Frequently Asked Questions


An Act of Violence is a physical injury to an employee resulting from an intentional, violent assault that occurred during the performance of assigned duties. The injury must be physical in nature and the assailant must have intended to do physical harm. Injuries caused by very young, or mentally/emotionally challenged students are not considered intentional if the action causing harm is typical of the age or disability of the student. Injuries resulting from misconduct of students are not covered unless there was an actual intent to cause physical harm to the employee. Accidental harm will not be considered even if due to gross misconduct. A physical injury caused by an assault with intent to harm will be considered an Act of Violence regardless of who the assailant is. The assailant could be a student, co-worker, parent or unknown/unwelcome intruder.See the Act of Violence Policy Bulletin 5047.1 for further information – BUL-5047.1

The Education Code provides District Employees with full salary in lieu of Workers’ Compensation Temporary Disability benefits for the first 60 working days off work. If an industrial injury is determined to be an Act of Violence, that 60 day period of full salary will be extended. The length of the extension varies by Bargaining Agreement. Specifics for each Union Contract is located here: Union Contract AOV language

  • The injured employee must be a member of a bargaining unit which has Act of Violence language in its Collective Bargaining Agreement.
  • The injury must be accepted as an industrial injury by the Workers’ Compensation Third Party Administrator (TPA), Sedgwick.
  • The injury must be designated as an Act of Violence by the Integrated Disability Management Branch of the Division of Risk Management & Insurance Services.
  • Temporary Disability benefits must be authorized by the TPA. Under no circumstances will Act of Violence benefits extend beyond the last day for which Workers’ Compensation Temporary Disability benefits are authorized.

Eligibility is determined by the specific Bargaining Agreement. Currently UTLA; Unit A; Unit B; Unit C; Unit D; Unit E; Unit F; and Unit G include Act of Violence language in their Collective Bargaining Agreements. Copies of the Bargaining Agreements can be accessed through the Staff Relations website.

Knowingly telling a lie in order to obtain workers' compensation benefits. Workers' compensation fraud is a crime and if it can be proven that a person told a lie to collect benefits, the District Attorney's office will be notified and will proceed with criminal prosecution. If an investigation uncovers evidence of malingering or exaggeration of symptoms, this would be considered abuse and not fraud. Such an investigative finding would result in termination of benefits, but not criminal prosecution.

Both fraud and abuse represent substantial and unnecessary costs to the District. The main difference is that fraud is a crime, prosecuted by the District Attorney, and punishable by fine, imprisonment or both.
FRAUD
  • Clear intent to misrepresent facts or fabricate injuries
  • Unlawful to make any knowingly false or fraudulent statement(s) or material misrepresentations for the purpose of obtaining
  • Crime punishable by law
ABUSE
  • Taking advantage of the system
  • Exaggeration of symptoms
  • Just as costly as fraud and probably more prevalent

Fraud can be committed by any party to a workers' compensation claim. Employee red flags:
  • Employees pending disciplinary action
  • Claim filed around time of discipline, layoff, or completion of seasonal or temporary work
  • Employee is vague, inconsistent, or refuses to cooperate in accident investigation
  • Monday morning/Friday afternoon injury
  • Unusually familiar with workers' compensation system
  • Seasonal injuries
  • Employee has had multiple prior injuries
  • No witness to accident
  • Employee cannot be reached at home during work hours
  • Employee has a side job, second job or business
  • Employee has had prior injuries or medical treatment not work-related
  • Employee is out of illness time but is seeking time off from work
  • Employee has no visible signs of injury (cut, bruise, scratch, etc)

The SIU will investigate. The investigation may involve taking statements from witnesses or it could involve surveillance depending on the nature of the suspected fraud and information obtained. If the investigation uncovers proof of fraud, the matter is submitted to the LA District Attorney for further investigation and prosecution.

Pursuant to section 1871.4 of the Insurance Code, penalty can be up to 5 years imprisonment or fine of up to $150,000 and restitution of monies defrauded.

Yes, you can report suspected fraud anonymously to any of the following numbers: Workers' Compensation Fraud Hotline
  • (866) 247-2287 ext. 7327
Division of Risk Management and Insurance Services, Workers' Compensation Department
  • (213) 241-3138
Office of the Inspector General Fraud Hotline
  • (866) 528-7364

The Special Investigation Unit (SIU) will acknowledge all tips received if contact information is provided. Every suspected fraud tip is carefully reviewed; however, in order to protect the integrity of the investigation and maintain confidentiality, the SIU will not provide updates or a status of the investigation.

If you believe you have a catastrophic illness, please contact our office at (213)241-3954 and we can check to see if you are eligible to be in the Donations for Catastrophic Illness Program.

The qualifications are as follows:
  • The employee must currently be experiencing a catastrophic illness or injury - a serious health condition causing incapacity for more than 12 consecutive weeks.
  • The 12 consecutive weeks must be currently occurring, but it may be a combination of the past (i.e. the employee has already been out for 5 weeks when applying for the program) and projected absence (i.e. the employee's doctor has indicated that the employee will be out for another 10 weeks due to the illness or injury.
  • The employee must be on an approved formal leave of absence of more than 20 consecutive working days, with a copy of the leave paperwork for the appropriate LAUSD personnel division submitted to the Donations for Catastrophic Illness Program.
  • The employee's site must also have designated the absence as FMLA.
  • The employee's health condition must also be confirmed by the health care provider.

If you are already aware of a specific employee who is in need of time and is already in the Donations for Catastrophic Illness Program, then you can donate your illness time prior to your retirement date. Unfortunately, if you do not have a specific employee in mind, you will not be able to able to donate your time. The Program cannot "bank" any illness hours.

A Medical Provider Network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer to treat workers injured on the job. Please check Segwick's Medical Provider Network website at http://www.sedgwickproviders.com/campn1 or You can search by county/city or address. A roster of all participating providers in California can be downloaded.

Birth of an employee’s son or daughter (“bonding” or “parental leave”). Leave must be completed prior to the son or daughter’s 1st birthday. Placement of a child with the employee for adoption or foster care, including time to prepare for the placement, as well as, bonding time after the placement of the child. Leave must be completed within one year of the child being placed with the employee. To care for the employee’s own serious health condition that makes the employee unable to perform one or more essential functions of the employee’s job. To care for an employee’s son, daughter, parent, spouse, domestic partner (CFRA only), sibling (CFRA only), grandparent (CFRA only), or grandchild (CFRA only) who has a serious health condition, including incapacity due to pregnancy and for prenatal medical care. (See BUL-1205 for definitions) Any qualifying exigency arising out of the employee’s son’s, daughter’s, parent’s, or spouse’s active duty in the United States Armed Forces (or if such eligible family member has been notified of an impending call or order to active duty) in support of a contingency operation. To care for the employee’s son, daughter, parent, spouse, or next of kin who is undergoing medical treatment, recuperation, or therapy, or is otherwise on the temporary disability retired list for a serious injury or illness while on active military duty in the Armed Forces for up to 26 workweeks (FMLA only).

Employees are eligible if they have worked for LAUSD for at least one year over the past seven years, and worked the equivalent of 130 workdays (or 1,250 hours for school police, skilled craft workers, playground aides and classified subs/temps) over the 12 months prior to the first day of absence due to a serious health condition. Please note: there is no work-time requirement for Pregnancy Disability Leave. The law provides up to 18 work weeks of job protections.

Eligible employees are entitled to up to 12 work weeks of protected leave and/or absence within any FMLA/CFRA year (12 month period) no matter how many FMLA-qualifying reasons an employee may have. For employees taking Pregnancy Disability leave, the employee is entitled to up to 18 work weeks of protected leave per pregnancy. Employees who are caring for a family member in the military who has sustained a serious injury or illness while on active duty are entitled to up to 26 weeks of protected leave.

An FMLA/CFRA year is the 12-month period that an eligible employee has to utilize their 12 work weeks of protection. It begins with the first qualifying FMLA/CFRA absence that the employee has. For example, if an eligible employee requests FMLA/CFRA protection beginning with their first FMLA/CFRA qualifying absence on January 4, 2013, then their FMLA year would end on January 3, 2014.

Substitute teachers can take a FMLA/CFRA leave if they meet the eligibility requirements of one year of service and 130 workdays in the year preceding the leave. If the FMLA/CFRA leave is for more than one pay period, FMLA/CFRA will protect their health benefits up to 12 work weeks.

FMLA/CFRA can be paid, unpaid or a combination of both. If the FMLA/CFRA absence is for the employee's own Serious Health Condition, then the employee is required to use any available full-pay illness, half-pay illness or vacation time. If the FMLA/CFRA absence is to care for the employee's Family Member, the employee is required to use any available Kin Care, Personal Necessity or vacation time. All other time is unpaid. If the employee is receiving benefits under the California Paid Family Leave program, however, the employee is not required to use available Kin Care, Personal Necessity or vacation benefits.

If your FMLA/CFRA absence is to care for a family member, District Policy requires you to use any available Kin Care, Personal Necessity or vacation time before taking unpaid time off. However, if you are receiving benefits under the California Paid Family Leave program, you are not required to use available Kin Care, Personal Necessity or vacation benefits before taking unpaid time off.

No, you may not. District policy requires employees to use all benefited time (i.e. illness and vacation) prior to taking an unpaid leave.

No, Workers' Compensation is not a protected absence. The employee must apply for FMLA/CFRA for Workers' Compensation absences to be protected.

Yes, FMLA/CFRA protection can be granted retroactively, but only in the current fiscal year.

FMLA/CFRA/PDL/PPL is not counted during times when a worksite is shut down for breaks. No protected absence codes can be used when a location is shut down during breaks.

Paid or unpaid FMLA, CFRA and/or PDL leave will not constitute a break in service for the purposes of establishing longevity or seniority, or for layoff, recall, promotion, job assignment, or seniority-related benefits. Unpaid FMLA, CFRA and/or PDL leave, however, is not treated as credited service time for permanency, retirement, or benefit accrual, vesting, and eligibility with CalSTRS or CalPERS.

Reasonable accommodation is mandated by District policy and Federal and State law, specifically Americans with Disability Act (ADA) and Fair Employment and Housing Act (FEHA). The term "reasonable accommodation" is defined as a change in the work environment or in the application process that enables a person with a disability to enjoy equal employment opportunities.

An individual with a disability: 1) has a physical or mental impairment that limits one or more of the person's major life activities, 2) has a record of such impairment, or 3) is regarded as having such an impairment.

The process starts when an oral or written request for reasonable accommodation is made to your principal, administrator, or supervisor for a reason related to a medical condition. The request may be made using "plain English" and does not require the mention of American and Disabilities Act (ADA) or related phrases such as "reasonable accommodation".

Once you have made a request for reasonable accommodation, your supervisor should discuss available options with you. If you have a disability that is not obvious, your supervisor may request documentation that demonstrates the disability and explains the need for reasonable accommodation. All medical records will be kept confidential. You and the supervisor must engage in an informal interactive meeting process to determine any appropriate accommodation. If informal accommodation cannot be made at your worksite, you or your supervisor should complete the reasonable accommodation application found in BUL-4569.1 Reasonable Accommodation for Individuals with Disabilities and provide it to the disabilitymanagement@lausd.net email address.

Upon Receiving the Application Materials from the Employee/Applicant or Supervisor, the Reasonable Accommodation Program Will Send a Written Acknowledgment of Receiving the Application for Reasonable Accommodations. The Program Will Evaluate the Reasonableness of the Requested Accommodation Based on the Specific Circumstances. If the Information Provided by the Employee/Applicant Is Insufficient or Needs Independent Verification, the Disability Coordinator May Refer the Case to the District Medical Director. The District May Request Additional Medical Information, Including an Independent Medical Examination of the Employee/Applicant, If It Is Job-related and Essential As per Legal Requirements. Additionally, the Disability Coordinator May Form a Reasonable Accommodation Committee, Consisting of Certificated and Classified Personnel. This Committee Will Review Requests for Reasonable Accommodation When an Informal Accommodation Is Not Viable in the Workplace. the Employee/Applicant Seeking Accommodation Will Be Given the Chance to Address the Committee, Provide Additional Relevant Materials, and Request the Site Administrator to Speak Before the Committee As Necessary.

Immediately notify your supervisor of any injury or illness and any work-related restrictions. Your supervisor or administrator will initiate the process by reviewing the work restrictions and identifying transitional work with the assistance of a Return- to-Work Specialist in the Division of Risk Management & Insurance Services.

The Los Angeles Unified School District employees that are injured or ill and have been prescribed work restrictions will be required to participate in the program. The employee, the administrator and the return-to-work specialist will be involved in a coordinated effort to keep or return the employee to a transitional position while recovering from his/her injury or illness.

Transitional work assignments last approximately 60 working days. If work restrictions are required for longer than 60 working days or become permanent, the employee will work with a Return-to- Work Specialist to explore all options with regard to maintaining employment with the district, which may include reasonable accommodation and disability retirement benefits.

If an employee is disabled from their job in the District, but is able to do other work, they can do so as long as they notify their claims' adjuster of the income so that their workers' compensation benefits can be adjusted accordingly.

No, an employee should be brought back to work as soon as possible. If they cannot perform all aspects of their job, then consideration shall be given to modified or alternative work.

Yes, if the investigator presents an introductory letter signed by the District’s Workers’ Compensation Manager to complete the investigation. Sedgwick manages Workers’ Compensation claims on behalf of the District. Sedgwick is required to review each claim to determine eligibility for benefits based on the facts of the loss. Sedgwick utilizes G4S, an investigation firm, to assist in this review. Sedgwick assigns a G4S representative assigned to conduct this confidential review and gather additional information about the employee’s injury. G4S representative can interview all witnesses identified to have pertinent information regarding this employee’s injury. G4S is not authorized to interview any students.

The workers' compensation benefits are paid by the Third-Party Administrator and Payroll for regular employees. If you are a regular employee, for the first 60 days you will receive your full salary instead of temporary total disability benefits. Temporary total disability is paid by the Third-Party Administrator at two-thirds of the gross (pre-tax) wages you lose while you are recovering from a job injury. However, you cannot receive more than the maximum weekly amount set by law. Your wages are calculated using all forms of income you receive from work and any secondary job. The Third-Party Administrator will consider all forms of income when calculating your temporary total disability benefits. Education Code Benefits: You are entitled to receive your 1/3 of wages using your illness time as a supplement Educational Code benefits with your temporary total disability benefits not to exceed your normal wages. Once the illness time are exhausted or expired, you will only receive temporary total disability benefits.

The temporary disability rate is 2/3 of your salary up to statutory maximums. If you are a regular employee, you will receive your full salary in lieu of temporary disability benefits for the first 60 days. Thereafter your temporary disability benefit will be supplemented from your illness and vacation bank.

The doctor must agree to be pre-designated. He does not necessarily have to sign the form, but if he has not then, at the time of the injury, it is the injured workers' burden to show that he had previously agreed to be pre-designated. This could take time, so having the doctor sign the form is a way to expedite treatment when an injury occurs.

Per the Educational Code, you are entitled to receive supplemental benefits along with your temporary total disability benefits per the Labor Code, not to exceed your regular wages. Once the illness time is exhausted or expired, you will receive only temporary total disabilities per the Labor Code. Your illness hours will not be restored. You can review your entitlement per the Labor Code 4656, the Education Code 44043, and your Collective Bargaining Agreements.

Please contact your administrator, manager or supervisor and report the injury immediately.

Yes, your employer is allowed to contact you to discuss employment-related issues, such as your ability to return to work, or the need to file for leave. However, your employer cannot discuss your workers' compensation claim with you.

No, an injured employee is encouraged to return to work as soon as possible. If the employee is not able to perform all aspects of their job, then a modified or alternative work assignment should be considered. Work restrictions, if any, will be determined by the treating physician.

The District provides workers’ compensation coverage for volunteers who were certified by the Office of Student, Family, and Community Engagement. As part of the registration process, the volunteer will receive a volunteer ID card. If you need to confirm that a volunteer was certified, please contact the Office of Student, Family, and Community Engagement at (213) 481-3350 to verify the registration and approval of the volunteer.

Sedgwick P.O. Box 14623 Lexington, KY 40512-4623 (866) 247-2287

The District uses a Medical Provider Network (MPN). When reporting the claim, you can talk to a registered nurse to discuss the need for medical treatment and direct and schedule a medical appointment for you. If you do not want to speak with a nurse, you can select a medical provider through the Medical Provider Network. Please review the Medical Panel List or the Medical Provider Network website. The medical provider will determine the follow-up treatment and if a specialist is necessary. The claims examiner will determine if the medical treatment will be authorized.

Medical appointments for a workers' compensation injury should be scheduled during non-work hours, whenever possible. If appointments must be scheduled during work hours, they should be scheduled to have the least amount of impact on the work site (either early or late in the day).

If you need to attend a medical appointment with an authorized doctor, you may be entitled to salary continuation. You are required to complete the salary continuation form each time you miss work for a medical appointment to treat your work-related injury. (See the Salary Continuation Authorization form). Efforts should be made to schedule medical appointments in a manner as to avoid as much as possible, disruption to the District's operation. You may be entitled to up to 60 days of salary continuation for each date of injury/workers' compensation that is accepted. Once the 60 days of salary continuation is exhausted, your illness time will be used for any time taken off work for medical appointments. Please refer to your union contract for further information.

Yes. An employer is required to report any work-related injury that is reported to them. Sedgwick will determine whether to accept or deny a claim. Sedgwick has 90 days from the date of the employer's knowledge of the injury to make a decision. Delays in reporting suspicious claims will decrease the time Sedgwick has to investigate.

If an employee has work restrictions that prevent him or her from performing his or her District job, but does not prevent them from performing different duties from a second job, then said employee is permitted to work the second job, as long as the income from the second job is reported to their Sedgwick adjuster so that their benefits are adjusted accordingly.