•              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 regard to fault. LAUSD is self-insured which means that the District, not an insurance company pays for the actual costs of claims. 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. In this time of physical distancing, please do not hesitate to contact the Workers’ Compensation Department if you have any questions about your workers’ compensation claim. 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.

     

Yes, if the investigator has been hired by Sedgwick to obtain information regarding the claim, then the investigator will have an introductory letter signed by the District's Workers' Compensation Manager. You may call Sedgwick or the District's workers' compensation department to confirm that the investigator is acting on behalf of Sedgwick and the District.

If you are a regular employee, your workers' compensation benefits will be paid by Payroll and included in your paycheck. If you are an un-benefited employee, you will receive your workers' compensation benefits by check from Sedgwick.

The temporary disability rate is 2/3 of your salary up to statutory maximums. If you are a regular employee, you will receive your full salary in lieu of temporary disability benefits for the first 60 days. Thereafter your temporary disability benefit will be supplemented from your illness and vacation bank.

The doctor must agree to be pre-designated. He does not necessarily have to sign the form, but if he has not then, at the time of the injury, it is the injured workers' burden to show that he had previously agreed to be pre-designated. This could take time, so having the doctor sign the form is a way to expedite treatment when an injury occurs.

If a regular employee's illness hours are charged immediately after the injury, they will be restored once payroll receives temporary disability authorization from Sedgwick. Regular employees receive 60 days of full salary during which any illness hours charged will be restored. If they remain off work longer than 60 days, then illness and/or vacation hours will be used to make up the difference between the WC temporary disability rate and their full salary. Those illness hours will not be restored.

Report an injury to your immediate supervisor, as soon as possible.

Yes, your employer is allowed to contact you to discuss employment-related issues, such as your ability to return to work, or the need to file for leave. However, your employer cannot discuss your workers' compensation claim with you.

No, an injured employee is encouraged to return to work as soon as possible. If the employee is not able to perform all aspects of their job, then a modified or alternative work assignment should be considered. Work restrictions, if any, will be determined by the treating physician.

Registered volunteers are entitled to workers' compensation benefits if they are injured while volunteering.

You may contact Sedgwick at (866) 247-2287 to speak with your assigned adjuster.

As with any injury, an employee claiming work-related stress should be referred to the District's approved referral panel to select a clinic. The treating physician will determine the type of follow-up treatment or specialist needed, and the Sedgwick Claims Adjuster will determine whether further treatment will be authorized.

Medical appointments for a workers' compensation injury should be scheduled during non-work hours, whenever possible. If appointments must be scheduled during work hours, they should be scheduled to have the least amount of impact on the work site (either early or late in the day).

If Sedgwick authorizes the time off, then you will be paid a workers' compensation salary, using the 60 days of continued salary, until exhausted. (See the Salary Continuation Authorization form) Once the 60 days of continued salary is exhausted, then your time taken for medical appointments will be charged to your illness time.

Yes. An employer is required to report any work-related injury that is reported to them. Sedgwick will determine whether to accept or deny a claim. Sedgwick has 90 days from the date of the employer's knowledge of the injury to make a decision. Delays in reporting suspicious claims will decrease the time Sedgwick has to investigate.

If an employee has work restrictions that prevent him or her from performing his or her District job, but does not prevent them from performing different duties from a second job, then said employee is permitted to work the second job, as long as the income from the second job is reported to their Sedgwick adjuster so that their benefits are adjusted accordingly.

Forward any legal documents related to workers' compensation claims to the District's Workers' Compensation Department.

Forward medical bills to the appropriate Sedgwick Claims Adjuster.

You may not ask an injured employee for his or her diagnoses or any details regarding their medical condition or treatment. You may, however, ask the employee about work restrictions, in order to determine whether or not a modified or alternative work assignment is necessary. 

You may contact Sedgwick's Client Service Liaison at (818) 265-3277, or the District's workers' compensation department.

No, injured employees do not pay any part of the treatment costs under workers' compensation.

Yes, mileage should be tracked to and from doctor visits and submitted to Sedgwick for payment. The mileage rate paid will be the rate effective at the time of the visit. Sedgwick will provide a mileage tracking form.

Time off with a temporary disability is only protected if the time has also been designated as FMLA. Workers' compensation on its own is not protected.

It is the employer's responsibility to provide the employee with a Claim Form within 24 hours of their knowledge that a work-related injury occurred, but it is the employee's choice to file a claim.

It is the employee's choice whether or not to seek medical care. If the employee declines treatment and does not miss time from work, then a claim does not need to be reported to Sedgwick. However, an ISTAR report must still be entered in order to document the incident. The employee may decide at a later time to seek treatment.

An employee will be separated from the District once the employee exhausts all District illness and vacation pay. Classified employees will be placed on a 39-month rehire list. Certificated employees will be placed on unpaid leave. Loss of paid status will result in loss of District paid health benefits.

Yes. Filing a workers' compensation claim does not protect an employee from pending disciplinary action if the action is for issues unrelated to the claim. Discrimination against an employee because a claim was filed is prohibited.