Workers' Compensation Claim Procedure Modification

Modifications have been made to the workers’ compensation claim procedures. These changes will assist in both the disability management process and provide the employee and supervisor with a resource for any questions that may arise.

Please note the following revisions to the "Workers’ Compensation Procedures for Supervisors”

• If an employee elects to file a claim, the claim form (DWC-1) should be hand   delivered to the Workers’ Compensation Specialist, Kari Dom, in Human   Resource Services, University Hall Room 185. Claim forms can be obtained   through the supervisor or Kari. Kari will complete the bottom portion of the   form and explain the claim process to the employee.

• Copies of all disability slips should be faxed immediately to Kari at ext. 7270.

• Upon an employee being released with restrictions, the medical report should   be hand delivered to Kari and a meeting should be scheduled with the   employee, the supervisor,and Kari to develop a Transitional Employment Plan.

All other procedures/forms remain unchanged. Supervisors will continue to fill out the Supervisor’s Accident Investigation Report (EH&S form 620) http://www-admn.csun.edu/ehos/forms/supervisor_accident_rpt.htm, and send one copy to EH&S (Maildrop 8284) and one to Human Resource Services (8229).

The Supervisor's Accident Investigation Report Guide http://www-admn.csun.edu/ehos/forms/supervisor_guide.htm will provide specific directions for filling out this form.

• Employees will continue to seek treatment at US Healthworks for all injuries   resulting in treatment beyond first aid.

• Questions regarding workers’ compensation issues may be directed to Kari   Dom at ext 3351.