Workers' Compensation Benefits

 

Benefits Available to Injured/ill Employees

 

If you become injured/ill on the job due to a work related injury or illness, you may be entitled to Workers’ Compensation benefits. If your claim is approved, Temporary disability benefits would continue until one of the following occurs:

• Doctor releases employee to return to regular, modified or alternative work (whether or not they actually return to work);

• Doctor determines that employee’s medical condition has reached its maximum medical improvement or that they are permanently unable to work.

 

If acceptance of your claim is delayed or denied and you are losing time from work, please contact Griselda G. Marquez, HRIE-Total Wellness at grgmarquez@fullerton.edu or (657) 278-5187 or Contessa Mata , HRIE - Total Wellness at (657) 278-4300 at comata@fullerton.edu for other available leave options.

 

Workers' Compensation (WC) benefits available to injured/ill employees are listed below.

 

 

Medical Care

Employees who suffer a work-related injury/illness will receive, at no cost to them, medical care that is required to cure or relieve the effects of the injury/illness. The medical care will be consistent with the appropriate evidence-based medical treatment guidelines.

 

Pharmacy Benefit Program

The University participates in a pharmacy benefit program with OptumRX. Therefore, at the onset of medical treatment the employee will receive an OptumRX form to take to their pharmacist/pharmacy to fill prescriptions at no cost. If your WC claim is accepted , you will receive a permanent pharmacy card in the mail. Please use that card for other work-related injury/illness prescriptions.

 

Temporary Disability Benefits

Temporary disability (TD) is a benefit paid to an injured/ill employee who is temporarily unable to work due to a work-related injury/illness. These benefits run concurrent with Family Medical Leave (FML). Industrial Disability Leave (IDL) is a type of TD that is only available to CalPERS members. In each case, the benefit is available after the employee serves a 3-day waiting period (using his or her own sick time). The waiting period will be waived (sick time restored) if time lost exceeds 14 calendar days, the injury/illness is caused by a criminal act of violence or the employee is hospitalized.

• Temporary Disability (TD)

  TD is a benefit that pays a flat rate for each calendar day of lost time. The rate is based upon 2/3 of the employee's average weekly wages with a minimum and maximum set by state law.

  The employee may be eligible to supplement the TD benefit with accrued sick and vacation leave credits. This option is referred to as TD with Supplementation. While on TD with Supplementation, the employee accrues partial PERS services credit based upon the supplementation portion only. The employee's health benefits remain in force.

• Industrial Disability Leave (IDL) – only available to CalPERS members

  IDL is a benefit only available to CalPERS members. It pays the first 22 work days of disability at an amount equal to the employee's net pay (full pay less an amount equal to Social Security and Medicare and withholding taxes based on your exemptions). If disability continues beyond 22 work days, IDL pays 2/3 of the employee's gross pay.

  The injured/ill employee may be eligible to supplement the 2/3 IDL benefit with accrued sick leave available as of the first day of lost time. This option is referred to as IDL with Supplementation.

  IDL is available for a maximum of 52 weeks within a 2-year period beginning with the employee's first date of lost time. While on IDL, the employee continues to accrue their full PERS service credit and their health benefits remain in force.

  Should the period off work exceed the maximum IDL benefit eligibility, the employee may be eligible to receive Temporary Disability benefits with supplementation of accrued sick and vacation leave credits.

  For more information, please refer to the IDL/TD Comparison Chart .

• Non-Industrial Disability Leave (NDI)

  Employees who are unable to work due to a non-industrial injury/illness may receive non-Industrial disability leave (NDI). The State Employment Development Department authorizes NDI benefits. Employees desiring NDI must complete a Formal Leave form and NDI questionnaire.

• Application for Catastrophic Leave

  The purpose of the catastrophic leave program is to supplement any disability for which an employee is eligible. If the employee is interested in applying, he/she must contact HRIE-Total Wellness for further information regarding the program. If the employee decides to apply for catastrophic leave, his/her choice is limited to Temporary Disability with Leave Credit Supplementation. All leave credits must be used before using leave credits donated from other employees.

 

Permanent Disability Benefits

Employees who have a permanent impairment as a result of a work-related injury/illness may be entitled to receive permanent disability benefits. These benefits address the nature of the injury and the employee's occupation, age and diminished future earning capacity.

The amount of permanent disability is based upon the medical evidence of permanent work limitations. The physician’s description is based on guidelines published by the American Medical Association (AMA) and outlined in a written final medical report.

 

Supplemental Job Displacement Benefit

This is an additional benefit available to injured/ill employees who have a permanent partial impairment as a result of their injury/illness. The voucher is a non-transferable voucher that can be used to pay for educational retraining or skill enhancement state-approved or accredited schools. The benefit is available when an employee is not offered a position at the university after permanent restrictions have bene imposed by a physician.

 

Death Benefits

Payments to employee’s spouse, children, or other dependents if employee dies from a job injury or illness. The amount of the death benefit depends on the number of total and/or partial dependents.