Benefits Available to Injured or Ill Employees
I. Medical Care
Employees who suffer a work-related injury or illness will receive, at no cost to them, medical care that is required to cure or relieve the effects of the injury or illness. The medical care will be consistent with the appropriate evidence-based medical treatment guidelines.
The University participates in a pharmacy benefit program with ScripNet. Therefore, at the onset of medical treatment the employee will receive a ScripNet form to take to their pharmacist to fill prescriptions at no cost. Once they have used this form, a ScripNet card will be mailed to them for future prescriptions for that particular injury/illness. Each injury/illness requires a separate card.
II. Temporary Disability Benefits
Temporary disability is a benefit paid to an injured or ill employee unable to work while recovering from a work-related injury or illness. If the injured or ill employee is a PERS member, he or she may be eligible to select from the following temporary disability plans. In each case, the benefit is available after serving a 3-day waiting period. The waiting period will be waived if time lost exceeds 14 calendar days, the injury or illness is caused by a criminal act of violence or the employee is hospitalized.
“In the course of employment” deals with the time and place that the injury occurred. If an injury occurs on the employer’s premises, such as in the parking lot or in the lobby of a building within a reasonable time before or after working hours, then workers’ compensation is likely to be accepted. There are two types of temporary disability benefits and they are detailed below:
A. Industrial Disability Leave (IDL)
IDL is a benefit that pays the first 22 work days of disability at an amount equal to the employee's net pay (full pay less an amount equal to Social Security and Medicare and withholding taxes based on your exemptions). If disability continues beyond 22 work days, IDL pays 2/3 of the employee's gross pay.
The injured or ill employee may be eligible to supplement the 2/3 IDL benefit with accrued sick leave available as of the first day of lost time. This option is referred to as IDL with Supplementation.
IDL is available for a maximum of 52 weeks within a 2-year period beginning with the employee's first date of lost time. While on IDL, the employee continues to accrue their full PERS service credit and their health benefits remain in force.
Should the period of temporary disability exceed the maximum IDL benefit eligibility, the employee may be eligible to receive Temporary Disability benefits with supplementation of accrued sick and vacation leave credits.
For more information, please refer to the CSU Industrial Disability Leave Guide [PDF].
B. Temporary Disability
TD is a benefit that pays a flat rate for each calendar day of lost time. The rate is based upon 2/3 of the employee's average weekly wages with a minimum and maximum set by state law.
The employee may be eligible to supplement the TD benefit with accrued sick and vacation leave credits. This option is referred to as TD with Supplementation. While on TD with Supplementation, the employee accrues partial PERS services credit based upon the supplementation portion only. The employee's health benefits remain in force.
Application for Catastrophic Leave
The purpose of the catastrophic leave program is to supplement any disability for which an employee is eligible. If the employee is interested in applying, he/she must contact Human Resources Management for further information regarding the program. If the employee decides to apply for catastrophic leave, his/her choice is limited to Temporary Disability with Leave Credit Supplementation. All leave credits must be used before using leave credits donated from other employees.
Non-Industrial Disability Leave (NDI)
Employees who are unable to work due to a non-industrial injury or illness may receive non-industrial disability leave (NDI). The State Employment Development Department authorizes NDI benefits. Employees desiring NDI must complete a Formal Leave form and NDI questionnaire. Both forms are available in Human Resources Management.
III. Permanent Disability Benefits
Employees who have a permanent impairment as a result of a work-related injury or illness may be entitled to receive permanent disability benefits. These benefits address the nature of the injury, the employee's age and occupation, and other factors.
The amount of permanent disability will be outlined in a final written medical report by the treating doctor after the employee’s condition has stabilized and determined unlikely to change. In the final report, the doctor will indicate the employee has reached their maximum medical improvement (MMI) or permanent and stationary (P&S) status. The doctor's finding is based on guidelines published by the American Medical Association (AMA).
If the employee or Sedgwick CMS disagrees with the final report, he or she may contact Sedgwick CMS or the Administrative Director for the Department of Workers' Compensation (DWC) Medical Unit to request a panel (list) of 3 Qualified Medical Examiners (QME's). Once the list is received, the employee has 10 days to make a selection. If they do not, Sedgwick will make the selection for them. All of the above information and instructions on how to request a QME panel will be provided to the employee by Sedgwick CMS once a final (MMI or P&S) report is received.
IV. Supplemental Job Displacement Benefits
Employees injured on or after January 1, 2004, who have a permanent disability caused by their injury may be eligible to receive "supplemental job displacement benefits" (vouchers) for retaining or skill enhancement.
Employees may be eligible if they do not return to work within 60 days after Temporary Disability (TD) benefits end, unless the employer offers modified or alternative work within 30 days after TD benefits end.
Vouchers may be used for education-related retraining or skill enhancement at state approved or accredited schools. The amount of the vouchers is determined by the rating of permanent disability. For all vouchers issued for dates of injuries on or after January 1, 2013, the vouchers expire two years after issuance or five years from the date of injury whichever is later.
V. Death Benefits
If an employee is fatally injured, reasonable burial expenses up to $5,000, are paid. In addition, the employee’s dependents may receive support payments for a period of time. These payments are generally payable in the same manner and amount as temporary disability benefits.
The total aggregate amount of support payments depends on the number of dependents and the extent of their dependency. Generally, the maximum (where three or more total dependents are eligible) is $320,000, though additional benefits are payable if there continues to be any dependent children after the basic death benefit has been paid.