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Three advisories to supervisors

Library Worker's Comp Procedures

The line supervisor must often judge what constitutes “notice” to the Library of an occupational injury—and therefore when to start Workers’ Comp paperwork. 

Not every casual remark or minor incident justifies a claim, on the one hand; on the other, a seemingly inconsequential problem may grow and complicate. In doubtful cases, ask the employee if he or she wishes to file a precautionary claim; if you have misgivings, err on the side of caution. As soon as medical care is sought, issue the Claim and file the Report

If there’s no immediate need for medical care or time off work, the employee loses nothing by delaying filing a claim and handling things informally may better satisfy everyone. 

In any case, don’t let the red tape distract you from helping your employee! Take measures to prevent aggravation or recurrence of the complaint. 

If you want help deciding whether ‘to file or not to file’ or with assessing workplace hazards and how best to correct them don’t hesitate to call LHRD. 

  •  Once you consider yourself “notified” you must issue the Employee’s Claim form, in person or by mail, no later than by the end of the next workday. (For example: notice received on Friday:  named & dated Claim form handed or mailed to employee and partly completed Employer’s Report sent to LHRD by close of business Monday.)  Dates of Notice and Claim issuance on both forms should reflect this interval.



    If you miss this deadline, a note of explanation is a good idea.

  • Workers’ Comp insurance is no-fault, and neither assumes nor assigns blame:  neither should you.  Be as open-minded and cooperative with your employee as you can.

  • It’s no one’s place in the Library to judge the legitimacy, seriousness, or work-relatedness of an injury or illness. If you or your employee suspects work-relatedness, treat the condition as such till it can be evaluated by medical and insurance services.

  • If you suspect that other issues may underlie an injury claim, as is often the case, you may want to ask LHRD for help addressing these. A Workers’ Comp claim sometimes provides an opportunity to air and resolve long-term problems.
Direct employees with non-emergency, work-related complaints to the Occupational Health Service at Tang Center, 2222 Bancroft Way: call 642-6891 for appointments). Meantime immediately file the Claim and Report forms via LHRD calling ahead if you have questions or concerns. 
Every unit should have a set of Employee's Claim and Employer's Report forms on hand.  Train supervisors on all shifts in their use, and keep these guidelines with them for reference.  Order new formsets from LHRD.

Help!  with Library filing & claim management procedures:
LHRD  447 Doe Library
Phone:  642-3778
Fax:      642-8675

Campus information website: 

 Managing a claim at the workplace-step by step

1 — Deal with the injury!
Call 642-3333 (Campus Police) or 9-911 for emergency assistance; or Library Security if you need help getting assistance: 381-6690.  (Alta Bates Hospital, Berkeley, is the campus’s emergency care provider.) Then call the Office of Environment, Health & Safety: 642-3073. Take action to control any further immediate hazard. 

Now start the paperwork ! 


Discuss the injury with your employee frankly and attentively: how it occurred, ideas about its treatment, possible precautionary measures against aggravation or  recurrence. If medical care is sought, immediately start WC paperwork. Otherwise you and the employee may also discuss whether filing a claim now is appropriate. The employee loses no rights or benefits by delaying to file a Claim, if no lost time or medical care has resulted. 

Employees normally obtain acute care first at the Occupational Health Service (OHS) clinic, a division of University Health Service, in Tang Center, 2222 Bancroft Way. It’s best to call ahead for an appointment:  642-6891. 

Time off for private medical appointments, like all Workers’ Comp absence, is initially charged to accrued Sick Leave (SL/WC) except that the Library grants up to 2 hours’ Administrative Leave with pay  (A/WC on OTHER line, leave report) per visit to OHS. 

 Employees who prefer to consult a private physician immediately should have a Physician Designation memo on file at LHRD (form memo included in Claim Packet). Time off to see a private doctor is always charged to accrued Sick Leave. 

Campus Police (642-6760)—Library Building Management Services (642-3613)—or in a pinch Library Mail Service (642-3625) may be able to give employees with mobility problems a lift to Tang Center. 

The employee will normally bring back a visit verification/release to work slip, from any WC medical appointment (which is later attached to the WC Lost Time Report). Use this slip as an opportunity to discuss any medical restrictions imposed by the healthcare provider. Consult LHRD if the restrictions are problematic for you or the employee. 

 2.   Start the paperwork!

Employee’s Claim form:  next-workday issuance deadline

Within 24 hours (workdays) of first notice of a potential Workers’ Comp incident the Library must give the employee this form (with name & date filled in)—or mail it, with “proof of service”—subject to statutory penalty. The supervisor or designated unit administrator is responsible for filing set-up papers, but LHRD can help you meet the deadline if necessary. 

If you cannot hand it to the employee then & there, issue the Employee’s Claim (see below) by mail instead, at once, with Proof of Service. 

At the same time file Employer’s Report (see below) via LHRD: 642-3778; FAX 642-8675 
If you can’t reach LHRD, file the Report and proof of Claim issuance directly with: 

Workers’ Compensation
University Health Service (Tang Center)
2222 Bancroft Way
(643-7921;  FAX 643-6505)

UPPER BOX:    LINE 1 only:  Enter employee’s name 

LOWER BOX:   LINES 11, 12:  Be sure to enter these dates.  #12 should be within one workday of #11;  if not explain why on the Employer’s Report. 

LINES 16-18: Issuing supervisor’s name, title, phone number. 

LINES 9-10 and 14-15 should be preprinted.  If not:  Employer = Workers’ Compensation/ UC Berkeley, 2222 Bancroft Way, Berkeley, CA 94720-4300;  Insurance carrier = Applied Risk Mgmt., 1956 Webster St., Suite 200, Oakland, CA  94612;  Policy #  = “self-insured” 

UPPER BOX:   LINE 8:  If issued by hand, employee signs and dates for receipt—and 

Supervisor retains the back copy (“Employer Temporary”), as proof of issuance: 
photocopy the top sheet if this back copy is illegible 

When issuing the Claim form, also give the employee: 
         “Facts About Workers’ Compensation” (brown pamphlet) 
         “What You Should Know” information sheet 

If the Claim form cannot be personally issued to the employee on time: Mail it
--retaining the back copy or photocopy along with a completed Proof of Service form 

Send copies of both the Proof Service & Claim forms to LHRD 

    Either way, issue the Claim within 24 hrs (workdays only) of the LINE 9 date 

    There is no deadline on the employee’s completion & return of the Claim form: 
    this is the employee’s prerogative & responsibility. 

    Forward the Claim’s “Employer Temporary” (+ Proof of Service) copies immediately to LHRD—along with the Employer’s Report form, completed as fully as possible.

When the employee returns completed Claim form  (no deadline): 

Record the date on LINE 13 and complete 

LINES 16-17.  Return the signed, completed “Employee Copy” to the employee; and forward all the remaining the copies promptly to LHRD. 

This is an opportunity to discuss progress in treating the injury, accommodations in progress or still pending at work, and other concerns with the employee. 

3 File the Employer’s Report!

This is the Library’s first official statement about the incident, completed to the best of your knowledge as soon as you issue the Employee’s Claim form. 

TYPE IT!— Reports are machine-scanned:  hand-written forms will not be accepted 

LHRD will complete any personnel/payroll data you’re unsure of; and will file the report for the Library. The issuing supervisor may sign off, or leave for LHRD to sign. 

DON’T DELAY FILING the Report in order to find out all the facts:  you’ll have plenty of opportunity to update & explain later 

DON’T WAIT for the employee to return the Claim form: he or she is under no deadline or even obligation to do so 

ATTACH any documentation you have that’s relevant to the background or circumstances of the injury 

The issuing supervisor completes at least the following items: 

LAST NAME, top right corner 

1A, 2A, 3A:  DEPARTMENT = “Library”; enter actual worksite phone numbers 

Leave payroll data  blank (lines 3, 12, 13, 15, 16, 25, 26) if unsure—or call LHRD 

14, 17–38:  you MUST provide information about the employee’s actual work schedule, site of incident, incident description, medical care (if known), etc. Interview the employee or witnesses carefully for details if necessary; enter “N/A” if unobtainable 

DATE OF INJURY ( #17): For cumulative or gradually evolving symptoms, use date of first serious complaint or medical treatment—which may or may not be the same as the DATE OF NOTICE (#27). 

If the DATE EMPLOYEE PROVIDED CLAIM FORM (#28) is more than one workday after the DATE OF NOTICE (#27), explain why in #35 or on an attached sheet. 

Call LHRD if you’re unsure of how to record any information on the Report. 

You’re welcome to attach additional information to the Employer’s Report, bearing on the incident, its circumstances, or previous history, if you believe it to be of significance. Such details can be of real help to UC’s insurance administrator, Applied Risk Management. 

Forward the entire, 7-part copy set immediatley to LHRD. (Photocopy for your records, if you wish.)  DON’T WAIT till the employee returns the completed Claim form! 

 4 Living—and working—with an “open claim”

Medical certification & work accommodations 

Because Workers’ Comp is a highly regulated benefit, a complete paper trail is desirable. Remind your employee of this as needed, and forward all claim-related documentation promptly to LHRD. Be sure to advise LHRD promptly of any significant change in status. 

The Library must provide “reasonable accommodation” for disability. To do so you may need clarification of modified-duty instructions on a medical release. LHRD will assist supervisors both in setting up unusual accommodations, and in obtaining medical clarification or other assistance as required. 

Confidentiality of medical records is a continuing concern: The employer is entitled to request information about how the injury affects the employee’s fitness for work, not diagnostic details. (The employee is free to volunteer information.) The Campus’s Workers’ Compensation & Vocational Rehabilitation office mediates between departments and healthcare providers, in obtaining sensitive information. 

Permit no employee to resume regular work duties following a substantial Workers’ Comp absence without a written medical release, specifying any restrictions on duties or schedule along with their expected duration which the Library is asked to accommodate. (Occupa-tional Health Service, for instance, routinely gives patients a visit verification/release to work slip for the supervisor’s information.) 

Remind your employee to ask all healthcare providers for a written release/restricted duty slip, to protect UC from liability and ensure that you’re properly advised of any special accommodation that’s required. 

Record all claim-related absences on a monthly WC Lost Time Report, as well as the regular monthly leave sheet. The Library grants up to 2 hours’ administrative leave with pay per visit to the Occupational Health Service only.  All other WC time off must be charged to accrued SL and, if the employee runs out of SL and so requests, VL. 

Once you’ve reviewed them with the employee, forward all medical slips to LHRD—immediately, for absences of one week or more (call LHRD, too); or for intermittent absences and medical appointments, attached to the employee’s monthly WC Lost Time Report. 

Lengthy absences, major restrictions. Call LHRD immediately if you learn that an employee will be off work or on restricted duty for any length of time. Update or complete the employee’s Job Description and PEM checklist (see above), and forward these promptly to LHRD. 

The Library is often asked to provide a copy of the employee’s current Job Description and Physical, Environmental, and Mental Demands (PEM) checklist, for injuries that could affect the employee’s regular job performance. It's a good idea to prepare these in advance, and file them with LHRD.  Ask LHRD for blank PEM forms if you don't have them. 

Keep tabs on your employee! Actively encourage an early return to work through regular contact, temporary "rehabilitative” periods of modified duty and/or reduced schedule, and if necessary modifications to the work environment.

 5—Lost Time Reports & leave accounting

WC wage and leave benefits are roundabout, retroactive, and subject to delay. Promptly forwarding correct, complete absence and medical documentation, however, will expedite the process.

Following an initial Workers’ Compensation incident, an employee may lose worktime intermittently for medical care or recurrence of symptoms--or regularly on a temporary short schedule. 

All absence related to a Workers’ Comp claim (except visits to Occupational Health Service) will initially be charged to the employee’s regular accrued sick leave—and, at the employee’s request, if SL runs out, to accrued VL. 

Employees who are paid Workers’ Comp Temporary Disability (TD) benefits normally use these payments to extend their time on sick leave.  TD payments, in turn, depend on claim-related absences being properly reported.  (see below) 

Regular, temporarily reduced “rehabilitative” work schedules usually need not be reported this way?but be sure LHRD knows about them! 

Solid periods of absence. When an employee loses a lot of time during the month let LHRD know promptly—don’t wait to file the month-end report. 

Occasional lost time. Otherwise, for intermittent absences, forward the Lost Time Reporting Form to LHRD monthly: 

Report all WC-related absences (including OHS visits) on the WC line, separated from other absences which should appear on the upper line. 

Don’t forget to complete the work schedule information at the top! LHRD will enter leave balances, below. 

Attach to these reports any medical documentation the employee hand in for WC-related absences and work-duty or schedule restrictions. 

Accrued leave—& unit budget—credit for WC “Temporary Disability”  (TD) payments

Once UC’s insurance administrator, Applied Risk Management, medically verifies sufficient lost worktime—3 straight calendar days, or 24 intermittent hours—Temporary Disability (TD) benefits will be paid for subsequent absences. These payments are at made at a partial hourly wage rate, up to a current weekly maximum of $490.  At UC, TD payments are normally farmed back into the employee’s payroll-and credited in arrears to the employee’s payroll-account through a retroactive coordination process called “buy-back.” 

During “buy-back,” TD payments are used to restore some of the SL the employee has used.  If this supplemental SL also runs out, the employee is placed on “Extended Sick Leave” (ESL) instead of leave without pay —a supplemental University benefit. During ESL the unit’s pay-roll account continues to be credited with the amount of any TD payments, and the employee receives 80% of his or her regular salary. 

Because TD benefits aren’t taxable, the employee’s take-home pay normally remains at (or above) its normal level throughout. Meantime, the unit’s staffing budget only bears part of the employee’s regular payroll cost, freeing up some funds for backup staffing. 

LHRD monitors TD payments, adjusts leave records, and advises employees of their options and status. LHRD does not monitor budgetary credits: if an employee has reported significant WC lost time, watch your fiscal reports and inquire if after a few months you’ve still not been credited for TD buybacks. 

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