« Worker's Compensation

1. The new employee pamphlet "Facts About Workers' Compensation" is to be given to all new employees at the time of hire or when an existing employee has a question about Workers' Compensation.


2. EFFECTIVE AUGUST 1, 2004 New Posting Notices are required to replace the old posters "If a Work Injury Occurs".
   The New Posting Notice: Is attached in PDF format.
   "State of California Notice to Employees - Injuries caused by Work"
   
   • Print/Photocopy the poster on legal size paper.
   • Print/ Photocopy and Post as many as you need. Take down all of the old posters (REV 11/02)
   • Post in all locations where employees regularly congregate.
   • Make sure every employee can easily read the poster.
3. The Employee's Claim for Workers' Compensation Benefits (employee Claim Form DWC-1) The title of the form and the language has changed. Throw away all of the old forms REV 1/94) and use only the REV 7/1/04 version.
   The form is now titled "Workers' Compensation Claim Form (DWC1) REV 7/1/04
4. There is a new cover sheet "Notice of Potential Eligibility" to be given to the employee along with the Workers' Compensation Claim Form (DWC1).
5. Give the injured employee the pamphlet "When an Injury Occurs." Pamphlets are available at OIRM ext 46952.

When a department has knowledge of a work injury/exposure:

1. Send the employee to Occupational Health Facility with a completed Employee Referral Slip.


2. Give the employee a Workers' Compensation Claim Form (DWC 1) and a "Notice of Potential Eligibility" within one working day of the knowledge of an injury/illness.


3. Document in the department records that a claim form was given, by name of the person and the date.


4. When the employee completes the Workers' Compensation Claim Form (DWC 1) you should date and sign the form. Keep a copy in your department records. Send one to Payroll/Human Resources.


5. Give a completed signed copy of the Workers' Compensation Claim Form (DWC 1) to the employee.


6. FAX a copy of the Referral Slip to OHF and the completed signed Workers' Compensation Claim Form (DWC 1) to OIRM via fax 310 794-6957.


7. Request that the employee bring back a work status slip from OHF. If there are work restrictions please try to accommodate. If you have questions on temporary restrictions/modified work contact Michelle Hochstein at OIRM ext. 46955

There are now 3 documents and a pamphlet given to an injured employee:
» Employee Referral Slip for treatment at OHF
» Workers' Compensation Claim Form (DWC 1)
» "Notice of Potential Eligibility"
» "When An Injury Occurs" pamphlet