Work Related Injury or Illness?
Injury Reporting:
Employer, within 24 hours of knowledge of claim, report workers’ compensation accident directly to your workers’ compensation carrier, in addition, you may notify your InterWest Insurance Services WC Claims representative.
Employer Forms:
- “Employer’s Report of Occupational Injury or Illness” – (5020) – complete within 5 days (required by law) of knowledge of claim
- “Supervisor’s Report of Injury or Illness“
- “Injury and Illness Incident Report” for Cal/OSHA recordable injury and illness’ use Cal/OSHA Form 301 – complete within 7 days after you receive information that a recordable work-related injury or illness has occurred
- “Injury and Illness Incident Report” for Federal OSHA recordable injury and illness’ use OSHA Form 301 – complete within 7 days after you receive information that a recordable work-related injury or illness has occurred
Employee Forms:
- “WC Claim Form” DWC-1 – must provide within 24 hours of notice of injury
- “Consent for Release of Medical Information” (carrier specific)
- “Employee Refusal of Medical Treatment” (carrier specific)
Emergency Care:
In the case of emergency, direct injured employee (s) to go to the nearest healthcare provider. Once condition is stable, contact your Medical Provider Network (MPN) you have established with your workers’ compensation carrier. If you are not certain of your MPN, contact InterWest Insurance Services or the California Division of Workers Compensation website provides the information on all carrier networks: Medical Provider Network (MPN)
First Aid Treatment:
Definition of First Aid: “Any one-time treatment, and any follow up visit for the purpose of observation of minor scratches, cuts, burns and splinters, or other minor industrial injuries, which do not ordinarily require medical care. This one-time treatment, and follow-up for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel” [CA Labor Code LC5401(a)]. Ask us how we can help you implement a 24/7 Workplace Injury Reporting and Nurse Advice Service.
When Do I Contact CAL/OSHA?
Contact the Division of Occupational Safety and Health’s Cal/OSHA enforcement unit immediately if employee’s injury was serious [requires hospitalization, amputation] or resulted in death. [CA Labor Code LC6409.1(b)] If you are unsure if this is a serious injury, inquire with your insurance carrier claims representative immediately.
Prior to Loss:
Provide all covered CA employees the following documents at the time of hire from your workers’ compensation insurance carrier:
- “Medical Provider Network Acknowledgement”
- “Covered Employee Notification of Rights”
- “Written Notice to New Employees”
- Post a copy of the “Covered Employee Notification of Rights” next to the required: “Notice to Employees- Injures Caused by Work” – DWC7 posting notice.
BE SAFE.
PRACTICE WORK PLACE SAFETY.
SAFETY IS EVERYONE’S CONCERN.
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