For School Claims Administrators

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CLAIM REPORTING PROCEDURE

 

This guide provides complete instructions and forms to assist you with reporting injuries at work.  Administering Workers’ Compensation claims can be complicated, and we encourage you to call your claims contacts with any questions or concerns that may arise.

 

It is most important to remember that time is of the essence in Workers’ Compensation!  Under California law, within 24 hours of receiving notice of an employee injury, employers must provide a claim form to the employee and have the employee sign the Acknowledgement of Receipt of Employee Claim Form.  Once the employee returns the claim form or wishes to seek medical treatment, you must submit an Employer’s First Report of Injury (Form 5020) to Acclamation Insurance Management Services (AIMS).  To locate these forms, click here.

 

Employers gained the legal right to lifetime control of medical care for their injured employees last year.  It is now imperative that you direct your injured employees to your designated clinic.  Please take a moment to review the list of designated clinics for your school site so you won’t be caught off guard during your first reporting experience. For list of designated SIG clinics, click here.

 

Our group’s success depends upon each member’s active involvement throughout the process by following reporting procedures and meeting deadlines that are required by law, and by helping your employees through the process with an attitude of respect and dignity.

 

 

 

 

Notice of Injury

The employer may receive notice of an injury from many sources, i.e. the injured employee, a co-worker, a supervisor, treating physician, or family member.

 

When the employer receives notice of an injury and the injured worker does not feel they need to seek medical treatment, the following procedure must be followed within one (1) working day:

 

1. The employer must provide the Claim for Worker’s Compensation Benefits
    (DWC-1 form) to the employee within one working day from their
    knowledge.

2. The employee must sign and date the Acknowledgement of Receipt of
    Employee Claim Form when the employer provides the employee with the
    DWC-1.

3. The appropriate supervisor should complete the Supervisor’s Report of
    Injury.

 

The above should be kept in the employee’s file until they return the DWC-1 form or wish to seek medical treatment.

 

NOTE: The above procedure is for “first aid” only claims. This is usually for a minor cut, scrape etc.

 

IF THE INJURY involves a back, knee, shoulder or upper extremity injury, it is strongly recommended the employer have the injured complete the DWC-1 and seek medical treatment.

 

To print a copy of the DWC-1 & Receipt, click here.

To print a copy of the Supervisor’s Report of Injury, click here.

 

When the employer receives notice of an injury and the injured worker requests medical treatment, the following procedure must be followed within one (1) working day:

 

1. The employer completes lines 9 – 17 of the DWC-1 (Employee’s Claim for
    Workers’ Compensation Benefits) and gives the DWC-1 to the employee.

2. The employee must sign and date the Acknowledgment of Receipt of
    Employee Claim Form when the employer provides the injured worker with
    the DWC-1.

3. The employee completes lines 1-8 of the DWC-1, he/she should be given
    the green copy of the DWC-1 and the employer should retain remaining
    copies.

4. Once the employee returns the DWC-1, the employer is to contact the
    medical clinic and authorize the employee to be seen. The employer will
    provide directions to the clinic to the employee and send him/her to the
    medical clinic for an evaluation.

5. The appropriate supervisor should complete the Supervisor’s Report
    of Injury.

6. The employer completes the Employer’s Report of Occupational Injury or
    Illness (Form 5020).

 

           * ABOUT ON-LINE 5020 Claims Reporting

           (Employer Report of Occupational Injury Form)

 

To sign up to submit this form online, go to www.aims4claims.com.  This web page has the sign up form as well as information about the process. When asked for employer group, please enter your district name.  If you are unable to use the on-line 5020, you will need to fax your written forms to Acclamation Insurance Management Services (AIMS) (916) 563-1919.

7. The employer sends all of the above to AIMS.
    The employee should get a copy of the DWC-1 & Receipt, and the
    employer should retain a copy of all information for their file.

 

 

Please note:

 

If the employee is not available, the employer must personally deliver the DWC-1 or send by certified mail within one (1) working day.

Due to state-mandated timeframes it is imperative that information be provided to Acclamation Insurance Management Services (AIMS) as soon as possible.

 

If you have any questions or concerns about the validity of a claim, please contact your assigned claims examiner to discuss as additional information may be necessary.

 

If you have any questions regarding these procedures, please contact your assigned claims examiner.

 

Please instruct your employee to return the clinic status report to you after the visit so you can determine what work will be appropriate while he or she is healing from the injury.  For a complete overview of the SIG Return-to-Work Program, Click here.

 

Your school district has committed to sustaining a safe, productive work environment that provides injured workers a clear opportunity to build physical capacity, strength and stamina after a work injury.  When your injured employee returns from a medical appointment with restrictions, the school site contact or the District Office Coordinator should work with the employee’s supervisor to see if they will be able to modify the regular job to fit the workers restrictions, or if they will need to assign a Bridge assignment that will not violate the worker’s medical restrictions.  The employee should be given (or mailed) a “Report to Work” letter to document the job offered, and the date the job was offered to the employee.  If the employee accepts the job and returns to work, he/she should be given an “Employee Responsibilities” during a Work Comp Injury or Illness document to read and sign.  To print out a sample letter and an Employee Responsibilities document, Click here.

 

You must contact your examiner at Acclamation Insurance Management Services (AIMS) immediately upon knowledge that your worker is off work so they can adjust benefit payments accordingly.

 

If you need help with any aspect of your Return-to-Work program, contact Jaxine Anderson, the Return-to-Work Coordinator at SIG.  (530) 823-9582, extension 205.

 

 

POSTING AND EMPLOYEE NOTIFICATION REQUIREMENTS

 

You are Required to Post a Notice on Workers’ Compensation in a Conspicuous Location

 

Labor Code Section 3550 states that every employer shall post and keep posted in a conspicuous location frequented by employees, and where the notice may be easily read by employees during the hours of the workday, a notice which shall state that the employer is self-insured and the name of the claims administrator.

 

•  Failure to post the required notices in a conspicuous place shall
   constitute a misdemeanor, and shall automatically allow an
   employee to treat with his or her personal physician for an injury
   occurring while the notices are not posted.

 

The posters are just one way of communicating to your employees the location of the pre-designated treatment facility. The notice shall also include information about where and how to get emergency medical treatment as well as medical treatment, benefits, right to select and change treating physicians, and to whom an injury should be reported.

 

Be sure new hires know where this information is posted and understand the contents of the poster in case of an injury. Go over this information periodically at staff meetings to refresh everyone’s awareness of this information and the importance of preventing and reporting injuries.

 

You Are Required To Provide Information about Rights, Benefits and Obligations of Workers’ Compensation to Every New Employee

 

Labor Code Section 3551 states that every employer shall provide to every new employee, either at the time of hire or no later than the end of the first pay period, information concerning the rights, benefits and obligations under Workers’ Compensation laws.

 

The pamphlet shall be in writing, in non-technical terms and shall include information regarding the scope of coverage, their rights to medical care, indemnity benefits and vocational rehabilitation, the procedures for reporting accidents and injuries, and where additional information can be obtained.

 

 

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