•                                         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.

     

1. Promptly report your injury or illness to your manager, supervisor, site, or administrator.

If your injury or illness developed gradually, report it as soon as you learn or believe it was caused by your job. Your manager, supervisor, site administrator, or designee will report the claim to Sedgwick, the Third-Party Administrator (TPA) who administrates the District's workers' compensation claims. Your manager, supervisor, site administrator, or designee will provide you with a State of California Claim Form (DWC 1).
You need to complete the employee section of this form and return it to your worksite as soon as possible. Any delay in completing and returning the claim form (DWC 1) could affect your rights to benefits.

2. There are several options when you are injured to receive medical treatment for your work-related injury.

  • If your injury or injuries appear to be critical, dial 911 immediately. If urgent medical treatment is required, you should be taken to the nearest emergency room or medical facility.
  • If your injury or injuries are not a medical emergency and only require first aid, first aid can be provided at your worksite.
  • Nurse Triage - For a work-related injury, when you report your injury to your administrator, manager, or supervisor and your injury is reported to the Third-Party Administrator telephonically, you can ask to speak with a telephonic registered nurse. The registered nurse will provide you with care recommendations for your injury. If a medical evaluation is recommended, the registered nurse will identify a medical provider and schedule you an appointment. Nurse Triage services include follow-up contact with you within 36 hours of the initial encounter. Use of Nurse Triage services is optional.
  • If your injury is not a medical emergency, but you require medical treatment, you can review and select a physician using the Medical Provider Network. The LAUSD MPN website is as follows: https://www-sf.talispoint.com/sedgwick/campn1/


3. You will be contacted within a couple of days by a Sedgwick claim representative. Your claim representative will contact you to obtain additional information regarding your injury if needed, and to explain what workers' compensation benefits you may be entitled to.

4. Promptly fill out and return any forms sent to you. These forms are necessary to help determine what, if any, benefits you are to receive.

5. Please keep your medical appointments. Provide medical and return-to-work information to the Sedgwick claim representative assigned to your claim, as well as to your Supervisor/Site Administrator.

 

 

The District uses a Medical Provider Network (MPN). When reporting the claim, you can talk to a registered nurse to discuss the need for medical treatment and direct and schedule a medical appointment for you. If you do not want to speak with a nurse, you can select a medical provider through the Medical Provider Network.

Please review the Medical Panel List or the Medical Provider Network website at http://www.sedgwickproviders.com/campn1

To search the MPN:

  1. Select method of search: physician name, address search or region search
  2. Input the state and zip code
  3. Click "Find Provider"

The workers' compensation benefits are paid by the Third-Party Administrator and Payroll for regular employees.

Temporary total disability is paid by the Third-Party Administrator at two-thirds of the gross (pre-tax) wages you lose while you are recovering from an accepted work-related injury. However, you cannot receive more than the maximum weekly amount set by law. Your wages are calculated using all forms of income you receive from work and any secondary job.  The Third-Party Administrator will consider all forms of income when calculating your temporary total disability benefits.

Education Code Benefits:
You are entitled to receive your 1/3 of wages using your illness time as a supplement Educational Code benefits with your temporary total disability benefits not to exceed your normal wages. Once the illness time are exhausted or expired, you will only receive temporary total disability benefits.

You can review the Educational Code and your Collective Bargaining Agreement.

If you are an un-benefited employee, you receive your workers' compensation benefits in a check from the Third-Party Administrator.

Partial days off due to doctor's appointments will be paid only if the Salary Continuation Verification form is completed and submitted to Sedgwick. Upon authorization by Sedgwick, the District's Payroll department will process continued salary pay if the full 60 days has not yet been exhausted. Upon exhaustion of the 60 days of continued salary, all further absences for doctor's appointments will be charged as illness time.

Yes, the District requires you to request a formal Leave of Absence anytime you will be away from work for 20 or more consecutive workdays.

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.

For Laws and Rules on Leaves of Absence, refer to Personnel Commission Rule 803: Leaves of Absence. You can find information related to Leave of Absence for your specific Collective Bargaining Agreement on the Office of Labor Relations website under Union Contracts.

Please contact your manager, supervisor, or site administrator to provide them with your temporary work restrictions.  Your manager, supervisor, or site administrator will review your temporary work restrictions and determine if they can offer temporary modified work.