INTEGRATED DISABILITY MANAGEMENTDawn Watkins, Director
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.
- When an Injury Occurs
When an injury occurs, there are certain steps that must be completed by the District prior to filing the claim with the Third Party Administrator (TPA). The District has contracted with Sedgwick as the TPA responsible for processing all LAUSD workers' compensation claims.
- The Supervisor/Site Administrator or designee must immediately:
- Investigate the injury/claim
- Determine if a claims is to be reported
- Provide a claim form
- Provide medical care
- Report the claim to Sedgwick at (800) LAUSDWC
- Report Time
- Report to Cal/OSHA
An incident that results in death or serious injury must be reported to Cal/OSHA within 8 hours. A serious injury is defined as death, amputation, permanent disfigurement or hospitalization of more than 24 hours.
- Reporting to the nearest Cal/OSHA office:
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.
- Evaluate the cause of injury/illness to determine if a safety hazard exists and report any safety hazards to OEHS at (213) 241-3199.
- Obtain the name and number of any witnesses.
- 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.
- Determine if a Claim is to be Reported
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.
- Provide Claim Form
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.
- 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.
- Once the claim form is completed by both the employer and the injured worker:
- 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
- Provide Medical Care and Report Claim to Sedgwick
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.
- For injuries/illnesses that are serious or require immediate medical assistance, call 911.
- 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.
- Report the claim to Sedgwick's Call Center at (800)-LAUSDWC or (800)-528-7392 and provide the following information:
- A) Detailed information, including any suspicions/concerns you may have; and,
B) Names and telephone numbers of witnesses.
- 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.
- 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.
- 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:
- 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.
- 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.
- Once the injury has been reported, Sedgwick will determine compensability of the claim (whether a claim will be accepted, delayed or denied).
- Sedgwick's claims office may be reached after reporting an injury. The claims office number is (866) 247-2287.
- If the injury was caused by an Act of Violence, complete the AOV-1 and report the incident to the School Police.
- Reporting Time
- Report the day of injury as regular time.
- The time reporter shall enter payroll code "FWC" on the employee's timecard for each date of absence attributed to the injury if the condition has been designated as FMLA. The "FWC" code will be used until the employee's FMLA time is exhausted. If the employee is not eligible for FMLA, or has exhausted their FMLA time, report time off as "WC".
- Report time as FWC or WC if employee reports time as industrial even if questionable. Sedgwick will determine if workers' compensation benefits are due and will notify payroll directly. The employee will be paid illness benefits unless payroll receives WC authorization from Sedgwick.
- Advise employee that, if their disability extends beyond 20 days, they must submit a "Request for Leave Form" as with any other absences.
- Provide injured worker the "Salary Continuation Verification Form" to use when reporting partial days off of work for medical appointments. The injured worker must forward this form to Sedgwick to receive salary continuation, once the doctor signs it. A copy should be returned to the work site.
- Notify Sedgwick immediately at 866-247-2287 if injured worker returns to work and/or is then taken off work again.
- Report time off for depositions as regular time – (Sedgwick can verify the deposition date and time).
- Report time off for court appearances as personal necessity(requires proof from clerk of the court).