
  • Human Resources forwards reports to the College’s Workers’ Compensation vendor who:
    • Determines employees’ eligibility for Workers’ Compensation
    • Works directly with eligible employees
    • Coordinates medical and wage benefits for employees’ who qualify
    • Provides medical case management by trained nurses or nurse practitioners
    • Provides medical expense and billing for each employee's individual case
    • Works directly with California’s State Compensation Insurance Fund (State Fund), the agency responsible for administering Workers’ Compensation in California

Prompt reporting of illnesses or injuries helps avoid problems and delays in receiving benefits, including medical care. 

Absence from Work Following Work-Related Illness or Injury

First Five (5) Days of Absence: The College will compensate 100% of employees’ base rate for up to the first five (5) days of absence from work (consecutive or intermittent) for work-related illnesses or injuries provided they have medical documentation that supports the absence and work-related nature of their medical condition. 

Leaves of Absence and Workers’ Compensation: Eligible employees will be placed on a medical leave of absence, as appropriate, if their absence from work due to work-related illnesses or injuries extends beyond five (5) days. Medical Leaves of absence are “unpaid” time away from work that employees may be eligible to take for medical reasons, including work-related illnesses or injuries. Workers’ Compensation is the means by which qualifying employees receive income replacement for work-related illness or injury during such leaves.   

Workers' Compensation Benefits and Use of Paid Time Off 

California refers to Worker’s Compensation benefits as Temporary Disability Benefits. Eligible employees will begin receiving Temporary Disability payments on the sixth (6th) day of absence from work as follows:

  • Workers’ Compensation Income Replacement – Temporary Disability Benefits payments provide employees with two-thirds of their average weekly wage, to a weekly maximum
  • Use of Sick, Personal and Vacation Time: Employees may elect to supplement their Temporary Disability payment with their available sick, then personal then vacation time
  • Other Workers’ Compensation Benefits: Workers’ Compensation may also cover payment of medical bills related to work-related illnesses or injuries, even if employees do not miss work. It may also cover reasonable costs of travel to and from medical visits and additional benefits for those more seriously injured

Return to Work

Employees must provide Human Resources with documentation from their medical provider clearing them to return to work following leave. Employees who are cleared to return to work with restrictions or on a part-time basis must contact Human Resources to discuss the circumstances. In some cases, it may not be possible for departments to accommodate employees’ restrictions. If employees are unable to return with restrictions or on a part-time basis, they may be eligible to continue to receive Workers’ Compensation, but it may be at a reduced rate.

Other Information

Non-Retaliation

The College prohibits retaliation against any member of the community who in good faith reports unsafe or defective equipment, or any unsafe or hazardous condition or any work-related illness or injury.

Fraudulent Claims

Employees who file fraudulent claims may be subject to termination.

Related Policies

Key Offices to Contact 

Please contact the Leave of Absence Administrator (Human Resources) for further information regarding this policy and its implementation.  

Links to Procedures or Forms

Contact the Leave of Absence Administrator (Human Resources) for assistance.

Definitions

Not applicable

 

The contents of this policy are informational only and are not conditions of employment.  This policy does not create any contractual obligations or alter the at-will employment of the College’s at-will employees. Emerson College reserves the right to modify, revoke, suspend, terminate, or change any and all policies and procedures at any time, with or without notice, as consistent with state and federal law.

 

Policy Effective Date:  May 2019 – revised January 2020