Workers' Compensation FAQ

Workers' Compensation is a state mandated insurance plan to provide benefits and assistance to all workers who are injured as a result of thier employement or who develop job-related illnesses. This is a "no fault" system that does not try to place blame on either the employer or the employee. 

Benefits may include: medical costs, temporary disability, permanent disability, vocational rehabilitation, or death benefits. The objective of the UCM Workers' Compensation Program is to assist in your quick recovery and return to work. 

The California Labor Code's definition of the term "injury" includes "any injury or disease arising out of employment and occuring in the course of employment." The injury may result from a trauma or disease. 

• Specific Injury - Injury to one or more parts of the body resulting from a specific injury
• Cumulative trauma injury - Injury from repetative traumatic activities over a period of time, such as exposure to chemicals or fumes.
• Aggravation - A pre-existing condition or non-work-related condition aggravated by an occupational injury or disease. The employer provides medical treatment until the employee returns to the pre-injury status of the pre-exisiting condition.

Generally, Workers' Compensation coverage begins the first minute you are on the job and continues any time you are officially on the job performing a service for the University as an employer or official volunteer.

Workers' Compensation does not provide coverage for injuries that occur during the normal commute to or from work; that occur during an unpaid mealtime; that result from recreational activities; that result from substance abuse or intoxication; or that result from starting a physical fight or engaging in horseplay.

Immediately report your injury to your supervisor. If in normal business hours, you will be sent to the Occupational Health Clinic on campus for treatment. If you want to be treated by your own doctor, you must fill out the Designation of Physician form in advance and have it on file with the Workers' Compensation Office. 

You or your supervisor need to complete the Employee RSS Injury & Illness Report. See the Injury and Illness Reporting Procedure.

1. Report your inury or illness to your supervisor.
2. Forward any disability or work status slips from your doctor to your supervisor and keep your supervisor up to date about your progress.
3. Keep track of any time you are away from work due to Workers Comp appointments
4. Participate in your recovery.
5. Advise your supervisor when your doctor releases you to return to work either as fully recovered or able to participate in the Transitional Return to Work Program.
6. Keep all pertinent documents for your records.

The Workers' Compensation Office coordinates all decisions concerning claims with Sedgwick CMS (Claims Management Services), the company contracted to administer all Workers' Compensation Claims for the UC campuses.

Within 14 days after filing a workers' compensation claim, Sedgwick CMS will notify you of your claim's status. Your claim will be accepted, denied, or delayed. 

If the injury or illness clearly arises from your employment it will be accepted. If if clearly does not, it will be denied. If the administrator needs more time to gather information, the claim is delayed. The administrator may gather additional information by talking directly with you, with your supervisor or colleagues, or by asking your consent to review your medical records. The administrator will notify you by letter when a decision will be made. 

There is no charge to you if your claim is accepted. Medical care approved by Sedgwick CMS will be covered at no cost to you. 

The treating physician may state that you can return to work, return to work with modified duty due to work restrictions, or that you require time off work to heal. Whatever the recommendation by the treating physician, you must present a Work Status Report to your supervisor. This report is completed by the treating physician. If the supervisor is not available, email the Work Status Report to the Workers’ Compensation office.

When you have been released from the physician’s care, the physician should indicate so on the Work Status Report. Present this to your supervisor or the Workers’ Compensation office.

If your medical provider issues you a prescription for a work-related injury/illness, you must contact the Workers’ Compensation office for a “first-fill” letter to get your first prescription filled. The University of California has a contract with Optum/Tmesys to administer the Pharmacy Benefit Network (PBN) for workers’ compensation claims. Optum/Tmesys utilizes specific pharmacies in their network.

For additional information, see the Pharmacy Benefit Network poster (English or Spanish).

If your injury or illness developed gradually, such as hearing loss, report it as soon as you learn it was caused by your job.

Incidents must be reported within 24 hours of University’s first notice of incident so that prompt and appropriate remediation can take place. Always report an incident, no matter how small.

• Follow up with employee continuously on medical treatments
• Forward all medical notes to the Workers’ Compensation office.
• If the employee is out for more than 3 continuous working days, contact Human Resources to request a Family Medical Leave (FMLA) packet.
• Work with the Disability Specialist on a transitional return to work agreement during the employee’s recovery period.

Contact our workers' compensaton department at benefits@ucmerced.edu

If you have an appointment outside of on campus OCC Health, you will need to record sick or vacation hours. If the appointment is after work hours, no action is needed.