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Workers' Compensation

It is the policy of Cal Poly Humboldt to:

  • Provide a safe and healthful work environment for all employees.
  • Ensure that employees that are injured or become ill on the job receive appropriate medical attention.
  • Return employees who have received disabling injuries to full or modified work as soon as their medical conditions permit.
  • Not discriminate against workers who are injured in the course and scope of their employment.

Employees of the Cal Poly Humboldt are covered for any injury/illness arising out of or in the course of employment, at no charge to the employee. Sedgwick CMS Services is the plan administrator for workers' compensation.

All job-related injuries or illnesses should be immediately reported to the employee's supervisor or Human Resources. Employees will be given an "Employee's Claim for Workers' Compensation Benefits" form to complete and return to Human Resources.

If emergency care is required, employees should seek services from Mad River Emergency Room or St. Joseph's Emergency Room.  For non-emergency care, employees must contact Mad River Occupational Health Services to provide medical treatment for the first 30 days from the date of injury. However, if prior to an injury, Human Resources has been provided with a Pre-Designation Form signed by a personal physician, employees may seek medical care from this physician immediately after injury. Under Labor Code Section 4600 (d) the designated physician must (1) be the employee's primary care physician, (2) have treated the employee in the past, (3) retain his or her medical records (including medical history), and (4) agree to be predesignated.

If an employee qualifies for workers' compensation, all approved medical bills will be paid in addition to any temporary or permanent disability payments to which an employee is entitled.

If an employee is unable to work as a result of a work-related injury or illness, he or she may elect to receive Industrial Disability Leave (IDL) in lieu of temporary disability payments. IDL provides full pay for the first 22 days of disability, with two-thirds pay for the next 11 months of disability. Employees disabled for 14 days or less do not receive IDL for the first three days (waiting period) unless hospitalized.

Workers' Compensation Forms

  • Claim Form DWC1
    Employee’s Report of Injury (DWC-1) – Must be given to employee at the time injury is reported to Supervisor, or as soon as possible after medical treatment is received
  • Supervisor's Report of Injury
    Supervisor’s Report of Injury – MUST BE SUBMITTED TO HUMAN RESOURCES WITHIN 24 HOURS OF KNOWLEDGE OF INJURY
  • Work-Related Injury Reporting Procedure
    The document includes links to all the necessary forms for the Workers' Compensation process.

St. Joseph's Occupational Health Care is no longer available for non-emergency treatment.
**DO NOT EMAIL DOCUMENTS WITH SSN's ON THEM!**

Additional Resources

Workers' Compensation Overview

Workers’ Compensation is an employer-paid benefit program that provides compensation and medical benefits if you are injured or become ill due to a work-related condition.

Sedgwick CMS is our Workers’ Compensation Third Party Administrator. They will provide any medical or compensation benefits an injured worker is entitled to receive. If you have any questions, contact Sedgwick CMS or the Humboldt Workers’ Compensation Manager in Human Resources.

If you cannot work because of an industrial injury, workers’ compensation pays your medical bills and provides compensation to help replace your lost income until you can return to work. Workers’ Compensation provides five primary benefits to an employee injured on the job:

  • Medical care to cure or relieve the effects of the industrial injury/illness.
  • Compensation payments to help replace lost wages.
  • Permanent disability to compensate for diminished earning capacity.
  • Death benefits to be made to qualifying dependents in work-related death cases.
  • Vocational Services for education-related retraining or skill enhancement.

The term “industrial injury” is used to describe any injury, illness, or disease which results from work or working conditions, and which occurs during the employee’s service to the employer. Injuries resulting from workplace crime, including psychiatric injury, may be considered industrial. Even first-aid type injuries are covered.

Generally, a claim for workers’ compensation benefits must be filed within one year of either the date of injury or the last payment of benefits, or for a cumulative injury, within one year from the date the employee suffered a disability and knew, or should have known, the disability was work-related.

However, benefits may not be provided for injuries occurring during voluntary participation in any off-duty recreational, social, or athletic activity, not part of any employee’s work related duties.

You must report your injury to your supervisor or employer immediately. You will be given a form titled “Workers’ Compensation Claim Form” (DWC 1 claim form) if your injury requires medical treatment beyond “First Aid” or it results in lost wages beyond the date of injury. (“First Aid” means any one-time treatment of minor scratches, cuts, burns, splinters or other minor work injury.) Return the completed form to your supervisor or campus Workers' Compensation Manager who will give you a completed and signed copy and send the remainder to Sedgwick CMS. State law requires employers to authorize medical treatment within one working day of receiving a claim form. Someone from Sedgwick CMS will be in touch with you to explain the benefits you will be receiving.

Insure your right to benefits by immediately reporting every work-related injury or illness. Any delay in reporting may delay or bar your workers’ compensation benefits.

Good medical care is important and quality medical treatment is the quickest way to recovery.

In general, approved medical care consists of treatment reasonably required to cure or relieve the effects of the injury or illness based upon guidelines established by state law.; Medical care includes such services as physician or hospital treatment, physical therapy, x-rays and prescribed medications.

What choices do I have for medical care?

Unless you have pre-designated a personal physician, treatment must be provided by:

Mad River Occupational Health Services
3800 Janes Rd
Arcata, CA 95521
(707) 825-4907; or

In the event of an emergency, please seek assistance at Mad River Community Hospital Emergency Room or the nearest hospital emergency room.

Your primary treating physician (PTP) has overall responsibility for treating your injury or illness. The PTP directs your medical care within recommended guidelines established by law. The PTP is responsible for coordinating care between other medical providers. In more serious cases, the PTP will assess permanent disability, entitlement to vocational services, and need for future medical services. You may change your treating physician to another physician 30 days after the injury is reported. If you want to change your treating physician, contact your campus Workers' Compensation Manager or Sedgwick CMS.

You may pre-designate a personal physician to treat you in the event of a work-related injury. Your personal physician must be designated by you in writing prior to your injury or illness, must be a Medical Doctor, must be your primary care physician who has previously treated you in the past and maintains your medical records, and agree to accept Workers’ Compensation Insurance. Contact your Workers' Compensation Manager for additional information about pre-injury physician designation.

Industrial Disability Leave (IDL)

If you are a member of PERS or STRS, you may be eligible to select IDL disability benefits in lieu of Temporary Disability benefits. IDL provides full pay for the first 22 days of disability, and two-thirds (2/3) pay thereafter less the amount calculated for state and federal taxes. Employees may receive IDL payments up to 52 weeks within two years from the first day of disability. If the employee is still disabled after exhausting the 52 weeks, the leave will automatically shift to Temporary Disability. While you are receiving IDL, your normal retirement contributions and voluntary deductions continue. While an employee is on IDL, the state will continue to pay its portion of the medical premiums, and the employee’s premium will be automatically deducted from his or her IDL benefit payment. IDL benefits may be supplemented to full pay with sick leave accrued up to the date of disability. Leave benefits will continue to accrue while on IDL, however, only those hours earned prior to disability will be available for supplementation.

Temporary Disability (TD)

If a work-related injury or illness prevents you from working, you are eligible for temporary disability (TD) income after three days off work (including weekends). You will be eligible to receive TD for the first three days if you are hospitalized during that period, a victim of a violent crime, or if you must stay off work for more than 14 days.

Temporary disability provides payment of up to two-thirds of your actual wages, with minimum and maximum payments set by state law. TD benefits are issued every two weeks. TD benefits will end when the treating physician releases you for work or says your condition has stabilized.

Permanent Disability (PD)

After you recover to the fullest extent possible, the physician who treated you will evaluate any permanent or lasting effects of your injury, which may make you eligible for permanent disability benefits.Your permanent disability benefits will depend upon the doctor’s report and factors such as your age, occupation, type of injury and the date of injury. If you have a permanent disability, Sedgwick CMS will send you a letter explaining how the benefit was calculated. Benefits are paid every two weeks.

In the event the work related injury or illness causes your death, payment may be made to your relatives or household members who were financially dependent upon you. The amount of dependent benefits is set by state law and depends upon the number of dependents. Benefit rates are the same as TD and payments are made every two weeks. Workers’ Compensation also provides a burial allowance.

If you have additional questions regarding your workers’ compensation benefits, contact either the Humboldt Workers' Compensation Manager in Human Resources (826-3626) or Sedgwick CMS. If you are dissatisfied with the information provided, you may contact an Information and Assistance Officer or an attorney. For the Information and Assistance Officer call (805) 485-3528. They will inform you of your rights and, if necessary, will provide you with a full review of your claim for compensation. The information and assistance service is free.

Some issues may need to be resolved by the Workers’ Compensation Appeals Board, the state agency responsible for handling disputes. The Appeals Board is a court of law. You can represent yourself or you may want to hire a lawyer. If you hire an attorney, the fee will be deducted from any benefits awarded by the Appeals Board.

If you have questions or need help regarding your workers’ compensation benefits, please contact the Workers' Compensation Coordinator in Human Resources (707-826-3626).  This person can provide immediate help with your questions or claim.

Medical services for workplace injuries may be provided by the Humboldt Student Health Center during normal work hours and when semesters are in session.  If the Student Health Center is unavailable, please seek non-emergency medical attention at:

Mad River Occupational Health Services
3800 Janes Road Arcata, CA 95521
(707) 825-4907

If medical treatment is considered an emergency, please seek treatment at:

Mad River Community Hospital Emergency Room
3800 Janes Road
Arcata, CA 95521
(707) 826-8264
or the nearest hospital emergency room.

CSU claims are administered by Sedgwick CMS (formerly Octagon Risk Services).  If you file a claim for Workers’ Compensation benefits Sedgwick CMS will assign a person to administer your claim.  That person will also be able to answer questions and help with the process.

Sedgwick CMS
P.O. Box 14629
Lexington, KY  40512-4629

If you are dissatisfied with the information provided, you may contact an Information and Assistance Officer or an attorney.  For the Information and Assistance Officer in Eureka, call (707) 441-5723.  They will inform you of your rights and, if necessary, will provide you with a full review of your claim for compensation.  The information and assistance service is free.

Some issues may need to be resolved by the Workers’ Compensation Appeals Board, the state agency responsible for handling disputes.  The Appeals Board is a court of law.  You can represent yourself or you may want to hire a lawyer.  If you hire a lawyer, the lawyer’s fee will be deducted from your benefits.