What to Expect When You File a Workers' Compensation Claim
WHAT TO EXPECT WHEN YOU FILE A WORKERS' COMPENSATION CLAIM
- Employee submits a Report of Accident/Illness Report, Workers' Compensation Claim Form (DWC 1), Supervisor Report (completed by the Supervisor) to HR.
- Employee receives confirmation from Sedgwick CMS, CSUMB's workers' compensation carrier that a claims has been filed.
- The employee will be referred to the university's designated physician for treatment. If employee previously filed a Physician Pre-designation form in HR, the employee may choose not be seen by the university's designated physician.
- Sedgwick obtains medical information from the employee so as to gather past medical history and may send a representative to interview the employee and any witnesses.
- If deemed necessary, the employee is sent to a physician evaluator to determine if the illness is industrially related (arises out of or in the course of employment). The physician would receive the employee's past medical records and any other information that could be helpful in the exam and in making a determination.
- Sedgwick has up to 90 days from the date the claim is filed to accept or deny a claim. Employee will receive a written notification of the decision.
- If Sedgwick determines the claim is work related, the employee would be notified and the medical services would be paid through Sedgwick.
- According to CSU policy if an employee has returned to work but is still under the care of a physician and "an employee loses work time for doctor's appointments, physical therapt, etc., such absences shall be charged to the employee's leave credits".
- Labor laws provide protections against retaliation for filing a workers' compensation claim.
- Claim information will be handled in a confidential manner.
- If you choose not to file a claim, please fill out the Report of Accident/Illness/Incident so the campus can track incidents that happen. Submit to HR within 1 workday of the injury.
- You have the right to file a Workers' Compensation claim within on year from the date of injury.