An Injury Happens - What Do You Do?

The Labor Code imposes strict time limits for filing Workers’ Compensation claims; however, PROMPT reporting will ensure immediate and proper delivery of benefits for any injury found compensable under the Workers’ Compensation laws.

It is absolutely essential that YOU take the following basic actions immediately upon being injured:

For EMERGENCY Situations:

If you are physically unable to make a decision about your condition, or your supervisor has been instructed to call 911 for an emergency response team. Or, you may request that 911 be called should your condition warrant this level of response.

The use of Emergency Facilities and Emergency Personnel should be limited to situations that are life threatening or which involve a severe injury needing the level of care of a hospital Emergency Department. The County’s Medical Panel is comprised of facilities whose hours of operation and capabilities are such that you can obtain immediate and appropriate medical treatment faster than if you go to an Emergency Room for an injury that is not life threatening. Note: incorporated into the Medical Panel are the addresses and phone numbers for many of the 24-hour Emergency Facilities located throughout the County. In an emergency situation you should go to the nearest emergency facility.

As soon as you are able, you must follow the reporting procedures outlined below under Non-Emergency Situations.

For Non-Emergency Situations:

1. NOTIFY YOUR SUPERVISOR IMMEDIATELY. If your supervisor is unavailable, contact a Manager. If you do not have a Workers’ Compensation Benefits Package, ask your supervisor or Payroll Clerk where you can get one.
2. Complete and sign the enclosed EMPLOYEE CLAIM FORM and SUPERVISOR'S REPORT OF INJURY with your supervisor, pull your copy, then forward the original to your Payroll Clerk. Your Payroll Clerk will complete an Employer's Report of Occupational Injury or Illness (Cal-OSHA 5020) and forward all three forms to Risk Management.
   1. If no authorized person is available to sign your EMPLOYEE CLAIM FORM,  you should pull the last copy as your temporary receipt, fax a copy to Risk Management at 650/363-4864 and forward the remaining copies to your supervisor or Manager for completion as referenced above.
   2. Only Risk Management staff, Managers, supervisors, Lead Persons and Payroll Clerks are authorized to sign the Employee Claim Form as the Employer’s Representative. A co-worker is not authorized.
   3. Failure to promptly notify your supervisor and complete your EMPLOYEE CLAIM FORM could adversely affect delivery of your benefits.

If you do not need medical treatment right after the injury, but decide later that you do need treatment, you must follow the County’s procedures regarding authorized physicians/facilities. You should always notify your supervisor of the incident. The supervisor can complete the Supervisor's Report of Injury and mark it "INCIDENT ONLY" and forward a copy to Risk Management if you do not need medical care.

If you do need medical treatment it can only be provided by a physician/facility listed on the County’s Medical Panel except if, and only if, you have processed a Predesignation form naming your personal physician prior to the date of the injury in question. In either event, review the County Medical Panel. Note that the Panel has been separated into Orthopaedic and Nonorthopaedic injury types. When selecting a medical provider you should first consider which type of injury has happened and select the provider best prepared to treat that type of injury.

Whether you obtain medical treatment from a Panel Physician or your Predesignated Physician you must obtain a Physician’s Statement which discloses the following information:

1. date of injury;
2. treatment date;
3. brief diagnosis;
4. whether you are being returned to work with a full release to your usual and customary duties, returned to work but with specified limitations, OR disabled;
5. date of follow up appointment.

Contact Your Supervisor and Payroll Clerk

 Immediately after leaving your treating physician’s office, advise your supervisor and your payroll clerk of your Physician’s Statement orders. If the physician has returned you to full or modified duty, you must report back to your supervisor with the form. If you are on Temporary Disability, notify your supervisor and arrange to submit the Physician’s Statement. If you have not yet processed your EMPLOYEE CLAIM FORM, do so NOW. If the physician has returned you to work or has returned you to full or modified duty, you must report back to your supervisor with the form. If you are on Temporary Disability, notify your supervisor and arrange to submit the physician’s statement.

If Your Physician Places You on Disability

Complete a DLWP request form (one has been provided in your Benefits Package) and submit it with the original Physician’s Statement which attests to your disability. You must complete this step after each visit to your physician which results in an extension of your disability period. It is imperative that you keep in contact with and submit the appropriate paperwork to your supervisor AND Payroll Clerk during periods of disability until you return to work