Faculty/Staff Disability Management
Chapter 1: What is Workers' Compensation?
Workers’ Compensation is a state-mandated program that provides benefits to employees who are injured or develop an illness as a result of their job. Employers are required to provide benefits in case of injury, illness, aggravation of a pre-existing condition, or death resulting from employment. The University of California is legally self-insured for these benefits. Be Well at Work-Disability Management coordinates this program for the Berkeley campus. Administration of claims and benefits is handled by the University's third-party administrator, Sedgwick.
The amount of Workers' Compensation benefits and the process for paying claims are mandated by law. Once a claim is determined to be compensable, the benefits are automatically paid to employees. These benefits include all authorized medical and hospital expenses, partial replacement of income if the employee is temporarily disabled, permanent disability payments if the employee is permanently injured, and death benefits for financial dependents if an injury or illness results in death.
When an injury or illness results in time away from work, the University also offers supplemental benefits above and beyond the state-mandated benefits. See the State Benefits/University Supplemental Benefits section of Chapter 4 When an Injury or Illness Results in Time Away from Work for more detailed information.
Who is Eligible?
UC Berkeley individuals who are eligible to receive Workers' Compensation benefits are:
- Faculty and staff
- Student employees
- Postdoctoral scholars
- Visiting scholars and visiting student researchers
- Volunteers (case-by-case basis)
Volunteers must be registered within their departments prior to an injury or illness to be eligible. The Workers' Compensation Program Registration Form for Volunteers must be completed in order to be eligible for benefits.
How is an Injury or Illness Defined?
According to the California Labor Code, the term "injury" includes any injury, illness, or disease arising out of employment and occurring in the course of employment (AOE/COE). Injuries are categorized in three ways:
Specific: Injury resulting from a specific incident and to one or more body parts (Example: Employee falls down stairs and fractures a bone)
Cumulative: Injury from repetitive exposures over a period of time (Example: Employee experiences hearing loss due to repeated noise exposure)
Aggravation: A pre-existing condition or non work-related condition aggravated by an occupational injury or disease. Medical treatment is provided until the employee returns to the pre-injury status of the pre-existing condition (Example: Employee’s previous back injury exacerbated by continued heavy lifting)
Types of Workers' Compensation Claims
Claims can be classified into three types:
First Aid: Refers to a one-time treatment of minor scratches, cuts, burns, splinters, etc. which do not ordinarily require medical care, with a follow-up visit for the purpose of observation, whether provided by a physician or registered professional.
Medical Only: Refers to medical treatments that are not expected to exceed six months. The employee has lost no more than three calendar days from work.
Indemnity: Refers to a claim that has anticipated medical treatments expected to exceed six months. The employee has lost three days or more from work or the claim has expected payments to exceed a defined level.
Workers' Compensation Benefits
Medical Treatment: Medical care required to help recover from the injury or illness caused by work. For example, care may include doctor visits, lab tests, physical therapy, and hospital services. There are some limits on some medical services such as physical therapy, occupational therapy, and chiropractic care.
Temporary Disability (TD): Benefit payment for lost wages (partial income replacement) if unable to work temporarily due to injury or illness while recovering. Payment limits are set by State law.
Permanent Disability (PD): Benefit payment for less that complete permanent recovery from the injury or illness. Payment rates are established by State law and are based on medical limitations, age, and occupation.
Supplemental Job Displacement Benefits: Benefit payment for retraining or skill enhancement at an approved school if unable to return to work at the University as the result of the injury or illness. Eligibility and limits are set by State law.
Death Benefits: Benefit payment due to financially-qualified dependents if the injury or illness results in death. Burial allowance is also provided. Benefits are set by State law.