You may be entitled to workers' compensation benefits if you are injured or become ill because of your job, or are a victim of a workplace crime. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as a hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over).

Benefits

Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat your injury. You should never see a bill.

Temporary Disability Benefits: Payments if you lose wages while recovering.

Permanent Disability Benefits: Payments if your injury causes a permanent disability.

Vocational Rehabilitation: Services and payments if your injury prevents you from returning to your usual job or occupation.

Death Benefits: Paid to dependents of a worker who dies from a work-related injury or illness.

Transportation Reimbursement: Medical travel expenditure (upon written request) and all other necessary and reasonable care ordered by your doctor.

Benefits such as temporary, permanent, vocational rehabilitation and death benefits are all payable at a rate based on 2/3 of your average weekly wage, and subject to state minimum and maximum amounts in effect on your date of injury. These benefits are paid every two weeks while you are eligible.

The State Law excludes disability payments for the first three days off (including weekends) unless you are off work more than 14 days or become hospitalized. Stanford's policy is to waive the waiting period and pay full salary for the remainder of the day in which the injury occurred and the three-day State required waiting period, plus two additional days. This five-day period is not charged to sick leave or vacation. After the five-day period, accumulated sick leave and/or vacation may be used to supplement Workers' Compensation benefits, thus continuing income equivalent to full pay.  Stanford Disability and Leave Services (DLS) processes and coordinates all disability leaves of absence (LOA) with Payroll, including those for workers’ compensation, as part of the Stanford salary continuation program.  Thus, the employee’s DLS representative needs to be informed about all Workers’ Compensation LOAs in order to calculate, coordinate and administrate accurately and in a timely manner all pay for which the employee is eligible. DLS can be reached at hrleaves@stanford.edu.  Employees may request clarification from Administrative Guide memos 22.5 (page 2), 22.6, 25.2, 25.6 and 27.7.

If you have any questions concerning your claim for benefits, please feel free to contact Risk Management at (650) 723-7400. SLAC employees may contact the Safety Department at extension 4533.

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If You Get Hurt

Get Medical Care. If you need first aid, contact your employer. If you need emergency care, call for help immediately.

Report Your Injury. Report the injury immediately to your supervisor. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you a claim form within one working day after learning about your injury and to submit appropriate forms: DWC-1, Employee Claim Form; SU-17, Accident, Incident, Exposure Report; and Form 5020, Employers Report of Injury. SLAC employees MUST report the accident/exposure to the SLAC Medical Department, extension 2281, you will then be asked to complete a claim form. The statute of limitations for filing a workers’ compensation claim is one year from the date of injury or, if resulting from repeated exposures, one year from when you realized or should have realized that your job caused it.

See Your Primary Treating Physician. This is the doctor with overall responsibility for treating your injury or illness. If you named your personal physician before injury you may see him or her for treatment. Otherwise, your employer has the right to select the physician who will treat you for the first 30 days. Your personal physician must have treated you and maintained your medical history and records before your work injury. If you wish to change doctors in the first 30 days, your claims administrator must select a new physician within five days of your request. (But if you gave your employer the name of your personal chiropractor or acupuncturist in writing before you were injured, you may switch to the chiropractor or acupuncturist upon request.) If you still need medical care after 30 days, you can switch to a doctor of your own choice. If your employer has an HCO contract, they may have longer medical control. See your employer for more information on your HCO.

Unless you have previously predesignated your personal physician (in writing) as mentioned above, all medical care for the first 30 days of treatment must be obtained from Stanford University Occupational Health Center, 480 Oak Road, Phone: (650) 725-5308 Fax: (650) 725-9218, hours from 8:00 AM to 5:00 PM. For life threatening emergencies go to the nearest Emergency Room or the Acute Care Center within the Emergency Room at Stanford Hospital and Clinics phone is (650) 723-5111 .

Discrimination: It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. Should discrimination be proven, you may be entitled to reinstatement with back pay, higher benefits and expenses up to limits set by State law. You may also have additional rights under the Americans with Disabilities Act (ADA) or the Federal Employment and Housing Act (FEHA). For additional information, contact FEHA at (800) 884-1684 or the Equal Employment Opportunity Commission (EEOC) at (800) 669-3362.

If medical care is not being provided by your employer you have several options. First, contact your claims administrator to find out the status of your claim. If the claim hasn’t been accepted yet, you can go to your group health plan for care, find a doctor, clinic or hospital that will bill the claims administrator directly, or use public health services.

You have the right to disagree with decisions affecting your claim. If you have a disagreement, contact your claims administrator first to see if you can resolve it.

You can get free information from a state Division of Workers' Compensation Information & Assistance Officer. Hear recorded information and a list of local offices by calling toll-free (800) 736-7401. Local Offices: San Jose 408 277 1292; San Francisco 415 703 5020. You may also go to the DWC web site at http://www.dir.ca.gov.

You can consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee may be taken out of some of your benefits. For names of workers' compensation attorneys, call the State Bar of California at (415) 538-2120 or go to their web site at http://www.californiaspecialist.org. You may get a list of attorneys from your local information and assistance officer or look in your yellow pages.

This form complies with Labor Code requirements §3551, §3553, and Administrative Rule §9880, and has been approved by the Administrative Director of the Division of Workers’ Compensation.