Workers' compensation is a state-mandated program for employees who become injured or ill in the course of their employment. All employees are automatically eligible the first day of employment.
The injured employee must be medically certified by a physician within the USC Medical Provider Network (USC MPN) to be eligible for benefits, and all medical bills will be paid by the university. If employee decides to treat with a provider outside the USC MPN, the university is not required to pay for the treatmentthis includes treatment by any doctor (including a USC doctor) who is not an authorized MPN physician.
USC's workers' compensation claims are handled by Sedgwick, a third party administrator. If an employee is eligible for benefits, they begin on the fourth day (after a 3-day waiting period).
In order for an injury to be considered work-related it must arise out of and occur in the course and scope of employment.
If you are injured
FIRST, if you wish to seek medical treatment or file a claim, immediately report any workplace injury or illness to your manager/supervisor and complete a Workers’ Compensation Claim Form (DWC-1). Employees who seek medical treatment and/or wish to file a claim must complete the Workers' Compensation Claim Form (DWC-1) within 24 hours of sustaining the injury. The home department must document that the Form has been offered to the employeeif the Form is mailed, home department must keep a copy of the letter sent with the Form in the injured worker's personnel file (use the Claim Form Letter Template) and email a copy to USC workers' compensation at firstname.lastname@example.org. (If the employee declines medical treatment or does not wish to file a claim, no DWC-1 is needed.)
Sedgwick has 30 days from the date the claim was considered a reportable injury to determine if the claim will be accepted, denied or delayed. If the claim is delayed (due to Sedgwick not receiving all required documentation in a timely manner), Sedgwick has 90 days from the reportable date to determine whether the claim will be accepted or denied.
SECOND, notify USC’s workers' compensation administrator, Sedgwick, by calling (800) 495-2315 (number is answered 24/7). Contacting Sedgwick is crucial as this is how an injured employee will receive a claim number allowing him/her to seek medical treatment. If the employee is unable to call, the manager or HR Partner may call Sedgwick.
If a serious injury has occurred, call DPS at (213) 740-4321 at UPC or (323) 442-2000 at HSCthey will contact paramedics and send personnel to the injured worker. If the employee is admitted to a hospital, the manager must immediately call USC's workers' compensation department at (213) 740-6205 or USC Environmental Health and Safety at (323) 442-2200 as per OSHA regulations.
For non-life-threatening injuries, USC coordinates treatment with several medical facilities. If you're injured during the workweek 8:30am 4pm, you can receive immediate treatment at the following medical facilities:
If you are injured during the workweek after 4pm or on the weekend, you can receive immediate treatment at the following facilities:
After initial treatment, you may continue treatment with the initial medical provider, or you may choose another physician in the USC MPN. To find a doctor in the USC MPN, visit the website www.harborsys.com/usc and enter the zip code where you want to be treatedyou can look up doctors by location and specialty. The USC workers' compensation department can also help youcall them at (213) 740-6205. Specialty care or diagnostic testing both require referral from treating physician and authorization from Sedgwick.
If employee is eligible for benefits, there is a 3-day waiting period before payments begin, starting from the first full day the employee is unable to work (the employee should be paid for the day of the injury).
Employees do not have to fulfill the 3-day waiting period if they are off work for 14 days or more for their injury, or if they are immediately hospitalized.
Sick leave, vacation leave, or a combination of both can be used to cover the waiting period. If the employee does not have enough accruals, he/she will be on leave without pay.
Return to Work Program
- Certified that the employee has a temporary condition
- Determined the employee's current physical capacities
- Released the employee to return to work with physical or hourly restrictions
- Estimated the recovery period
USC's Return to Work Program is designed to benefit injured employees and managers in the field by promoting the employee's rapid recovery, providing a safe and timely transition back to work, and maintaining productivity in the workplace. Employees whose medical condition temporarily prevents them from performing their full regular duties are automatically included in the Program when their treating physician has:
Modified duty means the employee can return to his/her usual and customary job with some modifications, in which case the Return-to-Work Coordinator will monitor the length of the modified duty.
Transitional duty means the employee cannot return to usual duties because of medical restrictions, and will be assigned temporary transitional tasks for up to 90 days. Transitional duty only applies to employees within Auxiliary Services, Facilities Management, Administrative Services, and Department of Public Safety. If an employee refuses a modified or transitional duty assignment, a reduction or suspension of disability benefits may apply.
The employee's manager or HR/Payroll Analyst must offer all modified or transitional duty assignments in writing using the applicable form (Modified Duty Assignment Form or Transitional Duty Assignment Form), which must be signed by the employee. The completed form must be faxed to the Return-to-Work Coordinator at (213) 740-7305.
Employee rights and responsibilities
- Seek treatment for your injury
- Receive applicable state-mandated benefits for your accepted claim: Medical care within the USC MPN including all authorized medical treatment needed for your work-related injury to help your recovery; temporary disability benefits (approximately 2/3 of the employee's average weekly wage dating back one year from injury date) if you lose wages because your injury prevents you from doing your usual job while recovering; permanent disability payments if your doctor deems you have reached Maximum Medical Improvement (MMI)
- Receive a second opinion through the USC MPN if you disagree with your initial doctor's evaluation
- Immediately call Sedgwick at (800) 495-2315 (number available 24/7)
- Notify your manager of your injury
- Complete and return, in a timely manner, all forms provided to you by your home department, Sedgwick, and your treating physician
- Inform your HR/Payroll Analyst or manager regarding which accruals (sick, vacation, or both) you wish to use to cover your 3-day waiting period, if you have earned said accruals
- Provide work status updates to your home department and Sedgwick on a timely and regular basis
- Fax all work-related medical bills to Sedgwick at (714) 258-5001 as soon as possible
- Coordinate your return to work, including modified work restrictions, with Sedgwick, your HR Partner, and USC's Return-to-Work Coordinator, available at (213) 821-3050
- Regularly provide your hours worked for each pay period to Sedgwick, if you return to work on a reduced work schedule
As an injured worker, you have a right to:
To receive the benefits you need, it is your responsibility to:
HR Partner/manager responsibilities and additional information
Report emergencies to DPS at (213) 740-4321 at UPC or (323) 442-2000 at HSC
Helping employees file a claim and seek medical treatment
- Immediately provide the Workers' Compensation Claim Form (DWC-1) to the injured workerit must be completed within 24 hours of incident
- Direct to call Sedgwick at (800) 495-2315 to initiate their claimDocument that you provided the Form using the Claim Form Letter Template, and email a copy to email@example.com or fax (213) 740-7305.
- Refer the injured worker to the USC MPN for treatment
- Ensure that employee is made aware that USC will not pay any medical bills for treatments and/or services performed by any doctor not part of the pre-approved MPNincluding employee's personal physician, or USC doctors who are not authorized MPN providers
Monitor the employee's time off work and progress
- Determine if employee will be using sick and/or vacation leave to cover the 3-day waiting period
- Have the employee provide work status updates on a regular basis, including information on the next appointment and any current work restrictionsfax reports to the Return-to-Work Coordinator at (213) 740-7305
- Work with the Coordinator, in a timely manner, to ensure the injured worker is accommodated with any restrictions
- Direct questions regarding the return to work process to the Coordinator at (213) 821-3050