UCI Worker's Compensation

REPORTING A WORK-RELATED INCIDENT

If an employee is injured or develops an illness during the course and scope of their employment at UC Irvine, including campus and UCI Health, the employee should inform their supervisor and get medical attention, if needed. The University is required by law to provide workers’ compensation benefits to employees free from retaliation if they are injured or become ill due to work related requirements.

HOW TO FILE A WORKERS’ COMPENSATION CLAIM AND OBTAIN CARE

CAMPUS

  1. Report your injury or illness to your supervisor.
    Inform your supervisor (within 24 hours of the injury/illness) of your work-related injury or illness in one of the following ways:
    1. In person
    2. By telephone
    3. By email
  2. Obtain medical care.
    If necessary, obtain immediate medical attention.

    IF YOUR INJURY OR ILLNESS IS LIFE THREATENING, DIAL 911 IMMEDIATELY OR GO TO THE NEAREST EMERGENCY ROOM

    If your injury or illness is not life threatening, treatment may be provided at one of the following clinics by having your supervisor or department administrator contact the clinic directly to authorize treatment.

    Newport Urgent Care
    (949) 752-6300
    1000 Bristol Street North, Suite 1-B Newport Beach, CA 92660-2906
    View map and details

    UCI Medical Center Occupational Health Clinic
    (714) 456-8300
    101 The City Drive South Orange, CA 92868 View map and details

    Kaiser Occupational Health Center, Irvine
    (949) 932-5899
    Alton/San Canyon Medical Offices, Floor 1
    6670 Alton Pkwy, Irvine, CA 92618
    View map and details

    Kaiser Occupational Health Center, Santa Ana
    (714) 830-6660
    Harbor-MacArthur Medical Offices
    3401 S Harbor Blvd, Santa Ana, CA 92704
    View map and details

    Long Beach Memorial Hospital Occupational Services
    (562) 933-0085
    1720 Termino Avenue, Long Beach, CA 90804
    View map and details

    Attend follow-up appointments with the Worker’s Compensation Clinic. If your condition requires medication, review the UC Pharmacy Benefit Network Overview flyer (Spanish) for potential additional coverage. If you visit a covered pharmacy, print out and bring a copy of a First Fill Card complete with your information.
  3. Report a work-related injury/ illness using one of the options below:
    Online: Complete each section of the Incident Report online to report any incident/accident/injury or illness arising out of and in the course of your employment.

    By Telephone: Report any incident/accident/injury or illness arising out of and in the course of your employment by calling 1-877-682-7778 to submit an incident report. You will be connected to a call center for Sedgwick CMS, UCI's insurance administrator. The call center can accommodate employees who speak a language other than English.

    If you are unable to complete either option, your supervisor must complete it on your behalf.
  4. Keep the Workers’ Compensation Unit and your supervisor informed.
    Inform the UCI HR Workers’ Compensation Unit and your supervisor of any updates following each physician visit(s), when lost time transpires, when work restrictions are assigned, or if you have concerns and/or your condition worsens.
  5. Accommodations & Return to Work
    Your department will consult the UCI HR Disability Management Specialist regarding return to work. If your department is unable to provide modified alternate temporary work, it may be necessary for you to work within another department. After an appointment with the worker’s compensation provider, your supervisor will be notified of your work status. If the work status indicates work restrictions, and your department is unable to accommodate, the Disability Management Specialist will be notified and will look for a temporary alternate placement. In the event a temporary alternate location is not identified, the next reasonable accommodation would be a leave of absence.
  1. Report a work-related injury/ illness using one of the options below:
    Online: Complete each section of the Incident Report online to report any incident/accident/injury or illness arising out of and in the course of their employment.

    By Telephone: Report any incident/accident/injury or illness arising out of and in the course of their employment by calling 1-877-682-7778 to submit an incident report. You will be connected to a call center for Sedgwick CMS, UCI's insurance administrator. The call center can accommodate employees who speak a language other than English.

    If your employee is unable to complete either option, you, the supervisor, must complete it on their behalf.
  2. Complete the following sections of the Workers' Compensation Claim Form (DWC-1) and hand it to the employee:
    Employee section:
    Line 1 - Employee name

    Employer section:
    Line 12 - Date when employee notified employer of incident.
    Line 13 - The date on which the form was provided to the employee.
    Line 17 - Your signature
    Line 18 - Your title
    Line 19 - Your telephone number

    Your employee should only complete DWC-1 if they are filing a claim for workers' compensation benefits, including obtaining medical care from one of our doctors.
  3. Notify EH&S of a work-incurred hospitalization or work-incurred death.
    Hospitalization: If an employee is hospitalized for 24 hours or more, the department must immediately inform EH&S at (949) 824-6200 and provide:
    • Time and date of accident
    • Employer's name, address and telephone number
    • Name and job title, or badge number of person reporting the accident
    • Address of site of accident or event
    • Name of person to contact at site of accident
    • Name and address of injured employee(s)
    • Nature of injury
    • Location where injured employee(s) was (were) moved to
    • List and identity any other law enforcement agencies present at the site of accident
    • Description of accident and whether the accident scene or instrumentality has been altered

    Death: Work-incurred deaths must be reported immediately to EH&S at (949) 824-6200, as required by California Division of Occupational Safety and Health.
  4. Make one copy of the partially completed DWC-1 form for your records and give the original to your employee.
  5. The employee is not obligated to return the DWC-1 form; however, if they do, they are notifying their employer that they are pursuing workers' compensation benefits. If the employee does return the form, the supervisor must complete:
    1. Employer section, line 14 - date when employer received claim form from employee.
  6. Email the form to Workers' Compensation unit at wcdm@uci.edu.
  7. Make a copy for your records and send the original, signed form to:

    UCI Human Resources
    ATTN: Workers' Compensation Unit
    111 Theory, Suite 200
    Irvine, CA 92697-4600

    Your employee should only complete DWC-1 if they are filing a claim for workers' compensation benefits, including obtaining medical care from one of our doctors.

UCI HEALTH

  1. Inform your supervisor.
    Inform your supervisor (within 24 hours of the injury/illness) of your work-related injury or illness in one of the following ways:
    1. In person
    2. By telephone
    3. By email
  2. Report the Injury or Illness.
    Complete a Injury/Illness Report. Community Network Co-workers, please visit your Employee Health Nurse for assistance with reporting the injury.
  3. Obtain medical care.
    If necessary, obtain immediate medical attention.

    IF YOUR INJURY OR ILLNESS IS LIFE THREATENING, DIAL 911 IMMEDIATELY OR GO TO THE NEAREST EMERGENCY ROOM

    MEDICAL CENTER CO-WORKERS ONLY
    UCI Medical Center Occupational Health Clinic
    (714) 456-8300
    101 The City Drive South Orange, CA 92868
    View map and details

    COMMUNITY NETWORK CO-WORKERS ONLY
    Click here to view authorized occupational health clinics.

    If after hours or on the weekend, go to the nearest emergency room (ED). If seen in an emergency room, follow up with Occupational Health the next business day.
  4. Complete a DWC- 1 Claim.
    UCI Occupational Health (Orange) will provide a Workers’ Compensation Claim Form (DWC-1) for you to complete if you are obtaining medical treatment and pursuing a Workers’ Compensation claim.

    For Community Network co-workers, the DWC-1 form will be provided by your local Employee Health Nurse, please report the incident to them.

    If you are NOT pursuing a Workers' Compensation claim, and not obtaining medical care, then you are required to submit an incident report.
  5. Attend follow-up appointments with the occupational health clinic where you initially received treatment.
  6. Keep the Workers’ Compensation Unit and your supervisor informed.
    Inform the Workers’ Compensation unit and your supervisor of any updates following each physician visit(s), when lost time transpires, when work restrictions are assigned, or if you have concerns and/or the condition worsens.
  7. Accommodations & Return to Work
    Your department will consult the Disability Management Specialist regarding return to work. If your department is unable to provide modified alternate temporary work, it may be necessary for you to work within another department.

    After your appointment with one of the authorized occupational clinics, your supervisor will be notified of your work status. If your work status indicates work restrictions and your home department is unable to accommodate, the Disability Management Specialist will be notified and will look for a temporary alternate placement. In the event a temporary alternate location is not identified the next reasonable accommodation would be a leave of absence.
  1. If your employee is not seeking treatment at the UCI Medical Center Occupational Health Clinic but elsewhere instead, as their supervisor, assist your employee in obtaining medical authorization if needed. Authorization can be provided by the following:
    1. An assigned worker’s compensation analyst
    2. UCI Employee Experience Center at eec@uci.edu or 949.824.0500
    3. Sedgwick at 1.877.682.7778
  2. Instruct the employee to submit an Incident Report online to report any incident/accident/injury or illness arising out of and in the course of their employment.

    Medical Center Co-Workers Only: If your employee is unable to complete the incident report, you, the supervisor must complete it on their behalf.

    Community Network Co-Workers Only: Please contact your Employee Health Nurse to submit the incident on their behalf.

    Ways to Report:
    Online: Complete each section of the Incident Report online to report any incident/accident/injury or illness arising out of and in the course of their employment.

    By Telephone: Report any incident/accident/injury or illness arising out of and in the course of their employment by calling 1-877-682-7778 to submit an incident report. You will be connected to a call center for Sedgwick CMS, UCI's insurance administrator. The call center can accommodate employees who speak a language other than English.
  3. Contact EH&S and notify them of the work-incurred incident/accident/injury at 949.824.6200.
  4. Submit the work-incurred incident/accident/injury to the Safety & Quality Information System (SQIS).

BENEFITS

MEDICAL AND HOSPITAL CARE

All authorized medical expenses are fully covered if care is received at one of the approved clinics. You are entitled to receive all medical and hospital treatment reasonably required to cure or relieve your work-related injury. There is no deductible or dollar limit. The insurance claims administrator pays these fees directly to the physician or health care facility, so you do not receive a bill.

DISABILITY PAYMENTS

Temporary Disability

These payments will be made according to state law and University policy. If hospitalized or unable to work more than three consecutive days you may be eligible to receive income equal to two-thirds of your average pay, up to a legal maximum per week. You may also be entitled to supplemental income. Contact your supervisor or the UCI Employee Experience Center (EEC) 949.824.0500 for further information.

Permanent Disability

If your injury results in permanent impairment that reduces your ability to compete in the labor market, you may be entitled to permanent disability indemnity benefits.

DEATH BENEFITS

If a work-related injury or illness results in death, benefits may be paid to your qualified dependents as provided by state law.

ADDITIONAL INFORMATION

Questions? Contact a UCI Workers' Compensation analyst or the contact the Employee Experience Center at eec@uci.edu or 949.824.0500.