Workers' Compensation Program

Employee's Guide - Frequently Asked Questions

As an injured worker, you may have many questions regarding your workers' compensation claim, your care and recovery, and your pay if you must miss work because of your injury or illness. If the answers to the questions below do not answer your concerns, please contact the Risk Management department.

What is occupational injury?

How do I report an injury?

Pre-designated physician form

Where do I receive initial treatment?

What are my responsibilities?

What is Workers' Compensation?

Who is eligible for Workers' Compensation?

How do I file for a Workers' Compensation claim?

Overview of Workers' Compensation benefits

What is the procedure for pending claims?

What is the procedure for accepted claims?

What are some payroll issues that may impact my Workers' Compensation claim?

Salary options prior to the approval of the claim

What is the procedure for denied claims?

What is Occupational Injury?

The term "occupational injury" is used to describe any injury, illness, or disease which results from work or working conditions, and which occurs during the employee's service to the District. Even first-aid injuries are covered. However, benefits may not be provided for those injuries that occur during voluntary participation in off-duty recreational, social, or athletic activities.

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How Do You Report an Injury?

Immediately report your injury to your supervisor.

The Los Angeles Community College District's mission is to provide a safe working environment for all employees and to minimize the adverse impact of work-related injuries. In this effort we provide a variety of injury, loss prevention and claims services for our employees. Our goal in requiring the reporting of incidents is to promote prompt notification of unsafe conditions so that prompt and appropriate remediation can take place.

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Pre-designated Physician Form

Please see the Statement of Employee's Pre-Designated Physician and Employee Consent form located on the LACCD intra and internet for detailed information regarding when and how to complete this form.

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Where do you Receive Initial Treatment?

Please see the Referral for Treatment of Occupational Injury or Illness form for approved medical clinics.

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What are Your Responsibilities?

  • You must report an occupational injury to your supervisor immediately and seek medical care when necessary.

  • Report to the campus Sheriff's office to report the incident or injury as soon as possible. The Sheriff will complete the Incident/Injury Report Form. Incident Reporting ensures that there is a record on file with your employer. In no way does this waive your right to workers' compensation benefits.

  • If you want or need non-emergency medical treatment, you must bring the Referral for Treatment of Occupational Injury or Illness form, which indicates all District approved clinics, to the clinic you have chosen from the form. This is your authorization to be treated at the chosen medical facility.

  • If an injury occurs, first aid may be the appropriate treatment. "First aid" means any one-time treatment and any follow-up visit(s) for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial incident, which do not ordinarily require medical care. This one-time treatment and follow-up visit(s) for the purpose of observation is considered first aid even though provided by a physician or registered professional personnel. No time is lost beyond the day you were injured.

  • If you pay a bill, submit a copy of your receipt to the Risk Management Office for review and determination if payment is appropriate.

  • Keep your supervisor informed of the status of your injury and claim.

  • Notify your supervisor prior to going to doctor appointments and/or physical therapy.

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What is Workers' Compensation?

Workers' Compensation is a state mandated benefit for employees with work-related injuries and illness, awarded without regard to who is at fault. California's Workers' Compensation laws are intended to ensure that employees receive prompt medical treatment, among other benefits, when they are injured on-the-job. Under workers' compensation an injury must meet the test of both arising out of employment and occurring during the course of employment to be compensable.

If you have questions regarding Workers' Compensation Policy and Procedure, please call or e-mail:

Ross Lee, Workers' Compensation Claims Specialist
(213) 891-2397
LeeRG@email.laccd.edu


Leila Menzies, Vice President, Administrative Services
MenziesL@email.laccd.edu

213-891-2036
Fax: (213) 891-2293

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Who is Eligible for Workers' Compensation?

LACCD employees and others who meet the college definition of "Others" for Workers' Compensation Coverage below:

Definition of "Others" for Workers' Compensation Coverage:

For the purpose of workers' compensation coverage, an "other" is defined as a person rendering services to the District where:

  • The District has control and direct supervisory responsibility over the manner and result of the services rendered by the individual; and

  • The individual receives no compensation for such services other than meals, transportation, lodging, or reimbursement for incidental expenses, if appropriate.

  • The individual is under a contractual agreement indicating they are to receive their workers' compensation coverage from the District.

The following categories do NOT fall within the "other" definition:

  • The service provided is solely in pursuit of the individual's personal education goals;

  • The individual receives compensation for services rendered from a non-District payroll, e.g., visitors or guests, academic or research visitors receiving support from home institutions, etc.;

  • The individual is sponsored by an outside agency and provides service to the District through that sponsoring agency, e.g., Red Cross volunteers or United Way volunteers;

  • The individual is an off-campus volunteer who is sponsored or referred by the District but is not under the direct supervision and control of the District, e.g., Student Internships, Student Teachers, etc.; and/or Guests of the District such as: casual visitors; computer users who are employees of an organization which has a formal contractual agreement to use computer facilities; or retired employees who desire occasional access to campus/laboratory/recreational facilities.

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Filing for a Workers' Compensation Claim

If you desire to file for a workers' compensation claim, contact your campus Focal Point to request an Employee's Claim for Workers' Compensation Benefits (DWC-1) Form.

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Overview of Workers' Compensation Benefits

Specific benefits are individually determined based on a range of factors. Generally, injured employees are eligible for the following types of benefits:

  • Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat the injury. For injuries occurring on or after 01/01/2004, there is a limit on some medical services.

  • Temporary Disability Compensation:Temporary disability payments are provided to injured employees to supplement their lost wages. (Throughout this policy temporary disability payments will be also referred to as workers' compensation payments);

  • Permanent Disability Compensation: Permanent disability compensation is provided when there is a permanent disability;

  • Death Benefits: Compensation is provided to the surviving dependents in the event of death;

  • Vocational Rehabilitation Services: These services help employees in returning to work. This benefit applies to injuries that occurred prior to 01/01/2004.

  • Supplemental Job Displacement Service: A non-transferable voucher payable to a state approved school if an employee is injured on or after 01/01/2004, the injury results in permanent disability, the employee doesn't return to work within 60 days after temporary disability ends, and the District does not offer modified or alternative work.

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Procedure for Pending Claims

The District has retained York Insurance Services Group (YORK) as a third-party administrator for the workers' compensation program. A YORK claims administrator will discuss your claim with you, investigate the injury and determine acceptance of your claim. Reporting an injury or submission of a claim form does not imply automatic approval of your claim. York Insurance Services Group has ninety (90) days from the filing date of the claim to determine whether the claim will be approved or denied.

Questions regarding claims and benefits may be referred to:

York Insurance Services Group
313 East Foothill Boulevard
Upland, CA 91786
Phone: (909) 608-7171
Fax: (909) 608-7165

York Insurance Services Group will mail a letter to your address stating when the decision will be made. If your sick leave is exhausted while your case is still pending, you may use your vacation leave with department approval.

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Procedure for Accepted Claims

Once a claim is approved, YORK authorizes medical treatment and issues any temporary or permanent disability payments related to the claim. The Los Angeles Community College District is self-insured and the cost arising from the workers' compensation claims are paid directly by the District.

When you are losing time from work on an approved claim, you are entitled to two-thirds of you average weekly wage. The District pays the two thirds and supplements the amount with Industrial Illness Leave for the first 60 days of the leave. Once the Industrial Illness Leave has expired your accrued sick leave is used to supplement the two third providing you with your regular salary. The Payroll Department issues your regular salary as long as you have available sick time. You will have to send a request to your supervisor if you would like to use your vacation time once your illness leave has exhausted. Once you have exhausted all of your illness leave and vacation time (used upon your request only), York Insurance Services Group will mail a check to you for approximately two-thirds of your weekly salary, up to a maximum amount determined by the State of California.

By law, there is a three-day waiting period before workers' compensation temporary disability payments begin. This waiting period for temporary disability benefits is waived if you are hospitalized for treatment more than observation, or you are disabled for more than 14 days. However the District pays the regular full time employee's full salary for the first 60 days of lost time for his/her industrial injury or illness.

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Payroll Issues impacting Workers' Compensation Claims

If you need assistance with resolving any payroll-related questions and problems, you must contact your campus Payroll Department.

Salary Options Prior to the Approval of the Claim:

If you are eligible to accrue sick and vacation leave and are determined by the treating physician to be temporarily disabled, you will need to follow the normal procedures to request the use of sick leave and/or vacation leave, accruals in order to continue receiving your basic salary while temporarily disabled. You may elect to take a leave of absence without pay, and not use accrued leave. York Insurance Services Group has ninety (90) days from the filing date of the claim to investigate and determine whether the claim will be approved or denied.

AFTER THE CLAIM IS APPROVED, WORKERS' COMPENSATION PAYMENTS ARE RECEIVED:

  1. Temporary disability (TD) is paid when YORK has approved the claim and the treating doctor certifies that your illness or injury causes you to lose time from work. The exact amount of the (TD) amount is determined by law, based on your average weekly earnings. It is approximately two-thirds of your actual wage loss, up to a current maximum weekly rate.

  2. The District will supplement the 2/3 of your average weekly wage allowed by the state with Paid Industrial Leave for the first 60 days of your industrial leave.

  3. You are placed on Paid Industrial Leave from the first day of industrial absence not to exceed the sixtieth (60) working day of your absence.

  4. During the first sixty (60) days of your industrial absence your accumulated illness balance will not be charged against.

  5. Once the sixty (60) day Paid Industrial Leave has expired your Temporary Disability payments will be supplemented with your accumulated illness leave to provide you with continued full salary.

  6. Workers' compensation payments or temporary disability (TD) checks are mailed directly to you from SCRMA once you have exhausted your illness leave.

OPTIONS FOR EMPLOYEES TO SUPPLEMENT WORKERS' COMPENSATION PAYMENTS:

You may choose to request that your vacation be used to supplement your salary while continuing on industrial leave.

Procedure for Denied Claims

If a claim is denied, YORK will mail a letter to your home explaining why the claim has been denied. A copy of this letter will be mailed to your department.

Any time lost on the day of the injury will no longer be considered Industrial Leave. Your accrued leave balances would be used to cover time lost on the days you were absent.

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