•                                         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.

     

Yes, if the investigator presents an introductory letter signed by the District’s Workers’ Compensation Manager to complete the investigation. Sedgwick manages Workers’ Compensation claims on behalf of the District. Sedgwick is required to review each claim to determine eligibility for benefits based on the facts of the loss. Sedgwick utilizes G4S, an investigation firm, to assist in this review. Sedgwick assigns a G4S representative assigned to conduct this confidential review and gather additional information about the employee’s injury.

G4S representative can interview all witnesses identified to have pertinent information regarding this employee’s injury. G4S is not authorized to interview any students.

The workers' compensation benefits are paid by the Third-Party Administrator and Payroll for regular employees. If you are a regular employee, for the first 60 days you will receive your full salary instead of temporary total disability benefits.

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 a job 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.

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.

 

Per the Educational Code, you are entitled to receive supplemental benefits along with your temporary total disability benefits per the Labor Code, not to exceed your regular wages. Once the illness time is exhausted or expired, you will receive only temporary total disabilities per the Labor Code. Your illness hours will not be restored.

You can review your entitlement per the Labor Code 4656, the Education Code 44043, and your Collective Bargaining Agreements.

Please contact your administrator, manager or supervisor and report the injury immediately.

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.

The District provides workers’ compensation coverage for volunteers who were certified by the Parent Community Services Branch (PCSB). As part of the registration process, the volunteer will receive a volunteer ID card.

If you need to confirm that a volunteer was certified by the PCSB, please contact them at (213) 481-3350 to verify the registration and approval of the volunteer.

Sedgwick
P.O. Box 14623
Lexington, KY 40512-4623
(866) 247-2287

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.

The medical provider will determine the follow-up treatment and if a specialist is necessary.

The claims examiner will determine if the medical 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 you need to attend a medical appointment with an authorized doctor, you may be entitled to salary continuation. You are required to complete the salary continuation form each time you miss work for a medical appointment to treat your work-related injury. (See the Salary Continuation Authorization form). Efforts should be made to schedule medical appointments in a manner as to avoid as much as possible, disruption to the District's operation. You may be entitled to up to 60 days of salary continuation for each date of injury/workers' compensation that is accepted.

Once the 60 days of salary continuation is exhausted, your illness time will be used for any time taken off work for medical appointments.

Please refer to your union contract for further information.

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.

Please send any legal documents related to a workers’ compensation claim via e-mail to WorkersCompensation@lausd.net

Please forward any medical bills to:

Sedgwick
P.O. Box 14623
Lexington, KY 40512-4623
(818) 265-4115

You can ask the injured employee the following information: how the injury occurred and the work restriction to determine if you can accommodate the temporary or permanent work restrictions.


You cannot ask the injured employee their diagnosis or any details about their medical condition or treatment.

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

No, an injured employee does not need to pay for any medical treatment when seeking medical care for the workers’ compensation claim.

Yes, mileage reimbursement for transportation to receive medical treatment for an accepted work-related injury or illness. Please complete the mileage form and send to the claims examiner.

Workers' compensation is not a protected absence.  You must apply and be approved for FMLA/CFRA for Workers' Compensation absences to be 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 if they want to file a claim.

It is the injured employee's choice to seek medical treatment or not. If the employee declines medical treatment and does not miss time from work, then a claim does not need to be reported to Sedgwick.

Please ensure an ISTAR report is e-filed.

If you exhaust all of your sick leave, vacation, compensatory over time, or other available paid leave and absence; you will be notified that available paid leave has been exhausted and offered an opportunity to request additional leave.

If, after all, leaves of absence, paid or unpaid, you are still unable to assume your position's duties, you shall be placed on a reemployment list for 39 months.

Yes. A workers’ compensation injury or leave is not a protected leave. If the action is unrelated to the workers’ compensation claim, the disciplinary process can move forward. Discrimination against an employee for filing a workers’ compensation claim is prohibited.