WORKERS COMPENSATION - DOC by v8F6UR

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									WORKERS’ COMPENSATION
Information & Instructions for Supervisors and Injured Employees
Please post in a public area and provide to those responsible for reporting work related illnesses or injuries. Information
and forms listed below are also available online at www.csustan.edu/hr on the Employee Benefits page.


When an employee reports a work related illness or injury please:

       Complete SUPERVISOR’S REPORT OF EMPOYEE INJURY (H.R. FORM #66, Rev. 04/05)
       Complete Employer Section of WORKERS’ COMPENSATION CLAIM FORM (DWC1) Rev. 06/10 and provide the
        injured employee a copy of the DWC1 along with the attached Notice of Potential Eligibility within one working
        day of knowledge of injury
       Notify Human Resources at Ext. 3392 and forward Supervisor’s Report and DWC1 if completed by injured
        employee to HR within 24 hours

When employee needs medical treatment please send to the following facility:
(if no Pre-designation of Personal Physician form on file with Human Resources)

TURLOCK CAMPUS
Sutter Gould Occupational Health Services                      Emanuel Medical Center Emergency Room
Open 7 days a week 8:00 AM to 7:00 PM                          After hours emergencies
1015 E. Main Street (cross street Colorado)                    825 Delbon Avenue
Turlock, CA 95382                                              Turlock, CA 95382
Phone: 209.632.3909                                            Phone: 209.667.5800
Fax: 209.656.8507
Walk-in treatment. No appointment necessary.


STOCKTON CAMPUS
CO Occupational Medical Partners (COMP)                        COMP Immediate Care
Monday – Friday 8:00 AM – 6:00 PM                              Monday – Friday, 9:00 AM – 9:00 PM
1801 E. March Lane, Bldg. D, Suite 480                         Saturday, Sunday & Holidays, 8:00 AM – 9:00 PM
Stockton, CA 95210                                             1801 E. March Lane, Bldg. D, Suite 470
Phone: 209.954.3200                                            Stockton, CA 95210
                                                               Phone: 209.954.3100

FRESNO
Kaiser
                                      st
7300 N. Fresno Street, Oak Building, 1 Floor
Fresno, CA 93720
Phone: 559.448-4886

QUESTIONS & CONTACTS

CAMPUS CONTACT-HUMAN RESOURCES / FAX: 209.667-6536
Vickie Harrang, Leaves/WC Coordinator, MSR340, Phone: 209.664.6921

CLAIMS ADMINISTRATOR
Sedgwick Claims Management Services (CMS)
Adjuster: Yvonne Rivera - CSU Claims Unit
P.O. Box 14629, Lexington, KY 40512
Phone: 510.302.3041
Toll Free: 800.225.2998, Ext. 3041
Fax:       (916) 851-8089
Email: yvonne.rivera@sedgwickcms.com

INFORMATION AND ASSISTANCE OFFICER
California Division of Workers’ Compensation
31 East Channel Street, Room 450, Stockton, CA 95202
209.948.7980
                                                                                 Path; Vickie; benefits; WC; WC Info and Insturctions.doc;
                                                                                                                    Revised: 06/27/12VH

								
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