Item 565 - Injury/Illness Code and Date

Coding:

Injury/Illness Code = X. See below for coding values.

Injury/Illness Date = MM/DD/YY or blank.

Temporary Disability Date = MM/DD/YY or blank.

Example:

Refer to Special Instructions for examples.

System
Audits:

None

Audit
Instructions:

1. If applicabable, enter the date the injury, illness or disability occurred. Leave the date blank if the injury/illness code is 3, 4, or 6.

2. The Temporary Disability Date is the date the employee is eligible to be placed on TD or IDL benefits, or the date certified by EDD as eligible to receive NDI benefit payments. Leave the date blank if the injury/illness code is 7.

More Info:

Refer to the Systemwide Human Resources Employee Policies and Programs web page for documentation requirements.  Also refer to Special Instructions.

Code

Action

Description

1

On TD

Do not take off payroll; employee has credits for full supplementation.

2

On TD

Take off payroll; employee does not have credits for full supplementation OR elected not to supplement (Item 606 must be completed.)

3

Off TD

Returned to work; was on payroll at time of return.

4

Off TD

Returned to work; was off payroll at time of return (Item 606 must be completed).

Code

Action

Description

5

On IDL

Take off payroll; place on IDL status (Item 606 must be completed).

6

Off IDL

Returned to work; was off payroll at time of return (Item 606 must be completed).

Code

Action

Description

7

Off Pay

Take off payroll; employee has used all available leave credits. (1) TPA or EDD reviewing employee's claim for Comp, IDL, or NDI benefits or (2) retirement system is reviewing employee's claim for disability retirement (Item 606 must be completed).

4

On Pay

Return to Pay Status. Employee returned to work; was off payroll at time of return. Determination by TPA/EDD still pending (Item 606 must be completed).

Code

Action

Description

8

On NDIL

Employee elected to use vacation credits OR campus elected to pay settlement pay to an academic employee.

9

On NDIL

Employee elected NOT to use vacation OR campus elected not to pay settlement to an academic year employee.