Faculty/Staff Disability Management

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Chapter 4: When an Injury or Illness Results in Time Away from Work

Lost Time 

When an injury results in time away from work, an employee receives Temporary Disability (TD) benefits for lost wages only if the physician certifies that the injury caused the employee to lose time from work and Sedgwick accepts the employee’s claim for Workers’ Compensation benefits.

If the claim is approved by Sedgwick, these benefits are not paid for the first three days (waiting period) the employee is unable to work. If the employee is hospitalized as an inpatient or unable to work for more than 14 days, the three-day waiting period does not apply.

Option Letter and Option Form

Once an injured employee is away from work for more than three days, Sedgwick will issue a check for TD lost wages. This may be for lost wages for the day of the medical exam if the claim is pending or for lost wages if the claim is accepted. The employee also will receive in the mail an Option Letter and Option Form from Disability Management. 

The Option Letter addresses the employee’s concerns regarding pay and employment. It offers the employee three options for receiving income, as outlined in the below table. The Option Form must be completed and returned to Disability Management within two weeks from the date of the Option Letter. Should the employee fail to respond to this notice, Option 2 is automatically selected. (It is important that the employee understand that the the compensation option chosen for the medical evaluation will also be used for future lost wages should the claim be accepted.)

UC Berkeley’s Pay Process

TD checks are mailed directly from Sedgwick to an injured worker’s home address. The employee’s department will provide normal salary checks to an employee who is using sick and vacation leave. If both the TD & UC checks are cashed, the employee is OVERPAID. Disability Management will send paperwork to instruct Payroll to deduct the employee’s TD amount from the employee’s paycheck.

Status Report and Instruction Sheet
Sedgwick notifies the employee and the Disability Management of the claim status. Disability Management then notifies departments using the Workers’ Compensation Status Instruction Sheet. This sheet also contains information regarding the employee’s current pay status including the option chosen. The Workers’ Compensation Status Report is also sent with the Sheet when Sedgwick issues a TD check. This report contains employee’s payroll and personnel information, TD check dates, and amounts. These forms will be sent every two weeks while the employee remains off work.

State Benefits/University Supplemental Benefits

State Mandated Benefits:

Medical Care
Empoyees are entitled to reasonable medical treatment to cure or relieve work-related injuries and illnesses.  

Temporary Disability
Temporary Disability (TD) benefits include compensation for lost wages for 66 2/3% of the average weekly salary up to statutory maximums until the employee’s medical condition is resolved or is determined to have reached Maximum Medical Improvement (MMI).

Permanent Disability
Permanent Disability is any lasting disability from an employee's work injury or illness that affects the employee's ability to earn a living.  If an injury or illness results in PD, the employee is entitled to PD benefits as established by state law.

Death Benefits
Death benefits are payments to a spouse, children, or other dependents if an employee dies from a work-related injury or illness.  These benefits are established by state law.

Supplemental Job Displacement Voucher
Voucher for retraining/skills enhancement if the employee is unable to return to work.

University Supplemental Benefits: 

In addition to the state-mandated benefits, the University provides supplemental benefits described below:

Supplemental Leave
An employee may remain on 100% of normal salary by using his/her sick leave and/or vacation leave to supplement the TD check(s). The employee receives one check from Sedgwick for TD payments and another check from the University. The department is credited with the amount of the TD check(s) by the campus Payroll Office. This will show on the Department’s Distribution of Payroll Expense (PPP 5302) as WCA (Workers’ Compensation Adjustment).

Extended Sick Leave (ESL)

An employee may remain on 80% of normal salary for up to 26 weeks after exhausting his/her sick leave. The employee receives one check from Sedgwick for TD payments and another check from the University. The salary supplement is paid by the department. The department is credited with the amount of the TD check(s) by the campus Payroll Office. This will show on the Department’s Distribution of Payroll Expense (PPP 5302) as WCA (Workers’ Compensation Adjustment).

Since they do not accrue sick leave, employees with less than a 50% appointment are not eligible for either Supplemental Leave or Extended Sick Leave. 

Liberty Mutual - Short-Term Disability (University Paid) & Supplemental Disability (Employee Paid) Plans

Short-Term Disability (University Paid)

This benefit does not apply for work-related disabilities, unless the Workers' Compensation claim has been denied or is on delay status.  

Supplemental Disability (Employee Paid)

This benefit could supplement Workers’ Compensation temporary disability after the Extended Sick Leave benefit has exhausted.

Coordination of Benefits

Coordinating these benefits and making the appropriate calculations can be complicated and confusing. Disability Management can assist department personnel and the employee during this process. Additionally, Disability Management offers classes every fall and spring addressing the coordination of these benefits. See Workshops and Training.

Workers' Compensation Supplement Benefit Options:

 

Option 1

 Option 2

 Option 3
Options Employee chooses to use accrued sick leave (SL) and vacation leave (VL) to supplement TD payments. Employee chooses to use only accrued sick leave (SL) to supplement TD payments. Employee chooses not to use accrued sick leave (SL) or vacation leave (VL) or does not accrue either. (Limited Appointment employees may not receive all benefits listed.)
Compensation
(TD = Up to 
66 2/3% of normal salary - to a statutory maximum per week).

100% of normal salary: 
TD+ SL/VL =100%
(2 checks)

80% of normal salary:
After SL/VL is exhausted, TD+UC salary check = 80% of normal salary (Extended Sick Leave-ESL). UC check for ESL continues up to 26 weeks (2 checks).

Up to 66 2/3% of normal salary:
TD check only after ESL benefit ends. The employee is now on Leave Without Pay (LWOP) from the department.

100% of normal salary:
TD+ SL = 100% 
(2 checks).

80% of normal salary:
After SL is exhausted, TD+UC salary check = 80% of normal salary (Extended Sick Leave-ESL). UC check for ESL continues up to 26 weeks (2 checks).

Up to 66 2/3% of normal salary:
TD check only after ESL benefit ends. The employee is now on Leave Without Pay (LWOP) from the department.

UP to 66 2/3% of normal salary: 
TD check only.


(Any UC check received for the same time period is an OVERPAYMENT and must be returned to UC.)

Supplemental Disability
(If Enrolled)

After ESL ends, SD + TD =70% of normal salary (less benefits from other incomes) up to a $10,000 maximum per month. After ESL ends, SD + TD =70% of normal salary (less benefits from other incomes) up to a $10,000 maximum per month.  Not eligible.
Health Insurance
(LWOP - Medical Plan)

Both the employee’s + UC’s contribution continue while on 100% of normal salary and ESL.

When ESL ends, UC continues contribution provided the employee is on LWOP status and receiving TD payments.

Both the employee’s + UC’s contribution continue while on 100% of normal salary and ESL.

When ESL ends, UC continues contribution provided the employee is on LWOP status and receiving TD payments.

The employee must pay full premium to continue coverage.
Credit for Sick and
Vacation Leave

At 100% of normal salary, SL/VL is accrued at the normal rate and may be used as earned.

At ESL,SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If the employee terminates, the employee will be paid for VL earned prior to LWOP status.

At 100% of normal salary, SL/VL is accrued at the normal rate and may be used as earned.

At ESL,SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If the employee terminates, the employee will be paid for VL earned prior to LWOP status.

SL/VL is accrued at the normal rate but may not be used until the employee returns to work. If the employee terminates, the employee willnot be paid for VL earned while off due to an accepted Workers' Compensation injury.
Retirement Benefits
(UCRS, PERS)

At 100% of normal salary, deduction and service credit continue at the normal rate.

At ESL, deduction and service credit continue at 80% of the normal rate.

Retirement service credit is based on pay status.

At 100% of normal salary, deduction and service credit continue at the normal rate.

At ESL, deduction and service credit continue at 80% of the normal rate.

Retirement service credit is based on pay status.

The employee must pay both the employee and the UC contribution to continue membership.
Voluntary Deductions
(Life, Credit Union, etc.)

At 100% of normal salary or ESL, deductions continue at the normal rate.

After ESL ends, the employee must make arrangements to pay directly.

At 100% of normal salary or ESL, deductions continue at the normal rate.

After ESL ends, the employee must make arrangements to pay directly.

The employee must make arrangements to pay directly.
 Taxability Sedgwick CMS checks are 
tax- free.
Sedgwick CMS checks are 
tax- free.
Sedgwick CMS checks are 
tax-free.