Workers’ CompensationMay 2015

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Management Training Class• Workers’ Comp Overview for Managers

• Quarterly at SMUCLA and RRUMC

• June 16 RRUMC

• Covers processes and procedures related to Workers’ Compensation

• Reviews Disability Management and the Interactive Process

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Who is eligible?• Career, casual, Per Diem employees are covered from

the first date of employment

• Vanpool injuries

• Non-UCLA employees are covered by their respective employers, e.g. Traveler’s, Registry, other temporary workers

• Volunteers

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Initial Employee ContactWas this injury work related?

• If the employee believes it was work-related or is unsure, provide Workers’ Compensation forms and direct the employee to seek immediate medical treatment at either Occupational Health Facility or the UCLA Emergency Department

• Employee should tell the UCLA Emergency Department that they are a UCLAMC employee and that they are being treated for a work-related injury

•Follow all procedures for a leave of absence

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Medical TreatmentWhere to send the employee for treatment?

Employee should be seen by Occupational Health Facility or the UCLA Emergency Department for the first 30 days

IF EMPLOYEE WAS SEEN AT THE EMERGENCY ROOM, direct employee to follow-up at UCLA Occupational Health.

Medical Control:

UC directs the employee’s medical care for an initial 30 days. UCLAMC’s designated providers are Occupational Health Facility (OHF), RRUMC Emergency Medicine, and SMUCLA Nethercutt Emergency Medicine

Exception: Employee pre-designates personal Medical Doctor in writing prior to the injury. Contact WC HR for more information.

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New Pharmacy Network• The University of California (UC) has partnered with Helios to

establish a Pharmacy Benefit Network (PBN) for workers’

compensation illness and injury related medications as part of the

overall pharmacy program.

• Injured workers within the PBN will only be able to fill prescriptions

from a pharmacy within the network after 4/1/2015.

• Posters should be posted next to the state mandated WC posters.

• Pamphlets will be given to all new hires with other state-mandated WC pamphlet

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Cal-OSHAFOR SERIOUS INJURIES,

page UCLA Health Safety at pager #90248 within EIGHT hours

or call the Campus 24-hour call-in phone number

EH&S Hotline: 310-825-9797

Serious injury includes:

Amputation Concussion  

Injury resulting in serious degree of permanent disfigurement such as crushing injury or severe burn

In-patient hospitalization >24 hours for other than medical observation

OSHA requires notice within 8 hours of Serious Injury

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When an Employee is injured on the job . . .Provide the employee with:

1.A completed Workers’ Compensation Claim Form (DWC-1) and Notice of Potential Eligibility This form must be provided within 1 working day of notice that an injury or illness has occurred as mandated by California state law. (Exception: First Aid incidents)

2. A completed UCLA Incident Report and Referral for Medical Treatment

3. Workers’ Compensation Information Sheet

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Paperwork1. Please review and complete all lines. Sign where appropriate.

Supervisor should sign all forms where indicated

2. Department keeps one copy for department records.

If notification was by phone, send the form to employee via Certified Mail

3. Immediately:

1.FAX a copy to the WC FAX line Health System HR 310 794 3337 or

2.EMAIL to hrworkerscomp@mednet.ucla.edu or

3.CALL 877-6UC-RPRT (877-682-7778) with the information on the form (see Step #5)

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Paperwork4. Employee keeps one copy of completed form

5. Send all other copies of the form immediately to Health System HR for distribution

6. Notify Health System HR Workers’ Comp x40500 if employee has been taken off work.

Follow all procedures for a leave of absence

Important InformationEmployees should be paid for the time at OHF and/or the EMC (to

complete the work shift.)

Charge hours to Home Cost Center

Employees must use SL for any time at off-site (non-OHF or EMC)

appointments, and for time taken for therapy, diagnostic appts

Charge hours to Home Cost Center

Employee may return to temporary work on a modified work schedule

or modified duties at any time.

Charge actual Modified duty hours worked as ‘Modified Duty

Workers’ Comp’ and to the Return to Work Cost Center.

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Disability ManagementMark Briskie

UCLA Health System Human Resources

(310) 794-0525

Legal ResponsibilitiesWorkers’ CompensationFamily Medical Leave

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Contacts for Return to Work ProgramContact UCLA Health HR Workers’ Compensation/ Return to Work coordinators to confirm employee meets eligibility criteria

UCLA Health Human Resources WC 310 794 0500Mark Briskie mbriskie@mednet.ucla.edu 310 794 0525

Cynthia Vazquez cvazquez@mednet.ucla.edu 310 794 0522

Ingrid Garcia igarcia@mednet.ucla.edu 310 794 3036

Return to Work Coordinators Mark Briskie mbriskie@mednet.ucla.edu 310 794 0525

Suzanne Bleibtreu sbleibtreu@mednet.ucla.edu

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Injury Prevention resources

UCLA Health Safety

SAFETY INSPECTIONS/TRAINING ERGONOMIC EVAL ACCIDENT INVESTIGATIONS

Jennifer Mempinjmempin@mednet.ucla.edu 310-267-9886 phone310 267 9887 fax PAGER 99828

SAFE PATIENT-HANDLING COORDINATOR

Larona Taylor lataylor@mednet.ucla.edu

310-267-9897 phone 310 267 9890 fax PAGER 91136

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Injury Prevention resources

Ergonomic Evaluation Request Form

• Bruin Ergo - UCLA UCLA Health Online Ergonomics Program (Cardinus)

User ID = Employee ID Number (link on HR website)

• To request onsite eval: UCLA Health Support Services Center 

Bruin Break

Jeri Simpson 310 794 0500 jasimpson@mednet.ucla.edu

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DirectorySEDGWICK CMSP.O. Box 14533Lexington KY 40512-4533Mail code 691448Phone 310 253 7500Fax 310 253 7569 CAMPUS PAYROLLUCLA Wilshire Center, Suite 620MC 141648Phone 310 794 8706Fax 310 794 8751 UCLA HEALTHCARE PAYROLL UCLA Wilshire Center, Suite 1700MC 167646Phone 310 794 0127Fax 310 794 8049 

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OCCUPATIONAL HEALTH FACILITY (OHF)67-120 Center for Health SciencesMonday through Friday 7:00 a.m. to 4:30 p.m.Mail Code 172524Phone 310 825 6771Fax 310 206 4585www.ohs.uclahealth.org

 EMERGENCY DEPARTMENT757 Westwood Plaza(ER entrance Gayley Ave, N of Le Conte)Phone 310 267 8406Open 24 hours a day  SMH Nethercutt Emergency Room1255 15th Street, Santa MonicaPhone 424 259 8400

PolicyHealth System Policy HS 7318 Employee Work-Related Illness and/or Injuryhttp://www.mednet.ucla.edu/Policies/pdf/enterprise/HS7318.pdf

Health System Policy HS 7324Employee Transitional Return to Work(TRTW) Policyhttp://www.mednet.ucla.edu/Policies/pdf/enterprise/HS7324.pdf

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Other Required formsRequired Workplace postings • DWC 7 Notice to Employees – Injuries Caused By Work• Workers’ Compensation Pharmacy Benefit NetworkHR Website http://hr.uclahealth.org

New Employee Pamphlets• Notice to Employees – Injuries Caused by Work• Helios/Pharmacy Benefit NetworkDistributed at time of Hire by HR Rep

Pre-designation of Physician formHR Website http://hr.uclahealth.org

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