Workers' Compensation is an employer-paid benefit that provides an injured employee with medical, compensation, and supplemental job displacement voucher (SJDB) benefits if you are injured on the job or become ill because of your work.
If you or your employee suffers a work-related injury, please complete the Workers' Compensation forms on our website and contact Demond Blanton (cell 214-458-1368, or firstname.lastname@example.org) for a referral to one of our designated medical facilities. Employees injured after 5 p.m. or during weekends or holidays should seek medical care at the nearest emergency room.
For Injuries on the Job
Reporting My Injury
- Inform your appropriate administrator (chair/supervisor) about your injury as soon as you are able.
- Contact the Workers' Compensation & Loss Control Program Manager for a referral to one of our occupational clinics and to complete the Workers' Compensation claim paperwork: Demond Blanton (email@example.com).
- Complete the Work-Related Injury Reporting form (link below) and either hand-deliver to ADM 258 or fax to Enterprise Risk Management at (415) 338 - 0597. Please note the Work-Related Injury Reporting form contains Level I data and should not be attached to an email. The form must either be hand-delivered or faxed to Enterprise Risk Management
Medical Treatment for Injuries on the Job
Kaiser on the Job and Concentra Occupational Health are SF State's designated occupational health clinics. Please contact Demond Blanton, Workers' Compensation & Loss Control Program Manager at firstname.lastname@example.org for a referral.
Employees injured after 5 p.m. or during weekends or holidays should seek medical care at the nearest Emergency Room.
If an employee receiving Industrial Disability Leave benefits is released by the physician to full-time employment and subsequently loses work time for doctor’s appointments, physical therapy etc., such absences shall be charged to the employee’s leave credits consistent with CSU policy for reporting of absences for non-exempt and exempt employees.
It is the CSU’s policy that the first visit to a MD following an injury is not counted against sick leave.
Employee Return to Work
The Return to Work (RTW) Guidelines are designed to assist in providing temporary transitional work assignments to employees unable to perform their usual jobs due to temporary injuries and/or illnesses.
- The employee is responsible for immediately reporting their injury or illness to their supervisor/manager/chair.
- The employee must report to ERM for a referral to Kaiser on the Job (KOJ) or Concentra Occupational Health for medical treatment. The employee should continue to keep all medical appointments.
- OFF-WORK STATUS: If the physician takes the employee off work, it is the employee's responsibility to notify their department supervisor/manager/chair and the Workers' Compensation team of their work status. The employee must provide the Workers' Compensation team with a copy of the physician's work status report.
- LIGHT-DUTY WORK RELEASE: If the physician releases the employee to light-duty, it is the employee's responsibility to provide the Workers' Compensation team with a copy of the work status report detailing their work restrictions. A determination will then be made regarding the availability of light or modified work.
- FULL-DUTY WORK RELEASE: If the employee is released to full-duty work, the employee must provide the Workers' Compensation team with a copy of the doctor's release note before reporting to work.
- The employee is responsible for cooperating with the claims administrator and providing all documentation to the claims administrator on a timely basis.
The following procedures must be followed by the supervisor when a work-related illness or injury has occurred in the workplace.
1. Arrange for appropriate medical treatment for the employee.
2. Contact ERM to report the injury as soon as you have knowledge of the employee injury, and provide regular updates regarding the employee's work status.
Keep the Workers' Compensation team informed of all updates to the employee's work status, including: off duty status, releases to light and full duty work. Provide the Workers' Compensation team with copies of all reports and notes from the treating physician(s).
Note: Serious injuries and illnesses must be reported by ERM to Cal-OSHA within 8-hours of the supervisor’s knowledge of the injury, regardless of the day or time the Supervisor was notified. (After hours, contact UPD to report the injury.)
Cal/OSHA, defines a serious injury or illness as one involving
- inpatient hospitalization, regardless of length of time, for other than medical observation or diagnostic testing;
- loss of an eye; or
- serious degree of permanent disfigurement.
3. Complete the Supervisor/Manager/Chair section of the 'Employee's Report of Work-Related Incident, Injury or Illness' (page 2) .PDF. Fax a copy of the form to ERM (fax: 415-338-0597) as soon as possible, but no later than 24 hours from the date the injury is reported to the Supervisor. ERM will send the employee the DWC1 form after the injury is reported by the Supervisor.