Employee & Supervisor Injury Information
If You Are Hurt on the Job, You Should:
Report the Injury To Your Supervisor: Report any workplace injury or illness to your supervisor immediately. If your injury or illness developed gradually (like tendonitis or hearing loss), report it as soon as you learn it was caused by your job. Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need to avoid further injury.
Get Medical Treatment:
Emergencies: call 911 from a campus phone or (818) 677-2111 from a cell phone.
First Aid only: you may seek care at the CSUN Klotz Student Health Center: Examples of first aid include minor injuries, illnesses, cuts, scrapes, scratches.
Treatment beyond first aid: go to USHealthWorks in Chatsworth, CA for Urgent Care, Occupational Medicine, Physical Therapy or the Medical Center.
US HealthWorks Medical Group
9700 De Soto Avenue Chatsworth, CA 91311
Phone: (818) 882-8100
Fax: (818) 700-8255
(If you already have a Personal Physician Designation form, on file in Human Resources, you may seek treatment with that doctor.)
If You Will Need Treatment Beyond First Aid, complete the Employee's Claim for Workers' Compensation : Your supervisor will have given you this form within one working day of learning about your injury or illness. This is required to request workers' compensation benefits. Fill out and sign the employee portion of the claim form. Describe your injury completely. Include every part of your body affected by the injury. Give the form to your supervisor. You have now "filed" a claim.
Participate With The Accident Investigation. The cause of your injury or illness needs to be determined by a thorough investigation by your supervisor and Environmental Health and Safety. The purpose of this investigation is to identify and locate accident causes and not to place blame. Accident investigation can uncover hazardous equipment or materials and helps the supervisor make engineering or work practices changes.
Keep All Medical Appointments. You are expected to keep all medical and therapy appointments or promptly notify the medical facility and supervisor and/or the Workers’ Compensation Specialist of schedule changes. After treatment by a doctor, clinic or hospital, you should provide the medical work status slip to your immediate supervisor or the Workers’ Compensation Specialist. During convalescence, you may be asked to respond to inquiries from the supervisor, the Workers’ Compensation Specialist or Claims Administration. You should maintain accurate records of visits to medical facilities and time away from the job to assist with wage adjustments. You are expected to provide medical status reports periodically or when requested by the supervisor, the Workers’ Compensation Specialist or the claims administrator.
When You are Released to Return to Work:
Injured Employee Returning-to-Work Without Restrictions: If you are released by the physician to return to your regular duties, without limitations, you must obtain from the physician a written release to return to full duty. You must fax or email a copy to the Workers’ Compensation Specialist & your supervisor in advance of your return to work. It is your responsibility to provide the release to return to work prior to the date of return.
Injured Employee Returning-to-Work with Restrictions: If the physician releases you to "modified" or "light" duty work, your manager and the Workers' Compensation Specialist will review the work restrictions and work with your department to determine if temporary modified work is available. If a temporary transitional plan is feasible, the supervisor and the Workers’ Compensation Specialist will meet with you to go over the temporary plan and to review the work restrictions prescribed by the physician.
Procedures for Supervisors:
It is your responsibility to ensure the previous first four steps are completed and provide the Employee's Claim for Workers' Compensation Benefits to the employee as well as fax or scan the Supervisors Accident/Illness Investigation Form to both Environmental Health & Safety and the Workers’ Compensation Specialist within 24 hours of the incident. See contact information below.
Supervisors Accident Investigation Report for Employee Injury: The supervisor completes the Supervisors Accident/Illness Investigation Form for every reported employee incident or injury/illness occurring on-the job. It should be completed through a one-on-one discussion of the circumstances that caused the accident so that workplace conditions or work practices that contributed to the accident can be corrected. For guidance with completing the form, see the Supervisor's Accident Investigation Guide.
State of California "Employee's Claim for Workers' Compensation Benefits" Form: For all incidents, the Employee's Claim for Workers' Compensation Benefits form must be given to the injured employee within 24 hours of the employer's knowledge of the injury/illness, according to state law. The form spells out the benefits an injured employee may be entitled to receive. To meet the time requirement, it may be necessary to mail the form to the injured employee. It is up to the injured employee to complete the form and return it to management for completion, if additional medical treatment is necessary. Additionally, when future medical treatment is necessary, this form must be provided to the Workers’ Compensation Specialist along with the Accident Investigation Report within 24 hours of incident.
Work Status Slip (Doctor's Note) This is the note from the treating doctor, clinic or hospital reporting on the injured employee's medical condition, required treatment and return to work status. The university requires a release from the treating doctor whenever an injured employee returns to work following an injury. Copies of the work status slip are supposed to be sent to the supervisor and the Workers’ Compensation Specialist to verify time off for an injury on the job.
Karyn Coté, Workers’ Compensation Specialist
Phone: (818) 677-3351
Fax: (818) 677-7270
Environmental Health & Safety
Phone: (818) 677-2401
Fax: (818) 677-5853
Susan Neville, Sedgwick Claims Examiner
Phone: (916) 636-4455
Fax: (919) 851-8089