Risk Management

• Specific Incident
  A single injury to one or more parts of the body resulting from a specific incident. Examples are injuries resulting from a “slip and fall,” a broken glass beaker, or lifting a heavy object.
• Cumulative Injury
  An injury resulting from repetitive traumatic activities over a period of time. Examples are loss of hearing from loud work-related noises or overuse syndrome from repetitive use of a keyboard.
• Occupational Disease
  Diseases that result over time that are directly related to a person’s work, such as asbestosis, which results from an employee’s long term exposure to asbestos.
• Aggravation of a Pre-Existing Condition
  If employment aggravates a pre-existing condition, the employer could be liable for proportion due to the aggravation.

Specific benefits are individually determined based on a range of factors. Generally, injured employees are eligible for the following types of benefits:

• Medical Care
  Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat the injury. For injuries occurring on or after 1/01/2004, there is a limit on some medical services.
• Temporary Disability Compensation
  Temporary disability payments are provided to injured employees to supplement their lost wages (temporary disability payments may also be referred to as workers' compensation payments).
• Permanent Disability Compensation
  Permanent disability compensation is provided when there is a permanent disability.
• Death Benefits
  Compensation is provided to the surviving dependents in the event of death.

Sedgwick CMS has a contract with the University of California to provide the services of a third party administrator for the University’s workers’ compensation self-insurance program.  Sedgwick CMS responsibilities include:

• Investigating all claims to determine if, legally, they should be accepted or denied
• Ensuring effective medical care and prompt payment of bills
• Providing prompt delivery of benefits on compensable claims
• Consulting with the Workers’ Compensation Office for claims management and early intervention planning
• Calculating the amount of reserved funds needed for each claim
• Defending the University’s position on questionable or litigated claims

Sedgwick, CMS
P.O. Box 14533
Lexington, KY 40512-4533
Phone:  (877) 682-7778
Fax: (916) 788-9990

The Cost Allocation Program takes a two-pronged approach. The first prong will apply a rate per $100 of payroll uniformly to all fund sources. This uniform rate will be reevaluated on an annual basis and adjusted, if required.

The second prong will assess an Incident /Claim Fee of $5,000 per qualifying incident/claim.

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