•                                         INTEGRATED DISABILITY MANAGEMENT
                                                Dawn Watkins, Director

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     Workers' Comp

     Workers' Compensation

     

    The Workers' Compensation program provides state-mandated benefits to LAUSD employees who sustain a work-related injury/illness without fault. LAUSD is self-insured, which means that the District, not an insurance company, pays for claims' actual costs. The District contracts with a third-party administrator for the management of its claims.

    The Workers' Compensation Department is committed to providing support, assistance, and resources to employees during these unprecedented times. The safety and well-being of all employees is a priority for the Workers' Compensation team. Please do not hesitate to contact the Workers' Compensation Department if you have any questions about your workers' compensation claim in this time of physical distancing. The team continues to work remotely, and they are responding promptly to e-mails. Please send your inquiry or request via e-mail to WorkersCompensation@lausd.net.

     

When an employee reports a work-related injury, the administrator, manager, or supervisor completes the following prior to reporting the claim to the Third-Party Administrator:

  • Investigate the injury
  • Provide the following forms to the injured employee:
    • claim form
    • temporary pharmacy card
    • medical authorization form
  • Complete an injury incident report - OPTIONAL
  • Complete an ISTAR
  • Call Sedgwick at 800-528-7392 to report the claim
  • Sedgwick will provide you with the claim number
  • When reporting the injury to Sedgwick, the in-take coordinator will provide you with a claim number.
  • When reporting the injury to Sedgwick, the employee will be given the option to speak with a telephonic nurse to assess the need for medical care and schedule a medical appointment within the Medical Provider Network.
  • Or use the website to locate a doctor within the network: https://www-sf.talispoint.com/sedgwick/campn1/

State law requires employers to notify a local Cal OSHA office within 8 hours of a “serious injury.” Serious Injury/Illness is defined as:

  • ANY hospitalization (regardless of length of time) for other than medical observation or diagnostic testing
  • Amputation
  • Loss of an eye
  • Serious degree of permanent disfigurement
  • Death

Cal/OSHA office phone numbers are as follows:

West Covina (626) 472-0046
Los Angeles (213) 576-7451
Torrance (310) 516-3734
Van Nuys (818) 901-5403

West Covina

(626) 472-0046 

Los Angeles

(213) 576-7451 

Torrance 

(310) 516-3734 

Van Nuys

(818) 901-5403 

 

A detailed account of the events leading to the injury/illness must be obtained and documented. Supervisors/site administrators (or designee) are responsible for conducting an investigation even if the incident does not need to be reported to Sedgwick.

  1. Evaluate the cause of injury/illness to determine if a safety hazard exists and report any safety hazards to OEHS at (213) 241-3199.
  2. Obtain the name and number of any witnesses.
  3. Go to the Division of District Operations website, (https://achieve.lausd.net/Page/1604), click on Incident System Tracking Accountability Report" (ISTAR) to report the incident and complete the Injury/Accident Investigations Report.

If medical treatment beyond first aid is not necessary and there is no lost time from work, then the injury/illness need not be reported. However, the incident needs to be investigated and an ISTAR report completed detailing the events leading to the injury/illness.

If medical treatment beyond first aid is necessary or it appears that the injured worker will be off work as a result, then the injury/incident must be reported to Sedgwick, the Third Party Administrator who handles the District's workers' compensation claims.

The supervisor/site administrator is required by law to provide the injured worker with the Workers' Compensation Claim Form (DWC-1) within 24 hours of knowledge of the injury/illness.

  1. If the injured worker is not available, complete the employer section except line number 13, and mail the form to their home address within 24 hours.
  2. Once the claim form is completed by both the employer and the injured worker:
  1. A) Provide copy to the injured worker;
    B) Place the employer's copy in the employee's file; and
    C) Mail original to Sedgwick to: P.O. Box 14623, Lexington, Kentucky 40512-4623

The District has contracted with Sedgwick, a Third Party Administrator, to manage workers' compensation claims. Supervisors/Site Administrators must contact Sedgwick as soon as possible to report an injury and arrange for medical care.

  1. For injuries/illnesses that are serious or require immediate medical assistance, call 911.
  2. Complete the "Workers' Compensation Injury Report Worksheet." This form allows the Supervisor/Site Administrator to document all relevant information necessary for Sedgwick to process the claim. This form is for the employer's use only and should be filed in the employee's file.
  3. Report the claim to Sedgwick's Call Center at (800)-LAUSDWC or (800)-528-7392 and provide the following information:
  1. A) Detailed information, including any suspicions/concerns you may have; and,
    B) Names and telephone numbers of witnesses.  
  1. If the employee is present while the claim is being reported to Sedgwick, then the Call Center will transfer the call to the Triage Nurse, who will speak to the employee and make arrangements for medical care.
  2. If the employee is at a different location, and/or the claim cannot be called in immediately, then provide the employee with the Sedgwick Call Center number (800-LAUSDWC or 800-528-7392) to call and speak with the Triage Nurse and receive a referral for medical care.
  3. If the injured employee declines to speak with the Triage Nurse, please direct the employee to an approved medical provider for treatment. See the LAUSD Medical Provider Network (MPN) Referral Panel to select an approved medical provider and complete the following steps:
  1. A) Complete the Medical Authorization form and provide the form to the injured employee to take to their selected medical provider. This form authorizes the first visit only;
    B) The medical provider should contact Sedgwick directly to obtain authorization to provide treatment beyond the first visit; and,
    C) Print and complete the Temporary Pharmacy Card and provide the card to the employee. The temporary pharmacy card, when presented to a participating pharmacy with a valid prescription, will allow the employee to receive the first fill of medication. Sedgwick will mail the employee a card for subsequent prescriptions.
  1. Please note: an injured employee is permitted to seek treatment from their primary care physician if the Pre-designation form is in the employee's file prior to the injury.
  2. Once the injury has been reported, Sedgwick will determine compensability of the claim (whether a claim will be accepted, delayed or denied).
  3. Sedgwick's claims office may be reached after reporting an injury. The claims office number is (866) 247-2287.
  4. If the injury was caused by an Act of Violence, complete the AOV-1 and report the incident to the School Police.

1. What code do you use when reporting an injured worker’s time when they are off work for your work-related injury?

The date of injury is reported as RG. When they are off work or attending doctors or therapy appointments, the time is reported as WC.

If the WC time qualified and is approved as FMLA, then the code is FWC.

  • Date of Injury: RG (regular)
  • Time off work: WC (workers' compensation)
  • FMLA: FWC (FMLA workers' compensation)
  • Deposition: RG (regular)

If the employee is off work for 20 or more consecutive work days, they will need to request a formal Leave of Absence.

The term "formal leave" refers to any leave of more than 20 consecutive workdays in duration. Formal leaves must be applied for in writing using District forms.

If an employee is released to return to work or off of work due to a work-related injury, please notify Sedgwick by calling 866-247-2287.