1 Workers’ Compensation UCLA Healthcare June 6, 2003

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Workers’ CompensationUCLA Healthcare

June 6, 2003

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What Is the Purpose of Workers’ Compensation?

To provide legally mandated benefits to workers who are injured at work or who develop a job-related illness as a result of their employment

Benefits may include payment for medical bills, mileage, lost wages and vocational rehabilitation

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Who Administers and Pays for Workers’ Compensation?

UC is self-insured and has selected Octagon Risk Services, an independent contractor, to administer our workers’ compensation claims.

Octagon Risk Services may discuss the claim with the department and the employee, investigate the injury/illness, and determine what workers’ compensation benefits the employee will receive.

Funding for the Workers’ Comp program is provided by the UC locations as a group. Each UC location is charged a premium amount per $100 of payroll based on the location’s overall claim performance.

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When an Employee Is Injured

on the Job . . . Provide the employee with:

1. A completed EMPLOYEE’S CLAIM FORM FOR WORKERS’ COMPENSATION BENEFITSThis form must be provided within 24 hours of receipt of notice that an injury or illness has occurred as mandated by California state law. (Exception: first aid incidents)

2. A completed EMPLOYEE’S REFERRAL SLIP FOR INDUSTRIAL INJURY AND REPORT OF ACCIDENT

3. UCLA WORKERS’ COMPENSATION BOOKLET WHEN AN INJURY OCCURS & Workers’ Compensation Instruction Sheet

Claim Form

Referral Slip

Booklet/Checklist

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Employee’s Claim For Workers’ Compensation Benefits

Instructions on how to complete the Employee’s Claim Form for Workers’ Compensation Benefits

1a. If the employee notifies you in person, the supervisor or department personnel representative must fill out lines 1, 9, 10, 11, 12, 13, 16, 17, 18Have employee sign on line 8. Continue to step 2– The employee may fill out the “employee” section of the claim form in your

presence and return the form to you– If the employee chooses to fill out the “employee” section on their own,

instruct them to mail the completed form to Healthcare HR

1b. If you receive notice of the employee’s injury by phone: supervisor fills out lines 1, 9, 10, 11, 12, 16, 17, 18. On line 11, fill in the date supervisor received phone report of injury. On line 12, fill in the date form was mailed to the employee– Certified mail is advisable as proof of mailing– Continue to step 2

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Employee’s Claim For Workers’ Compensation Benefits (Cont’d)2. Make a copy of the Claim Form and proof of mailing form for the

department’s records. Department keeps the 5th copy “Employers’ Temporary Receipt” for department records.

3. Immediately FAX a copy of the completed form to the WC FAX line x 40530.

4 Employee keeps the 4th copy “Employee’s Temporary Receipt.”

5. Send all other copies of the form immediately to Healthcare HR for further distribution.

6. Notify Healthcare HR Workers’ Comp x40522 or via email to Cynthia Vazquez as soon as you are aware that an employee has been taken off work.

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Employee’s Referral Slip For Industrial Injury And Report Of Accident

Instructions on how to complete the Employee’s Referral Slip for Industrial Injury and Report of Accident.

1. Supervisor is responsible to complete this form describing how the injury occurred and where. Note the date the injury was reported.

2. Send the employee to the Occupational Health Facility with the Referral Slip. If OHF is closed, direct the employee to the Emergency Medicine Center for treatment.

3. Keep a copy of the Referral Slip for the department’s records.

4. Immediately FAX a copy of the completed form to the WC FAX line x 40535.

5. Notify Healthcare HR Workers’ Comp x 40522 or via email to Cynthia Vazquez as soon as you are aware that an employee has been taken off work.

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Employee’s Referral Slip For Industrial Injury And Report Of Accident

SPECIAL CIRCUMSTANCE #1: PRE-DESIGNATED DOCTORIf the employee reports he/she has pre-designated MD –• Advise the employee to obtain medical care with the pre-designated MD as soon as

possible. He/She may go to Occupational Health or the Emergency Medicine Center for immediate treatment, if the employee desires. Pre-designation of a private MD does not bar the employee from getting treatment at OHF or the EMC.

• Give and complete the WC Claim Form, Referral Slip. Provide When an Injury Occurs brochure and WC Checklist per previous instruction.

SPECIAL CIRCUMSTANCE #2: : EMPLOYEE HAS BEEN RECEIVING OUTSIDE TREATMENT

If the employee reports that he/she is being treated by a private MD –• Give and complete the WC Claim Form, Referral Slip. Provide When an Injury

Occurs brochure and WC Checklist per previous instruction.• Send the employee to Occupational Health with any medical records/MD notes they

have been given.• Advise the employee to contact Octagon Risk Services and give ORS the physician’s

information.

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Workers’ Compensation Process

Octagon Risk Services reviews the claim and determines what benefits the employee should receive. ORS notifies the employee by mail and by phone whether claim is accepted, delayed, or denied.

If the injury is delayed or denied, employee should file for disability benefits. Contact the employee’s supervisor or dept personnel rep to begin leave notification process. HR WC will direct inquiries to the department per the Benefits leave process.

If the injury is approved as work related and the employee receives a temporary disability check from ORS, HR WC will immediately notify the department. HR WC mails out Options letter to the employee. Department receives a copy.

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Workers’ Compensation Process (Cont’d)

Workers’ Compensation payments for Temporary Disability or Vocational Rehabilitation will effect the employee’s pay.

The employee must use his/her sick leave for first three calendar days of the leave.Follow the PTR instructions outlined in the next pages to pay the employee appropriately.

The employee needs to immediately choose how he/she would like us to treat his/her pay and notify Cynthia Vazquez in Human Resources, and the department:

Option 1 -- Employee elects to receive only the workers’ comp payments.

Option 2-- Employee elects to use sick leave only to supplement the workers’ comp payment.

Option 3-- Employee elects to use sick leave and vacation time to supplement the workers’ comp payment.

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OPTION 1

Employee elects to receive only the workers’ comp temporary disability payments.

Revise the LOA NotificationLOA Notification as Approved WC Option 1 and email to Human Resources Benefits Team and update the leave in EDB.

Immediately place the employee, if eligible,on FMLA leave without pay.If not eligible for FMLA, place the employee on Workers’ Comp Leave Without Pay.

Use 09 for Workers’ Comp Code & clarify action on comments.

Do not report any time on WPS or EPRs.

Employee should receive no pay from payroll while receiving temporary disability.

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OPTION 1 (Cont’d)

Employee is fully responsible for Benefits contribution according to the FMLA guidelines.

Employee must make employee contribution for health.HR Benefits will notify the employee directly regarding all benefits which are not paid for by FMLA.Employee will also need to pay directly for health, dental, and vision once the 12 weeks of FMLA exhaust.

Review the IDER and timesheet to determineif there was any payment of sick leave/vacation time.

Sick leave and vacation paid are considered “overpayment”. Enter a reduction transaction “RX” for the overpayment amount. When the employee repays the amount, the sick leave and

vacation hours will be returned to balance by Hospital Payroll.

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OPTION 2

Employee elects to use sick leave only to supplement the temporary disability payment.

Employee uses only a few hours SICK LEAVE each pay period to supplement temporary disability to equal 100% of his/her regular salary.

You will need to know:1. The employee’s SICK LEAVE balance as of the date of injury/date when employee first began losing time. Refer to Accrual slips/Hospital Payroll/Timesheet. 2. The regular hours the employee would have worked for the dates listed on the WC worksheet. Dates are inclusive.3. Any pay that the employee may have already received for the

dates listed on the WC worksheet. Refer to the IDER screen.

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OPTION 2 (Cont’d)Complete the Option 2 worksheet sent by HR WC.

IF the Balance is enough to cover the “Difference” then the employee remains at 100% pay for the WC Worksheet period.Forward a completed copy of the worksheet via email to the Hospital Payroll representative for your department.

Hospital Payroll will update the sick leave balance and award full accruals to the employee. Sick leave may be used as accrued while @ 100% salary.

Enter the transactions on PTR per the PTR Manual and Payroll instruction.

Per University Policy, employee should receive shift differentials in addition to base pay. Use DOS code REG for base pay.Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.Use DOS code WCR for WC check deduction.PROCESS BY PAY COMPUTE DEADLINES!

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OPTION 2 (Cont’d)


Place employee, if eligible, on FMLA Leave With Pay.If not eligible for FMLA, place the employee on Workers’ Comp Leave With Pay.

Use 09 for Workers’ Comp Code & clarify action on comments

Once the employee’s own sick leave exhausts, the employee is eligible to receive 80% Extended Sick Leave benefit.

Reduce employee time on EDB to 80%.

Do not report any time on WPS or EPR’s Department will process the pay on PTR

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OPTION 3

Employee elects to use sick leave and vacation to supplement the temporary disability payment.

Employee uses only a few hours SICK LEAVE and VACATION each pay period to supplement temporary disability to equal 100% of his/her regular salary. Exhaust sick leave first, then vacation.

You will need to know:1. The employee’s SICK LEAVE and VACATION balance as of

the date of injury/date when employee first began losing time. Refer to Accrual slips/Hospital Payroll/Timesheet.

2. The regular hours the employee would have worked for the dates listed on the WC worksheet. Dates are inclusive.

3. Any pay that the employee may have already received for the dates listed on the WC worksheet. Refer to the IDER

screen.

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OPTION 3 (Cont’d)Complete the Option 3 worksheet sent by HR WC.

IF the Balance is enough to cover the “Difference” then the employee remains at 100% pay for the WC Worksheet period.Forward a completed copy of the worksheet via email to Hospital Payroll.

Hospital Payroll will update the sick leave/ vacation balance and award full accruals to the employee. Sick leave and vacation may be used as accrued while @ 100% salary.


Per University Policy, employee should receive shift differentials in addition to base pay. Use DOS code REG for base pay.Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.Use DOS code WCR for WC check deduction.PROCESS BY PAY COMPUTE DEADLINES! 17

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OPTION 3 (Cont’d)


Place employee, if eligible, on FMLA Leave With Pay.If not eligible for FMLA, place the employee on Workers’ Comp Leave With Pay.


Once the employee’s own sick leave and vacation exhausts, the employee is eligible to receive 80% Extended Sick Leave benefit.

Reduce employee time on EDB to 80%.

Do not report any time on WPS or EPRs Department will process the pay on PTR

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80% Extended Sick Leave

Employee elected Option 2 or 3 and accrual bank has exhausted.

When an employee elects Options 2 or 3, the employee is eligible for this benefit once the SL or SL/VA in the employee’s bank is exhausted.

Department pays the employee the difference between [80% of regular salary based on appt] and the [WC temporary disability payment.]

80% ESL does not come out of employee’s individual bank.Benefit is paid for 26 weeks from the date employee exhausted his/her own SL or SL/VAC time on the WC worksheet and continues to receive WC temporary disability.Employee continues to accrue SL/VAC @ 100 % but cannot use accruals until return to work or separation.

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80% Extended Sick Leave (Cont’d)Calculate 80% of the employee’s regular hours based on appt for the dates listed on the 80% ESL Worksheet sent by HR WC. Dates are inclusive.

Forward a completed copy of the worksheet via email to Hospital Payroll.

Hospital Payroll will update the sick leave/ vacation balance and award full accruals to the employee upon return to work or separation.


Per University Policy, employee should receive shift differentials in addition to base pay. Use DOS code ESL for base pay.Use appropriate DOS code (e.g. NSD, SDF, etc.) in addition to base pay.Use DOS code WCR for WC check deduction.PROCESS BY PAY COMPUTE DEADLINES!

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80% Extended Sick Leave (Cont’d)

Confirm the LOA NotificationLOA Notification to Human Resources Benefits Team and confirm the leave is current.

Place employee, if eligible, on FMLA Leave With Pay.

If not eligible for FMLA, place the employee on

Workers’ Comp Leave With Pay.Use 09 for Workers’ Comp Code & clarify action on comments

Reduce employee time on EDB to 80%.Begin and end date of 80% reduction in time can be found on 80% ESL worksheet.

Do not report any time on WPS or EPRs Department will process the pay on PTR

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AFTER 80% ESL

HR WC will notify the department rep to update the LOA NotificationLOA Notification for the Human Resources Benefits Team and update the leave in EDB.

Email the LOA Notification promptly so HR Benefits can mail a disability packet to the employee.Place the employee on Workers’ Comp Leave Without Pay.


Correct employee time on EDB from 80% to original appt.

Do not report any time on WPS or EPR’s NOTIFY the HR Benefits Team via email on the Return to Work NoticeReturn to Work Notice form if the employee returns to work or pay status

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AFTER 80% ESL (Cont’d)

Health Insurance coverage may continue -- UC Regents will continue to pay the employee’s full health benefits (Employee and University contribution) via the Health Contingency Fund while the employee continues to receive temporary disability payments AND has not been separated from UCLA Medical Center.

Employee must make payment for all other insurances and Benefits that he/she wishes to keep current

HR Benefits will coordinate direct payment of premiums for all other benefits with employee.

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General guidelines . . .

TIMESHEETS (EPRs/WPS)WAITING PERIOD --

Fill out the WPS/EPR with first 3 calendar days of sick leave. If the employee does not have enough sick leave to cover the first 3 days, the employee is entitled to receive 80% of his/her regular salary. Notify Human Resources, Cynthia Vazquez, if the employee does not have enough sick leave. Record no sick leave/vacation on timesheet after waiting period.

TO AVOID OVERPAYMENTS ONLY RECORD WAITING PERIOD AS SL:

Individual situations may be considered. Advise employees about potential overpayments if the employee requests sick leave/vacation pay while waiting for the WC paycheck.

UPDATE the LOA NOTIFICATIONLOA NOTIFICATION form as needed.

UPDATE the leave in EDB.

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What else should you do? FMLA

Provide the employee with a FMLA packet. All workers’ compensation leaves are FMLA leaves if leave is more than 3 days.

TIMELINESS Complete the worksheets and process in EDB and PTR as they are provided to you. If they are not processed, the employee does not receive pay, and benefits may be discontinued.

HOLIDAYSEmployees should receive FULL holiday pay while at 100% or 80% pay. Do not include holidays when calculating the hours worked for the worksheets.

PTOIf the employee on workers’ comp is eligible for PTO, immediately notify Enterprise Payroll. Send notification by e-mail to the department’s payroll representative and copy Lillian Wilson, Hospital Payroll.While on Workers’ Comp, the PTO rules no longer apply and the employee’s accrual bank reverts back to vacation and sick time. 25

FMLA

TIMELINESS

HOLIDAYS

PTO

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New Employee Pamphlet/Pre-designation of Physician

NEW EMPLOYEE PAMPHLET For employees hired on or after 01/01/03

New employees must be given written notice of workers’ compensation rights Includes a tear-off form to pre-designate their personal physician to treat them in the event of a work-related injury.Written notice must be provided to an employee no later than the end of his first pay period.Pamphlet with approved language available in Healthcare HR.

PRE-DESIGNATION OF PHYSICIAN Current form is available on the HR website Current employees may utilize that form – only new employees must receive

the whole pamphlet including the tear off form. Employee must designate PRIOR TO AN INJURY the name and address

of the MD or DO in writing. The doctor must be someone who had treated the employee before and who has the employee’s medical records.

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PRE-DESIGNATION OF PHYSICIAN

IF employee chooses to complete the form, HE/SHE must return the form to Human Resources as soon as he/she fills it out.HR will clock in date of receipt.HR must add the information to our database. HR will return the original form to the department to be retained in the employee’s personnel file.

If department receives form from the employee, Clock in date of receipt.Forward copy of the form to HR immediately.Retain the original form in the employee’s personnel file.HR must add the information to our database.

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Types of Injuries

Types of Injuries

Indemnity– Examples: Repetitive motion, fracture, or sprain– Claims with lost time more than 3 days or anticipated permanent

disability– Temporary disability, permanent disability, vocational rehabilitation,

partial replacement of lost wages

Medical – Claims with lost time of 3 days or less– May receive medical care and follow-up by Occupational Health or

Workers’ Compensation medical provider

First Aid– No medical treatment needed

WC

Basics

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Types of compensation

• Medical coverage– Medical examinations, therapy, co-pays, prescriptions, mileage, equipment,

vocational rehabilitation

• Temporary disability– Represents 2/3 of the employee’s regular salary, up to the current maximum of

$602.00 per week for injuries occurring on or after 01/01/03.– Starts with the fourth calendar day the employee is unable to work. The three-

day waiting period is waived if the employee is hospitalized or disabled for 14 days or more

– Can also be WAGE LOSS which represents 2/3 of the employee’s lost earnings from the total average weekly earnings, up to maximum, when return to work on a part-time/modified basis

• Vocational Rehabilitation– Training when employee’s injury prevents return to usual and customary job

• Permanent disability– Long-term effects on ability to work are calculated, or “rated”, taking into

account the body part affected, the occupation, the age and rate of pay at the time of the injury/illness.

WC

Basics

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Assistance Directory

OCTAGON RISK SERVICES

10880 Wilshire Blvd, Suite 850Los Angeles, CA 90024-6914Mail code 691448Phone 310 794 8247Fax 310 794 8268

OCCUPATIONAL HEALTH FACILITY(OHF)200 UCLA Medical Plaza, Suite 224Monday through Friday 7:30 a.m. to 4:30 p.m.Mail Code 172524Phone 310 825 6771Fax 310 206 4585

CAMPUS PAYROLLUCLA Wilshire Center, Suite 620MC 141648Phone 310 794 8706Fax 310 794 8751

UCLA HEALTHCARE HUMAN RESOURCES

10920 Wilshire Blvd, Suite 400MC 167648Phone 310 794 0500Fax 310 794 0530

EMERGENCY MEDICINE CENTER (EMC)BE-144 CHS Center for Health SciencesOpen 24 hours a dayPhone 310 825 2111Fax 310 794 0599

ENTERPRISE PAYROLL UCLA Wilshire Center, Suite 1700MC 167646Phone 310 794 0127Fax 310 794 8049

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INFORMATIONINJURY REPORTINGPROGRAM INFORMATION

INJURY ANALYSIS/TRENDS

SUPPLEMENTAL PAYROLL WORKSHEETS

Cynthia Vazquez

Med Center Human Resources

x 40522

DISABILITY MANAGEMENTRETURN TO WORK

VOCATIONAL REHABILITATION

LOSS CONTROL ASSISTANCEMark Briskie

Med Center Human Resources

x 40525

CLAIM STATUSINJURY INVESTIGATION

ASSISTANCEClaims Account ExecutiveOctagon Risk Services (ORS)x 48247 phone

ACCIDENT PREVENTIONSAFETY INSPECTIONS/TRAININGACCIDENT INVESTIGATION

COORDINATIONERGONOMIC EVALUATIONVictor Kennedy x 54012200 Medical Plaza, Suite 202692624Daniel Phillips x 53389Derick Nguyen x 45170Building and SafetyMC 694116

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• Review a Workers’ Compensation Review a Workers’ Compensation Worksheet Worksheet

• Calculate Sick Leave and Pay AdjustmentsCalculate Sick Leave and Pay Adjustments

• Process a Leave of Absence in EDBProcess a Leave of Absence in EDB

• Process Pay Adjustments and a Workers’ Process Pay Adjustments and a Workers’ Compensation Check in PTRCompensation Check in PTR

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IMA EXAMPLE - OPTION 2IMA EXAMPLE - OPTION 2

Title: Hospital __ Asst. I - 9252

Appointment: 100% (40 hr/wk, evening shift)

Salary: $13.50 hr/ + $.85 SDF

Injured: March 18, 2002

Sick Leave: 25.5 on date of injury

Note: Accrual date on March 30, 2002

ORS Check: $720.00 (March 19-Apr 1, 2002)

Returned to Work: April 2, 2002

SAMPLE # 1 (OPTION 2)SAMPLE # 1 (OPTION 2)

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WORKERS’ COMPENSATION INSTRUCTI ON SHEET OPTI ON 2 – Sick Leave

REVISION DATE DATE: 04/03/02 EMPLOYEE: IMA EXAMPLE

EMPLOYEE ID: 987654321

EMPLOYEE’S HOURLY RATE: $13.50

DEPARTMENT: MODEL DEPARTMENT

DEPARTMENT REP: POLLY PROCESSOR

EXTENSION: 52003

DATE OF INJURY: 03/18/02

NATURE OF INJURY: STRAIN, LOW BACK

ORS CASE #: 200212345

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 720.00, for the period 03/19/02 to and including 04/01/02. The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The employee continues to accrue sick leave and vacation benefits while disabled. The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay. The following must be done: Adjust the employee’s sick leave: a) Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct

sick leave accruals to the employee’s balance. b) Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not

include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of hours represented by the ORS check (53.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The “difference” represents the number of sick leave hours required to keep the employee at 100% pay status.

Sick leave hours available on 03/19/02 = 25.5

Total Normal Working Hours = 72 Total Sick Leave Balance = 32.89

Accruals (if applicable) + 7.39

Hours represented by ORS check = 53.3 Difference from column #2 = 18.7

TOTAL Sick Leave balance = 32.89

“DIFFERENCE” = 18.7 (deduct this “difference” from sick leave records)

Balance sick leave left for next worksheet = 14.19

If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay. Adjust the employee’s pay: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University. The department must notify the Workers’ Compensation Representative on the date the employee returns to work. Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500.

Distribution: Department POLLY PROCESSR Medical Center Payroll Office MED CTR PAYROLL REP 1

Campus Payroll Office GTAYLOR

This balance is left in

employee’s bank.

ADD in full accruals of SICK LEAVE

while on Option 2

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WORKSHEET WORKSHEET

SAMPLE 1SAMPLE 1IMA EXAMPLE $13.50/hr100% BW $.85 SDF

WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)AMOUNT OPTION

For the period 3/19/02 through 4/1/02 $720.00 Option 2

SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)HRS/% DOS CODE

Payperiod: 3/30/02 32 REG 8 worked hours + 24 SL hoursWas paid on 04/10/02 payday

PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)HRS/% DOS CODE

Payperiod: 3/30/02 8 REG 1 day worked, 03/18/028 REG 1 holiday @100%, 03/25/02

64 REG 8 days @ 100% pay, 03/19-03/22/02, 03/26-03/29/02

4/13/02 8 REG 1 day @100% pay, 04/01/02

PTR TRANSACTIONS:TC PER. END DATE TIME RATE DOSLX 3/30/02 48 hrs $13.50 REGLX 4/13/02 8 hrs $13.50 REG

Inst. Sheet TC PER. END DATE RATE/Amt DOSRX 04/01/02 $720.00 WCR

Note:

Any other payments such as NSD, SDF etc. due employee (refer to EDB appointment) should also be calculated and paid based on the above.

MARCH 2002 S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

APRIL 2002 S M T W T F S

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

28 29 30

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PPIDER0-I1214 Departmental Inquiry 04/15/02 13:50:17 Earnings Distributions Userid: HPJRV Pay Cycle: B2 Processed In: 03/30/02 Check Date: 04/10/02 ID: xxxxxxxxx Name: EXAMPLE, IMA SSN: XXX-XX-XXXX Hm Dept: 280300 MC-HUM RES Disp: 8 Emplmt Status: A Check No: Type: CUR-ACTIVITY PAR Control No: 697 01 TC: AP FAU: 4-427705- -63000- -2 Title: 9252 Gross: 432.00 Rate: 13.5000 Time H: 32.00 Time %: .0000 Period: 03/30/02-B- - -N ERC: E Typ: 2 TUC: EX SHC: DUC: Cov: C Ret: 0 DOS: REG 02 TC: AP FAU: 4-427705- -63000- -2 Title: 9252 Gross: 6.80 Rate: 0.85000 Time H: 32.00 Time %: Period: 03/30/02-B- - -N ERC: Typ: TUC: SHC: DUC: Cov: Ret: DOS: TC: FAU: Title: Gross: Rate: Time H: Time %: Period: ERC: Typ: TUC: SHC: DUC: Cov: Ret: DOS: Next Func: ID: Name: SSN: Pay Cycle: Check Date:

IDERIDER SCREENSCREEN

Review IDER screen to verify if any hours have been paid

during the pay period for which the adjustments are being made.

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EXAMPLE, IMA

033002-

987654321

9252 HOSP__ASST II

031702-

0.00

8.00

0.00

32.00

03/29/02

03/17/02 03/18/02 03/19/02 03/20/02 03/21/02 03/22/02

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03/17/02 03/30/02

EXAMPLE, IMA

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Logging on to OASIS for PTR

Log on to OasisOasis Menu Screen will appear, enter PPPOnline Application Main MenuGo to Next Function field, enter EDAT, enter Employee ID#, then the Enter key/

Dept Adjustment Transaction menu will appearGo to Next Function field:

Enter EDLREnter Employee ID#Refer to “Schedule for Updating PPS ON-Line” and enter the Pay Cycle, I.e., B1 or B2 as appropriateEnter the Pay Period End Date for the pay day on which the transaction(s) will be processed and then the Enter key

The (EDLR) Dept. Adj. Trans screen will appearProcess LX and RX transactions from the Worker’s Comp Instruction Sheet

LX: REG 80.00 hours or ESL , and all other data, I.e., Title Code, Full Account Number, Rate, enter “H” in AH fieldRX: WCR (worker’s comp payment) enter “A” in AH field

Go to F10 and enter comments, Go to F6 to add Payroll Notification and appropriate HR Benefits Team members as carbon copy recipients of the ASAP notification, Go to F3 to return to list of ASAP recipients, then F9 to Update transactionRefer to PTR User Guide, Section E13, Special Processes for additional help

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PPELVE0-E0875 EDB Entry/Update LOAB 11/08/01 17:03:11 10/23/01 22:18:37 Leave of Absence Data Userid: HPJRV ID: 987654321 Name: example, ima SSN: 987-65-4321 Leave of Absence Action Code :07 Leave of Absence Begin Date :031902 Return: 040202 Type:16

Leave of Absence Action Codes07 Leave with Pay08 Leave without Pay

Leaves of absence due to a work incurred injury run concurrent with Family & Medical Leave.

The leave should first be processed as a Family & Medical Leave, either with or without pay as appropriate.

The comments on the ASAP notification should state that the employee is on worker’s comp and the time period.

Once the employee has exhausted the Family & Medical Leave period and is still on worker’s comp, the leave type would then be 09 - Worker’s Comp.

EDB - Leave of Absence

OPTION 2OPTION 2

Type of Leave of Absence01 Sabbatical at full salary02 Sabbatical at partial salary03 Sabbatical in residence at full salary04 Pregnancy Disability05 Extended I llness

06 Government/ Public Service07 Professional Development08 Personal

09 Worker’s compensation10 Furlough11 Military12 Special Research

13 Administration14 Sabbatical in Residence at partial Salary15 Family and Medical Leave Without Pay16 Family and Medical Leave With Pay99 Other (as specified in Personnel File)

41

PPETLR-E1064 Dept. Adj Trans 11/08/01 19:45:38 11/05/01 23:40:13 Late/Reduce Pay (EDLR) Userid: HPJRV ID: 700486135 Name: EXAMPLE, IMA SSN: 987-65-4321 Emp Status: A Pay End: 04/13/02 Check Date: 04/24/02 Pay Cycle: B2 Page 1 of 1 C Seq: Tr:LX Per End:033002 Pay Cy:B Dst:11 E: E T: D: Ttl:9252 LACFPS: 4 427705 63000 2 Rate:13.5000 AH: H DOS:REG Time: 48.00 H%: H DOS: Hr: DOS: Hr: WSP: Seq: Tr:LX Per End:033002 Pay Cy:B Dst:12 E: T: D: Ttl:9252 LACFPS: 4 427705 63000 Rate: .8500 AH: H DOS: SDF Time: 48.00 H%: H DOS: Hr: DOS: Hr: WSP: Seq: Tr: RX Per End:040102 Pay Cy:B Dst: E: T: D: Ttl: 9252 LACFPS: 4 427705 63000 2 Rate: 00720.00 AH: A DOS: WCR Time: H%: DOS: Hr: DOS: Hr: WSP:

OPTION 2OPTION 2

Worker’s comp check

amount & end date of

period covered

Payroll pay period

end date & hours

covered by worker’s

Comp check

LX Transaction = Hours employee would have worked during the period covered by the Worker’s Comp check

RX Transaction = Credit for the Worker’s Comp check

WCR = DOS code used to report the amount of the Worker’s Comp check as a credit for the period of the check

PTR – Pay Adjustments

EDB preparer must take two (2) separate actions

adjust the employee’s sick leave accruals (Coordinate w/Hospital Payroll))

adjust the employee’s pay

Injured: 3/18/02

ORS Check: 0319 -040102

NEED TO ENTER THE LX FOR PPE 04/1302 8 HOURS ON NEXT PAGE

MARCH 2002 S M T W T F S 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

42

Transaction Codes and Notifications

Screen Label Data Name Data Values/Comments PTR Screen Tr Transaction Type Code Code indicating the nature of the transaction EDLR

LX - Late Pay

Used to report the sick leave and/or 80% ESL to be paid

RX - Reduction in pay or leave

Used to report the ORS check as a by-agreement credit

Carbon Copy Recipients of ASAP:

Payroll Notification and HR Benefits Team

HR WC Cynthia Vazquez OPTIONAL

Comments on the ASAP notification:

EXAMPLES: “Employee on approved WC leave, Option 2 use of Sick Leave”

“Employee has filed WC claim pending Approval. Extended Illness.”

“Employee on 80% Extended Sick Leave under workers’ comp”

“Extend WC LWOP. 80%ESL exhausted 05/30/03.”

43

SAMPLE #1 (OPTION 2)

PPETLR-E1064 Dept. Adj Trans 11/08/01 08:45:0211/05/01 23:51:40 Late/Reduce Pay (EDLR) Userid: MFLWO

ID: 700486135 NAME: EXAMPLE, IMA SSN: 987-65-4321 Emp Status: A

Pay End: 041302 Check Date: 042402 Pay Cycle: B2 Page 1 of 2

Seq: Tr: LX Per End: 033002 Pay Cy: B Dst: 11 E: E T: D: Ttl: 9252

LACFPS: 4 427980 63000 2 Rate: 13.5000 AH: HDOS: REG Time: 48.00 H%: H DOS: Hr: DOS: Hr: WSP:


LACFPS: 4 427980 63000 2 Rate: .8500 AH: HDOS: SDF Time: 48.00 H%: H DOS: Hr: DOS: Hr: WSP:

Seq: Tr: RX Per End: 040102 Pay Cy: B Dst: E: E T: D: Ttl: 9252

LACFPS: 4 427980 63000 2 Rate: 00720.00 AH: ADOS: WCR Time: H%: DOS: Hr: DOS: Hr:

WSP:

Payroll pay period end date & hours covered by worker’s comp Check

Worker’s Comp check

amount and end date of period covered

44


PPETLR-E1064 Dept. Adj Trans 11/08/01 08:45:02

11/05/01 23:51:40 Late/Reduce Pay (EDLR) Userid: MFLWO

ID: 700486135 NAME: EXAMPLE, IMA SSN: 987-65-4321 Emp Status: A



LACFPS: 4 427980 63000 2 Rate: 13.5000 AH: HDOS: REG Time: 8.00 H%: H DOS: Hr: DOS: Hr:

WSP:


LACFPS: 4 427980 63000 2 Rate: .8500 AH: HDOS: SDF Time: 8.00 H%: H DOS: Hr: DOS: Hr: WSP:

Seq: Tr: Per End Pay Cy: Dst: E: T: D: Ttl: LACFPS: Rate: AH:

DOS: Time: H%: DOS: Hr: DOS: Hr: WSP:

Payroll pay period end date & hours covered by worker’s comp Check

45

MISTER JONES - OPTION 3MISTER JONES - OPTION 3

Title: CN II (9139)

Appointment: 90% (36 hr/wk, night shift)

Salary: $29.51 hr/ + $4.00 NSD

Injured: February 1, 2001 @ 3a.m. (sent to ER, taken off work)

Sick Leave: 18 s/l and 24 v/l on date of injury

ORS Check: $980.00 (February 2-15, 2001)

$980.00 (February 16-March 1, 2001)

Returned to Work: March 2, 2001

SAMPLE #2 (OPTION 3)SAMPLE #2 (OPTION 3)

46

WORKERS’ COMPENSATI ON I NSTRUCTI ON SHEET OPTI ON 3 – Sick Leave and Vacation

REVISION DATE DATE: 03/04/01 EMPLOYEE: MISTER JONES


EMPLOYEE’S HOURLY RATE: 29.51

DEPARTMENT: MODEL DEPARTMENT B

DEPARTMENT REP: INGRID INPUTTER

EXTENSION: 98765


NATURE OF INJURY: STRAIN, R ARM

ORS CASE #: 200112345

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 980.00, for the period 02/02/01 to and including 02/15/01. The employee has elected OPTION 3 (use of all sick leave and vacation). This option entitles the employee to 100% of his/her earnings minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The employee continues to accrue sick leave and vacation benefits while disabled. The department must take two separation actions items: 1) adjust the employee’s sick leave and vacation accruals and 2) adjust the employee’s pay. The following must be done:

Adjust the employee’s sick leave: a) Determine the employee’s sick leave balance on the date of injury. If the date of the ORS check passes an accrual, add the correct

sick leave and vacation accruals to the employee’s balance. b) Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not

include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of hours represented by the ORS check (33.2), which is calculated by dividing the ORS check by the employee’s hourly rate. The “difference” represents the number of sick leave and vacation hours required to keep the employee at 100% pay status.

Sick Leave and Vacation hours available on 02/01/01 = 18 + 24

Total Normal Working Hours = 72 Total Sick Leave and Vacation Balance = 56.96

Accruals (if applicable) = 6.65 + 8.31


TOTAL Sick Leave and Vacation balance = 56.96

“DIFFERENCE” = 38.79 (deduct this “difference” from SL/VA records)

Balance sick leave/vacation left for next worksheet = 18.17

If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.

Adjust the employee’s pay: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field.

Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department ingridi inputter

Medical Center Payroll Office med center payroll rep 2 Campus Payroll Office g taylor

Add in the appropriate accruals based on

Option 2 or 3!!!

While at 100% pay,

add in 100%

accruals.

47


REVISION DATE DATE: 03/04/01 EMPLOYEE: MISTER JONES





EXTENSION: 98765



ORS CASE #: 200112345





Sick Leave and Vacation hours available on 02/01/01 = 18.17

Total Normal Working Hours = 64.8 Total Sick Leave and Vacation Balance = 18.17

Accruals (if applicable) = NONE




Balance sick leave/vacation left for next worksheet =

If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay.

Adjust the employee’s pay: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University.

The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department

Medical Center Payroll Office Campus Payroll Office

Not enough

SL/VAC to complete worksheet

!

Contact Healthcare HR to

change to 80%ESL.

48


REVISION X DATE 03/06/01 DATE: 03/04/01 EMPLOYEE: MISTER JONES





EXTENSION: 98765



ORS CASE #: 200112345





Sick Leave and Vacation hours available on 02/01/01 = 18.17

Total Normal Working Hours = 28.8 Total Sick Leave and Vacation Balance = 18.17

Accruals (if applicable) = NONE




Balance sick leave/vacation left for next worksheet = 5.97

If the employee’s sick leave/vacation balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the employee’s sick leave and vacation balance is enough to cover the “difference,” the employee will remain at 100% pay. Adjust the employee’s pay: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave and vacation hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave and vacation balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University. The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department INGRID INPUTTER

Medical Center Payroll Office MED CTR REP 2 Campus Payroll Office G TAYLOR

This balance is

left in employee’s

bank. Accruals while on 80%ESL will be

added to this

balance.

NOTE REVISION

DATE

49

WORKERS’ COMPENSATION I NSTRUCTI ON SHEET 80% Extended Sick Leave Benefit

REVISION X DATE 03/04/01 DATE: 03/04/01 EMPLOYEE: MISTER JONES





EXTENSION: 98765



ORS CASE #: 200112345

80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or vacation, depending on which option was selected. The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 490.00, for the period 02/23/01 to and including 03/01/01. This employee, who previously selected OPTION 2 OPTION 3 X, has exhausted all sick leave (and vacation, if applicable), and is now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from 02/23/01 through 08/22/01, or until he/she is released to return to work, which occurs first. The department must adjust the employee’s pay as follows: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Vacation and Sick Leave Accruals Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’ compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate adjustment. Holiday Hours Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University. The department must notify the Workers’ Compensation Representative on the date the employee returns to work. Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department INGRID INPUTTER

Medical Center Payroll Office MED CENTER PAYROLL REP 2 Campus Payroll Office G TAYLOR

BEGIN and END dates

of the

80% ESL benefit.

50

PPEAPP0-E1287 EDB Entry/Update 11/13/01 18:25:38 11/05/01 23:40:13 Appointments/Distributions Userid: HPJRV ID: 123456789 Name: JONES, MISTER SSN: XXX-XX-XXXX Pri Pay: BW PAF Gen No: 48 Pg 01 of 02 Appt Actions Pgm Typ Bas Pd Ovr Appt Begin Appt End Dur Dept FLSA 40 1 2 091597 999999 I 280300 0 Title Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv 9139 CLINICAL NURSE II 0.90 F 29.5100 H BW N N Dist Actions L Acct CC Fund PC S FTE Dis % 42 4 427705 63000 2 MEDCTR-HUMAN RESOURCES 0.9000 Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP 093001 022201 29.5100 REG Dist Actions L Acct CC Fund PC S FTE Dis % 41 16 4 427705 63000 2 MEDCTR-HUMAN RESOURCES 0.8000 Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP 022301 082201 29.5100 ESL

EDB Transaction for Employee on EDB Transaction for Employee on 80% Extended Sick Leave80% Extended Sick Leave

ESL = DOS code for the 80% Extended Sick Leave period

Page 1 of 2

51

PPEAPP0-E1287 EDB Entry/Update 11/13/01 18:25:38 11/05/01 23:40:13 Appointments/Distributions Userid: HPJRV ID: 123456789 Name: JONES, MISTER SSN: XXX-XX-XXXX Pri Pay: BW PAF Gen No: 48 Pg 02 of 02 Appt Actions Pgm Typ Bas Pd Ovr ppt Begin Appt End Dur ept FLSA 40 1 2 091597 999999 I 280300 0 Title Grade %Full F/V Ann/Hr Rate Rt Sch Time Lv 9139 CLINICAL NURSE II 0.90 F 29.5100 H BW N N Dist Actions L Acct CC Fund PC S FTE Dis % 43 4 427705 63000 2 MEDCTR-HUMAN RESOURCES 0.9000 Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP 082301 999999 29.5100 REG Dist Actions L Acct CC Fund PC S FTE Dis % Pay Begin Pay End Step O/A Rate/Amount DOS PRQ DUC WSP

EDB Transaction for Employee on EDB Transaction for Employee on 80% Extended Sick Leave (Cont’d)80% Extended Sick Leave (Cont’d)

Comments on the ASAP notification: “Employee on 80% extended

sick leave under workers’ comp”

Carbon Copy Recipients of ASAP: Payroll Notification and HR Benefits Team

Page 2 of 2

52



ID: 000345789 NAME: JONES, MISTER SSN: 239-00-2367 Emp Status: A

Pay End: 020301 Check Date: 11/21/01 Pay Cycle: B2 Page 1 of 4


LACFPS: 4 427980 63000 2 Rate: 29.5100 AH: H

DOS: REG Time: 7.20 H%: H DOS: Hr: DOS: Hr: WSP:


LACFPS: 4 427980 63000 2 Rate: 4.0000 AH: HDOS: NSD Time: 7.20 H%: H DOS: Hr: DOS: Hr: WSP:



WSP:

53





Seq: Tr: LX Per End: 021701 Pay Cy: B Dst: E: E T: D: Ttl: 9139





LACFPS: 4 427980 63000 2 Rate: 490.00 AH: A

DOS: WCR Time: H%: DOS: Hr: DOS: Hr: WSP:

54











WSP:

55








Seq: Tr: LX Per End 030301 Pay Cy: B Dst: E: E T: D: Ttl: 9139

LACFPS: 4 427980 63000 2 Rate: 29.5100 AH: HDOS: ESL Time: 28.80 H%: H DOS: Hr: DOS: Hr:

WSP:


56

SAMPLE # 3 (Option 1)

HOURLY01, STUDENT - OPTION 1HOURLY01, STUDENT - OPTION 1

Title: Admin Specialist (7646)

Appointment: 100% (5 days/week, day shift)

Salary: $19.25/hr

Injured: May 12, 2003 @ 9 a.m. (sent to OHF, taken off work)

Sick Leave: 110 s/l and 24 v/l on date of injury

ORS Check: $513.30 (May 12-18, 2003)

Returned to Work: May 19, 2003

57

58

PPIDER0-I1214 Departmental Inquiry 05/30/03 13:50:17 Earnings Distributions Userid: HPJRV Pay Cycle: B2 Processed In: 05/24/03 Check Date: 06/04/03 ID: xxxxxxxxx Name: HOURLY01, STUDENT SSN: XXX-XX-XXXX Hm Dept: 280300 MC-HUM RES Disp: 8 Emplmt Status: A Check No: Type: CUR-ACTIVITY PAR Control No: 697 01 TC: AP FAU: 4-427705- -63000- -2 Title: 7646 Gross: 770.00 Rate: 19.2500 Time H: 40.00 Time %: .0000 Period: 05/24/03-B- - -N ERC: E Typ: 2 TUC: EX SHC: DUC: Cov: C Ret: 0 DOS: REG 02 TC: AP FAU: 4-427705- Title: 7646 Gross: Rate: Time H: Time %: Period: 03/30/02-B- - -N ERC: Typ: TUC: SHC: DUC: Cov: Ret: DOS: TC: FAU: Title: Gross: Rate: Time H: Time %: Period: ERC: Typ: TUC: SHC: DUC: Cov: Ret: DOS: Next Func: ID: Name: SSN: Pay Cycle: Check Date:

IDERIDER SCREENSCREEN

Review IDER screen to verify if any hours have been paid

during the pay period for which the adjustments are being made.

59


PPETLR-E1064 Dept. Adj Trans 11/08/01 08:45:0211/05/01 23:51:40 Late/Reduce Pay (EDLR) Userid: MFLWOID: 700486135 NAME: HOURLY01,STUDENT SSN: XXX-XX-XXXX Emp Status: APay End: 052403 Check Date: 061803 Pay Cycle: B2 Page 1 of 1

Seq: r: RX Per End: 052403 Pay Cy: B Dst: 11 E: E T: D: Ttl: 7646


Seq: Tr: Per End: Pay Cy: Dst: E: T: D: Ttl:

LACFPS: Rate: AH:DOS: Time: H%: DOS: Hr: DOS: Hr: WSP:

Seq: Tr: Per End: Pay Cy: Dst: E: T: D: Ttl: LACFPS: Rate: AH: DOS: Time: H%: DOS: Hr: DOS: Hr: WSP:

UNDER OPTION 1

Reverse SL hours paid during same period as Workers’ Comp check

60

SAMPLE # 4 (Wage Loss)

WORKER, WANDA – OPTION 2/80% ESL/WAGE LOSSWORKER, WANDA – OPTION 2/80% ESL/WAGE LOSS

Title: ASST I (4724)

Appointment: 100% (5 days/week, day shift)

Salary: $13.60/hr

Injured: February 28, 2003

Saw OHF, given restrictions which department

can accommodate 20 hours/week

Sick Leave: 7.39 s/l and 0 v/l on date of injury

Returned to Work: March 3, 2003 for 20 hours/week

on modified duty

ORS Check: $181.33 wage loss check March 2-March 8, 2003

$181.33 wage loss check March 9-March 15, 2003

61

WORKSHEET WORKSHEET

SAMPLE 4 (WAGE LOSS)SAMPLE 4 (WAGE LOSS)WANDA WORKER $13.60/hr100% BW

WORKER'S COMP PAYMENTS: (Refer to Worker's Comp. Instruction Sheet)AMOUNT OPTION

For the period 3/2/03 through 3/8/03 $181.33 Option 2 WAGE LOSS3/9/03 3/15/03 181.33 80 % ESL WAGE LOSS

SALARY PAYMENTS:(Refer to ROE or to the IDER/IERN screen)HRS/% DOS CODE

Payperiod: 3/15/03 20 REG WORKED 4 HOURS/DAY20 REG WORKED 4 HOURS/DAY

PAYMENT ANALYSIS: (Refer to BW Payroll Calendar)HRS/% DOS CODE

Payperiod: 3/15/03 20 REG 5 days @4 hours/day worked20 REG 5 days @ 4 hrs/day @100%

3/15/03 20 REG 5 days @ 4 hours/day worked16 ESL 5 days @ 4 hrs/day @ 80%

PTR TRANSACTIONS:TC PER. END DATE TIME RATE DOSLX 3/15/03 20 $13.60 REGLX 3/15/03 16 $13.60 ESL

Inst. Sheet TC PER. END DATE RATE/Amt DOSRX 3/8/03 $181.33 WCRRX 3/15/03 181.33 WCR

Note:

Any other payments such as NSD, SDF etc. due employee (refer to EDB appointment) should also be calculated and paid based on the above.

MARCH 2003

S M T W T F S

x 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

62

WORKERS’ COMPENSATI ON I NSTRUCTI ON SHEET OPTI ON 2 – Sick Leave

REVISION DATE DATE: 03/10/03

WAGE LOSS: YES

EMPLOYEE: WANDA WORKER

EMPLOYEE ID: XXXXXXXXX


DEPARTMENT: MODEL DEPARTMENT 4

DEPARTMENT REP: ELMO ENTRY

EXTENSION: XXXXX


NATURE OF INJURY: SPRAIN

ORS CASE #: XXXX55555

The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for the period 03/02/03 to and including 03/08/03. The employee has elected OPTION 2 (use of all sick leave). This option entitles the employee to 100% of his/her earnings minus the amount of the ORS check until his/her accruals are exhausted, at which time he/she is eligible for the 80% Extended Sick Leave benefit. The employee continues to accrue sick leave and vacation benefits while disabled. The department must take two separation actions items: 1) adjust the employee’s sick leave accruals and 2) adjust the employee’s pay. The following must be done:


sick leave accruals to the employee’s balance. b) Determine the actual number of hours the employee would have worked during the period covered by the PRM check. (Do not

include holidays. The employee is to receive full holiday pay for any holiday falling within the above period.) Deduct the number of hours represented by the ORS check (13.3), which is calculated by dividing the ORS check by the employee’s hourly rate. The “difference” represents the number of sick leave hours required to keep the employee at 100% pay status.

Sick leave hours available on 02/22/03 = 7.39

Total Normal Working Hours = 20 Total Sick Leave Balance = 7.39

Accruals (if applicable) + NONE


TOTAL Sick Leave balance = 7.39

“DIFFERENCE” = 6.7 (deduct this “difference” from sick leave records)

Balance sick leave left for next worksheet = 0.7

If the employee’s sick leave balance is NOT enough to cover the “difference,” contact the Workers’ Compensation Office. If the employee’s sick leave balance is enough to cover the “difference,” the employee will remain at 100% pay. Adjust the employee’s pay: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. For positive time employees, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “REG” DOS code to report the actual number of hours the employee would have worked during the period covered by the ORS check. Reflect the sick leave hours used. (Med Center – send completed copy of this worksheet to Hospital Payroll for adjustment to sick leave balances) Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – OPTION 2. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Holiday Hours: Employee should receive FULL pay for holidays while on Option 2. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University. The department must notify the Workers’ Compensation Representative on the date the employee returns to work.

Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department ELMO ENTRY

Medical Center Payroll Office R POTTS Campus Payroll Office R CRUZ

NOTE: WORKSHEET

WILL INDICATE

THIS IS WAGE LOSS

WAGE LOSS

Use only the remaining hours needed to reach

100%.

Worked hours will be submitted

regularly through

WPS

63

WORKERS’ COMPENSATI ON I NSTRUCTI ON SHEET 80% Extended Sick Leave Benefit

REVISION DATE DATE: 03/10/03

WAGE LOSS: YES

EMPLOYEE: WANDA WORKER

EMPLOYEE ID: XXXXX XXXX


DEPARTMENT: MODEL DEPARTMENT 4

DEPARTMENT REP: ELMO ENTRY

EXTENSION: XXXXX


NATURE OF INJURY: SPRAIN

ORS CASE #: XXXX55555

80% Extended Sick Leave Benefit is automatic if the employee has selected Options 2 or 3 and has exhausted sick leave and/or vacation, depending on which option was selected. The above employee has received a Workers’ Compensation check from Octagon Risk Services (ORS) in the amount of $ 181.33, for the period 03/09/03 to and including 03/15/03. This employee, who previously selected OPTION 2 X OPTION 3 , has exhausted all sick leave (and vacation, if applicable), and is now eligible for the 80% Extended Sick Leave Benefit. The employee should remain on the 80% Extended Sick Leave basis from 03/09/03 through 09/13/03, or until he/she is released to return to work, which occurs first. The department must adjust the employee’s pay as follows: Refer to the PTR User Guide, Section E13.0 Workers’ Compensation. If the EDB has not been updated with the 80% distribution in time to pay a positive time employee from the Roster, use the Late/Reduce Pay screen (EDLR) to first enter a regular “LX” transaction, using the “ESL” DOS code to report 80% of the actual number of hours the employee would have worked. Next, enter an “RX” transaction, using the “WCR” DOS code to report the amount of the ORS check as a credit for the same period. Enter the actual last date of the ORS check in the “Pay Period End Date” field. Add the Payroll Office and the HHR Benefits Team as a carbon copy recipient on the ASAP notification screen. Note in the comments that the transaction is for a worker’s compensation adjustment – 80%ESL. The Payroll Office will match the transaction to their copy of the Instruction Sheet. Vacation and Sick Leave Accruals Employees should receive FULL accruals for the time they were receiving less than full pay while they were out on workers’ compensation, including the time they were entitled to 80% Extended Sick Leave benefits. Adjustments should be made to vacation and sick leave accruals after the employee returns to work. Notify your Medical Center Payroll Representative and coordinate adjustment. Holiday Hours Employee should receive FULL pay for holidays while receiving the 80% Extended Sick Leave benefit. Employee will accrue the full holiday hours, and those accruals will be deducted after the employee returns to work or upon separation from the University. The department must notify the Workers’ Compensation Representative on the date the employee returns to work. Questions regarding University paychecks and/or EDB/PTR processing should be directed to the Medical Center Payroll Office at extension 40127. Questions regarding the injury, or personnel policy should be directed to the Medical Center Human Resources Workers’ Compensation Representative at extension 40500. Distribution: Department ELMO ENTRY

Medical Center Payroll Office R POTTS Campus Payroll Office R CRUZ

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SAMPLE #4 (WAGE LOSS)

PPETLR-E1064 Dept. Adj Trans 11/08/01 08:45:0211/05/01 23:51:40 Late/Reduce Pay (EDLR) Userid: MFLWOID: 700486135 NAME: WORKER, WANDA SSN: XXX-XX-XXXX Emp Status: A


Seq: r: LX Per End: 031503 Pay Cy: B Dst: 11 E: E T: D: Ttl: 4726LACFPS: 4 427980 63000 2 Rate: 13.6000 AH: HDOS: REG Time: 20.00 H%: H DOS: Hr: DOS: Hr: WSP:


LACFPS: 4 427980 63000 2 Rate: 13.6000 AH: HDOS: ESL Time: 16.00 H%: H DOS: Hr: DOS: Hr: WSP:

Seq: Tr: RX Per End: 030803 Pay Cy: B Dst: E: E T: D: Ttl: 4724LACFPS: 4 427980 63000 2 Rate: 181.33 AH: A


UNDER WAGE LOSS

Only need to LX the remaining hours needed to reach 100% or 80%

Worked hours will be submitted regularly through WPS

WC check amount and end date of

period covered

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SAMPLE #4 (WAGE LOSS)

PPETLR-E1064 Dept. Adj Trans 11/08/01 08:45:0211/05/01 23:51:40 Late/Reduce Pay (EDLR) Userid: MFLWOID: 700486135 NAME: WORKER, WANDA SSN: XXX-XX-XXXX Emp Status: A


Seq: Tr: RX Per End: 031503 Pay Cy: B Dst: E: E T: D: Ttl: 4724LACFPS: 4 427980 63000 2 Rate: 181.33 AH: A


Seq: Tr: Per End: Pay Cy: Dst: E: T: D: Ttl: LACFPS: Rate: AH: DOS: Time: H%: DOS: Hr: DOS: Hr: WSP:

Seq: Tr: Per End: Pay Cy: Dst: E: T: D: Ttl: LACFPS: Rate: AH:

DOS: Time: H%: DOS: Hr: DOS: Hr: WSP:

Documents

1 Workers’ Compensation UCLA Healthcare June 6, 2003