Workers’ Compensation

Note: if the employee is unable to drive, the supervisor or supervisor’s designee should accompany the injured worker to an authorized medical provider for initial treatment.

In cases where injuries require medical treatment, SDSU Workers’ Compensation will report the incident to the University Claims Administrator, Sedgwick CMS.

Sedgwick CMS makes the final determination of whether your injury is work-related and what benefits you are entitled to receive. In some cases, the Claims Administrator conducts an investigation into the incident — a process that may cause a delay with you receiving your benefit compensation. You should receive a notice from the Claims Administrator shortly after the injury report is filed. It’s important to keep in touch with SDSU’s Workers’ Compensation Manager, in addition to the Claims Administrator, to prevent unnecessary delays in resolving your case.

All medical bills and reports will be sent to Sedgwick CMS. SDSU’s Workers’ Compensation Coordinator needs to be aware of your continued absences due to the injury. Please forward copies of all work status slips you receive to SDSU’s Workers’ Compensation Manager and provide copies to your supervisor.

• Steps to take if the employee is seeking medical treatment:

• Once the immediate needs of the employee have been taken care of, complete the Supervisor’s Report of Work Related Accident/Illness Form.  Have the employee complete questions #1—#8 of the Employee’s Claim for Workers’ Compensation Benefits Form and you will complete questions #9—#18 of the claim form. Both of these forms need to be faxed to the Workers’ Compensation Office at 619-594-4013 within 24 hours of knowledge of the injury.

• Steps to take if the employee is not seeking medical treatment:

• Once the immediate needs of the employee have been taken care of, complete the Supervisor’s Report of Work Related Accident/Illness Form.  Complete questions #9—#18 of the Employee’s Claim for Workers’ Compensation Benefits Form and give a copy of the incomplete claim form to the employee within 24 hours of knowledge of the injury. Fax the Supervisor’s Report of Work Related Accident/Illness Form and the incomplete claim form to the Workers’ Compensation office at 619-594-4013 within 24 hours of knowledge of the injury. Inform the employee that if they need to seek medical treatment in the future, they will need to complete questions #1—#8 of the claim form and return it to their supervisor. The completed claim form should be faxed to the Workers’ Compensation office at 619-594-4013.

• Deliver the originals to the Workers’ Compensation Manager, located in Room 406 of the Extended Studies Center or via campus mail at mail code 1625. The Workers’ Compensation Manager will forward copies to Sedgwick CMS, the university’s claims administrator.

• If the employee requires medical attention on the date of the injury, the employee is paid for a full day’s work regardless of the number of hours worked.
  
  
• Absences due to the industrial injury are only allowed with a doctor’s note. Periodic doctor visits or physical therapy visits are deducted from the employee’s sick leave balance. The employee should make every effort to schedule these appointments around their work hours.
  
  
• Notify the Workers’ Compensation Manager when the employee begins to lose time due to the industrial injury.
  
  
• Maintain contact with the employee on a weekly basis.

• The employee must provide a written release to return to work from the treating physician before they return to work. Forward copies of these documents to the Workers’ Compensation Manager.
  
  
• Upon advice of the treating physician, the employee’s work duties may be restricted, i.e., lifting restrictions, restricted work hours, restricted movement, etc. while they recover from the injury or illness. Before the employee can return to work on modified duty, a meeting will be arranged between the employee and their immediate supervisor, to review work restrictions, determine the feasibility of modifications to their work duties and ensure that any modified duties are consistent with the work restrictions. It is recommended that the immediate supervisor consult with the Workers’ Compensation Manager regarding questions of accommodating work restrictions.
  
  
• Ensure that the employee released to modified work is working within their job restrictions. The modified work should not be at a higher classification.
  
  
• The Workers’ Compensation Manager will keep in contact with the treating physician to be in compliance with doctor’s orders and to provide feedback on the employee’s progress towards recovery.