DPSS ePolicy

Converted document, no content change.

Revision of existing policy and to release a new form. 

What changed?

1. As of December 1, 2021, the name of the new workers’ compensation (WC) carrier for In-Home Supportive Services (IHSS) providers is Intercare Holdings Insurance Services (Intercare).
   
   
2. The Form 5020, Employer’s Report of Occupational Injury or Illness, has been revised with Intercare’s information.
   
   
3. The electronic submission of the Form 5020 has been changed to the Intercare website with new log in instructions.
   
   
4. Provides an updated listing of the WC District Liaisons (WCDL) and the Intercare claims adjusters.
   
   
5. The York Acknowledgment of Receipt form is now obsolete.
   

Note: Changes are shown highlighted in grey throughout the document.

Effective December 1, 2021, Intercare Holdings Insurance Services (Intercare) administers the delivery of WC benefits and services for the IHSS Program in California.

IHSS staff must give prospective providers, at provider orientation, the DWC 7, Notice to Employees – Injuries Caused by Work, and Intercare’s Facts About Workers’ Compensation pamphlet.

Within one (1) working day of knowledge of a provider’s injury or illness, the IHSS Social Worker (SW), acting as an agent for the IHSS recipient/employer, must give personally or by first-class mail, the DWC 1, Workers’ Compensation Claim Form, to an IHSS provider who reports an injury or illness that resulted while caring for an IHSS recipient (California Labor Code Section 5401).

The designated WCDL must forward to Intercare the completed DWC 1 within one (1) working day from receiving the completed DWC 1 from the SW. 

Note: Intercare is required to make an initial payment of WC benefits to the IHSS provider within 14 calendar days from recipient’s/employer’s knowledge of the work-related injury or illness.  If Intercare cannot make an initial determination and payment within the 14-day time frame, a 10 percent penalty assessment will be made against the State.

The IHSS SW/WCDL shall provide all necessary information related to individual WC claims of work-related injury or illness to Intercare examiners/adjusters/investigators.

Note: Cooperating with Intercare examiners/adjusters/investigators and providing them with requested information is not a violation of confidentiality under Welfare and Institutions Code Section 10850 or MPP Division 19, as Intercare is under contract with the California Department of Social Services (CDSS) to administer WC benefits/services and is acting on CDSS’ behalf.

CDSS is required by law to provide WC coverage to IHSS providers.  The WC benefit amount is two-thirds of the provider’s average weekly wage, paid every two weeks.

Designated IHSS social work staff must comply with procedures outlined below to ensure the timely provision of WC benefits and treatment, verification of injuries, and third-party responsibility.

First Aid

A one-time treatment of minor scratches, cuts, burns, or splinters.  The administration of first aid is not considered a WC injury.

Immediately

Within eight (8) hours of when the SW knows or with diligent inquiry would have known of the serious illness or injury, or death.  Failure to make an immediate report is subject to a minimum $5,000 fine.

Serious Injury or Illness

Any injury/illness while performing services for an IHSS recipient that:

• Requires inpatient hospitalization for a period in excess of 24 hours for other than medical observation; or
  
  
• Results in a loss of any member of the body, or any serious degree of permanent disfigurement.

Note: Full verification that the injury/illness occurred while the IHSS provider was providing services is not required prior to the reporting of the serious injury, illness, or death.

Workers’ Compensation (WC)

Insurance at no cost to the IHSS provider that the law requires an employer to carry to help the employee (i.e., IHSS provider) if he/she is injured on the job or becomes ill due to the job.

Workers’ Compensation Injury/Illness

Any injury or illness that occurs due to employment.

N/A

N/A

N/A