Workers’ Compensation
Frequently Asked Questions
- What is workers’ compensation?
- What does this benefit cover?
- When am I covered?
- What are my benefits?
- What should I do if I am injured?
- Can I seek medical treatment from my primary care physician?
- What should I do when I return to work?
- What should I do if my doctor tells me I cannot return to work immediately?
See also, General Department.
Q1: What is workers’ compensation?
A: Workers’ Compensation is an employer-paid benefit program that provides compensation and medical benefits if you are injured or become ill due to a work related circumstance. In addition, if you are unable to work, the university provides continued salary or compensation to help replace lost wages until you are able to return to work.
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Q2: What does this benefit cover?
A: Any injury or illness is covered if it is caused by your job. This includes serious injuries as well as first aid injuries. Under Workers’ Compensation law, you will receive help if you are injured, no matter who was at fault. Eligibility for benefits will be determined by the university’s third party claims administrator, Sedgwick CMS.
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A: Coverage begins the first minute you are on the job and continues anytime you are working.
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A: The program will pay all approved medical and hospital bills associated with your work-related injury or illness. If you are disabled and cannot work, you may be eligible for either Industrial Disability Leave (IDL) or Temporary Disability (TD). A three day waiting period will apply in most cases for either benefit. In more serious injury or illness cases, employees may be entitled to permanent disability benefits. Supplemental job displacement vouchers may be provided for education-related retraining or skill enhancement. Finally, benefits are paid to qualifying dependents in work-related death cases.
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Q5: What should I do if I am injured?
A: You must report any injury to your supervisor within 24 hours, no matter how trivial the injury may seem. You will need to tell them when and where the injury occurred, what happened, and if anyone witnessed the injury. Once you report your injury to your supervisor you will receive an Employee’s Claim for Workers’ Compensation Benefits Form
to complete. Your supervisor will submit your claim form in addition to preparing a Supervisor’s Report of Work-related Accident/Illness Form to the Workers’ Compensation office.
These forms should be faxed to 619-594-2841 within 24 hours of knowledge of the injury. If your injury requires medical treatment, your supervisor will refer you to SDSU Health Services or to one of the authorized Sharp-Rees Stealy Occupational Health Services facilities. If it’s not medically possible to return to work, report to your supervisor via phone immediately following your medical evaluation.
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Q6: Can I seek medical treatment from my primary care physician?
A: Unless you have pre-designated a personal physician, treatment must be provided by one of the authorized Sharp-Rees Stealy Occupational Health Services facilities. Your primary treating physician (PTP) has overall responsibility for treating your injury or illness. The PTP directs your medical care within recommended guidelines established by law.
You may change your treating physician to another physician 30 days after the injury is reported. If you want to change your treating physician, contact Sedgwick CMS. You may pre-designate a personal physician to treat you in the event of a work-related injury by completing the Notice of Pre-Designation of Physician Form. Your personal physician must be designated by you in writing and in the Workers’ Compensation department prior to your injury or illness, be a medical doctor, be your primary care physician who has previously treated you in the past and maintains your medical records, and agree to accept Workers’ Compensation Insurance.
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Q7: What should I do when I return to work?
A: You are required to provide a work status report from your doctor to your immediate supervisor and the Workers’ Compensation Coordinator upon returning to work. If you are not able to return to your full duties, the university will offer you a temporary or modified job assignment. It is your responsibility to follow your medical provider’s recommendations with respect to established work restrictions, limitations, therapies and physical capacities. You will return to your normal work assignment as soon as your medical provider deems it is safe.
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Q8: What should I do if my doctor tells me I cannot return to work immediately?
A: Inform your supervisor and the Workers’ Compensation Coordinator if you are off work due to the injury or illness. Keep your supervisor and the Workers’ Compensation Coordinator informed of your progress and provide them periodic updates from your physician concerning your recovery. You are also responsible to record all absences, with your signature, on the Attendance Summary form. After the University’s Claims Administrator, Sedgwick CMS, approves your time off work, your leave balance will be credited back to you.
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