Workers' Compensation Benefits Time-of-Hire Notice

What Is Workers’ Compensation?

If you get hurt on the job, your department is required by law to pay for workers’ compensation benefits. You could get hurt by:

An individual event at work. Examples include but are not limited to hurting your back in a fall, getting burned by a chemical that splashes on your skin, or getting hurt in a car accident while making deliveries.

—or—

Repeated exposures at work over time. Examples include but are not limited to hurting your hand, back, or other part of your body from doing the same repeated motion or losing your hearing because of constant loud noise.

—or—

Workplace crime. Examples include but are not limited to getting injured in a store robbery or physically attacked by a customer.

Workers Compensation for injured or ill City employees are managed by the Department of Human Resources (DHR)’s Workers Compensation Division (WCD) for most City departments, and by Intercare Holdings Insurance Services Inc. for four City departments (Department of Public Health, Department of Public Works, Department of Human Resources, and City Attorney’s Office) and the San Francisco Municipal Transit Agency. Additional information on the City’s Self-Insured Workers Compensation Program may be found at https://www.sf.gov/resource/2023/workers-compensation.

What benefits are included in Workers’ Compensation?

Medical care: Paid for by your employer to help you recover from an injury or illness caused by work. Doctor visits, hospital services, physical therapy, lab tests and x-rays are some of the medical services that may be provided. These services should be necessary to treat your injury. There are limits on some services such as physical and occupational therapy and chiropractic care.

Temporary Disability (TD) Benefits: Payments if you lose wages because your injury prevents you from doing your usual job while recovering. The amount you may get is up to two- thirds of your wages. There are minimum and maximum payment limits set by state law. You will be paid every two weeks if you are eligible. For most injuries, payments may not exceed 104 weeks within five yearsfromyour date of injury. Temporary Disability (TD) stops when you return to work, or when the doctor releases you for work, or says your injury has improved as much as it’s going to.

Permanent Disability (PD) Benefits: Payments if you don’t recover completely. You will be paid every two weeks if you are eligible. There are minimum and maximum weekly payment rates established by state law. The amount of payment is based on:

• Your doctor’s medical reports
• Your age
• Your occupation

Supplemental Job Displacement Benefits (SJDB): This is a voucher for up to $6,000 that you can use for retraining or skill enhancement at an approved school, books, tools, licenses or certification fees, or other resources to help you find a new job. You are eligible for this voucher if:

• You have a permanent disability.
• Your employer does not offer regular, modified, or alternative work, within 60 days after the claims administrator receives a doctor’s report saying you have made a maximum medical recovery.

Return-to-Work Supplemental Program: For dates of injury after 1/1/2013, you may qualify for additional money from the Division of Workers' Compensation program known as the Return-to-Work Supplement Program (RTWSP) if you received the Supplemental Job Displacement Voucher (SJDB). If you have questions or think you qualify, contact the Information & Assistance Unit by calling 1-800-736-7401 or visit the website at https://www.dir.ca.gov/RTWSP/RTWSP.html.

Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness. The amount of payment is based on the number of dependents. The benefit is paid every two weeks at a rate of at least $224 per week. In addition, workers’ compensation provides a burial allowance of up to $10,000.00.

Are there any other benefits associated with Workers’ Compensation?

State Disability Benefits: You may file a claim with the Employment Development Department (EDD) to get state disability benefits when workers’ compensation benefits are delayed, denied, or have ended. There are time restrictions, so for more information, contact the local EDD office or go to their web site at www.edd.ca.gov.

Disability Pay (DP) for Police and Fire Sworn Personnel: Sworn Police and Fire first responders receive Disability Pay, which is a form of salary continuation where the injured employee receives full salary in lieu of Temporary Disability (TD) benefits until they return to work or up to a maximum of 365 days.

Labor Code Section 4850 for all other Sworn Personnel: For all other Sworn Personnel, employees receive LC 4850 salary continuation benefits until the injured employee returns to work or up to a maximum of 365 days within 5 years from the date of injury.

Assault Pay: Assault Pay (also referred to as Battery Pay) is a form of salary continuation where a nonsworn or civilian City employee is injured and temporarily disabled as a result of a criminal assault by another person in the capacity of their duties, as defined by Administrative Code Section 16.170. Assault Pay is payable until the employee returns to work or for a maximum of 12 months.

What should I do if I have an injury?

Report your injury to your supervisor!

Tell your supervisor right away no matter how slight the injury may be. Don’t delay – there are time limits to filing a claim. You could lose your right to benefits if your employer does not learn of your injury within 30 days. If your injury or illness is one that develops over time, report it as soon as you learn it was caused by your job. For work-related injuries that happen over time, you have one year from when you realized your injury was job related to file a claim. If you cannot report to the employer or don’t hear from the claims administrator after you have reported your injury, contact the claims administrator yourself.

You may be able to find the name of your employer’s workers’ compensation insurer at www.caworkcompcoverage.com. If no coverage exists or coverage has expired, contact the Division of Labor Standards Enforcement at www.dir.ca.gov/DLSE as all employees must be covered by law.

Get emergency treatment if needed

If it's a medical emergency, go to an emergency room right away. Tell the medical provider who treats you that your injury is job related. Your department may tell you where to go for treatment.

Fill out DWC 1 claim form and give it to your department contact or DPO

Your employing department must give you a DWC 1 Claim Form within one working day after learning about your injury or illness. Complete the employee portion, sign, and give it back to your supervisor, DPO, or designated WC contact. The WC contact at your department will then file your claim with the claims administrator. The City must authorize treatment within one working day of receiving the DWC 1 claim form. If the injury is from repeated exposures, you have one year from when you realized your injury was job related to file a claim.

In either case, you may receive up to $10,000 in employer-paid medical care until your claim is either accepted or denied. The City (CCSF WCD or Intercare) has up to 90 days to decide whether to accept or deny your claim. For injuries presumed to be work related for first responders, the timeframe to decide liability is shortened to 75 days. Otherwise, your case is presumed payable. Your employer or the claims administrator will send you “benefit notices” that will advise you of the status of your claim.

What else should I know about medical care?

What is a Primary Treating Physician (PTP)?

This is the doctor with overall responsibility for treating your injury or illness. They may be:

• The doctor you name in writing before you get hurt on the job,
• A doctor from the medical provider network (MPN),
• The doctor chosen by your employer during the first 30 days of injury if your employer does not have an MPN, or
• The doctor you chose after the first 30 days if your employer does not have an MPN.

What is a Medical Provider Network (MPN)?

An MPN is a select group of health care providers who treat injured workers. The City and County of San Francisco has an established MPN (#1258) for all injuries and illnesses on the job. As such, if you have not named a doctor before you get hurt, you will see a MPN doctor. After your first visit, you are free to choose another doctor from the MPN list. The City’s Medical Provider Network listing may be found here: https://www-lv.talispoint.com/intermed/ccsfmpn/.

What is Predesignation?

Predesignation is when you name your regular doctor to treat you if you get hurt on the job. The doctor must be a medical doctor (M.D.), doctor of osteopathic medicine (D.O.) or a medical group with an M.D. or D.O. You must name your doctor in writing before you get hurt or become ill. You may predesignate a doctor if you have health care coverage for non-work injuries and illnesses. The doctor must have:

• Treated you,
• Maintained your medical history and records before your injury, and
• Agreed to treat you for a work-related injury or illness before you get hurt or become ill.

You may use the Pre-Designation of Physician form included with this notice. After you fill in the form, be sure to give it to your Department Personnel Officer (DPO) and also to Intermed CCS as described on the form.

Are there any limits to chiropractic visits?

With some exceptions, state law does not allow a chiropractor to continue as your treating physician after 24 visits. Once you have received 24 chiropractic visits, if you still require medical treatment, you will have to select a new physician who is not a chiropractor. The term “chiropractic visit” means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management.

Exceptions to 24 visits include postsurgical physical medicine visits prescribed by the surgeon, or physician designated by the surgeon, under the postsurgical component of the Division of Workers’ Compensation’s Medical Treatment Utilization Schedule, or if your claims administrator has authorized additional visits in writing.

What if there is a problem?

If you have a concern, speak up. Talk to your department or adjuster handling your claim and try to solve the problem. If this doesn’t work, get help by trying the following:

Contact the State Workers’ Compensation Information and Assistance Unit. For claims that are not covered by the City’s Alternate Dispute Resolution Program, you may contact the Division of Workers’ Compensation (DWC) Information and Assistance (I&A) Unit. All 24 DWC offices throughout the state provide information and assistance on rights, benefits and obligations under California's workers' compensation laws. I&A officers help resolve disputes without formal proceedings. Their goal is to get you full and timely benefits. Their services are free. To contact the nearest I&A Unit, call 1-800-736-7401 or go to https://www.dir.ca.gov/dwc/ianda.html.

Alternate Dispute Resolution Program for Police and Fire Sworn Personnel

Labor Code Section 3201.7 allows employers and unions to form a labor-management Alternative Dispute Resolution Program (ADR), commonly known as a “carve-out”, to resolve Workers Compensation disputes that otherwise would be resolved through the state administered process overseen by the California Division of Workers Compensation. The City and County of San Francisco (CCSF) has entered into an agreement with the San Francisco Police Officers Association and the San Francisco Firefighters Local 798 to resolve workers compensation disputes through a carve-out for all injuries sustained and/or claimed on or after 7/1/19 by current and retired employees covered by these two labor organizations. Additional information on the Carve-Out program may be found on DHR’s website here: https://www.sf.gov/alternative-dispute-resolution-program.

Workers Compensation injury claims covered under the Carve-Out Agreement entitle you to:

• The services of an employee organization approved Ombudsperson, Maria B. Mariotto, who serves as a Member Advocate to assist injured employees in resolving any problems you may have during the course of your claim.
• Resolution of medical treatment and medical-legal disputes using Independent Medical Evaluators (IME) approved by your labor representatives.
• An ADR Program Director who approves settlements and is responsible for overall program oversight.
• Mediators and Arbitrators approved by your labor organization who can efficiently resolve legal disputes as they arise.

Injured Employees covered under CCSF’s ADR program may contact the adjuster assigned to their claim, or their Ombudsperson and Member Advocate, Maria B. Mariotto, at 415-932-6770 for any questions or concerns on a claim.

Consult with an attorney

Most attorneys offer one free consultation. If you decide to hire an attorney, their fees 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 visit their website at www.californiaspecialist.org. You may also get a list of attorneys from your local I&A Unit by calling 1-800-736-7401.

Additional rights

You may also have other rights under the Americans with Disabilities Act or the California Fair Employment and Housing Act. For additional information, contact California Civil Rights Department at 1 -800-884-1684 or the Equal Employment Opportunity Commission at 1-800-669-4000.

The information contained in this notice conforms to the informational requirements found in Labor Code sections 3551 and 3553 and California Code of Regulation, Title 8, sections 9880 and 9883.This document is approved by the Division of Workers’ Compensation Administrative Director.

Please visit the California Division of Workers’ Compensation website at www.dwc.ca.gov or call 1-800-736-7401.

California Department of Industrial Relations
1515 Clay Street, 17th Floor
Oakland, CA 94612

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Workers' Compensation Benefits Time-of-Hire Notice