What are the procedures to report a work-related injury, illness, or accident?

Resources

Employee How-To: Report a Work-Related Injury, Illness, or Accident

Supervisor How-To: Report a Work-Related Injury, Illness, or Accident

 Incident Report
Claim for Workers' Compensation Benefits form (DWC - 1)

ANSWER

Employees: Reporting a work-related injury, illness, or accident

If an employee is injured or develops a job-related illness as a result of employment at UC Irvine, they are to inform their supervisor, obtain medical attention, and complete the Incident Report and the Claim for Workers’ Compensation Benefits form.

The reporting process:

  1. Report the injury or illness to supervisor and/or department administrator (i.e., Department Benefits Representative - DBR).
  2. If necessary, obtain immediate medical attention.
  3. Submit an online Incident Report.
  4. Supervisor/department representative must provide the Claim for Workers' Compensation Benefits form (DWC-1) to the employee.
    1. If employee is NOT pursuing a workers' compensation claim, the employee *keeps the DWC-1 for their records.
    2. If initiating/pursuing a claim, the employee will complete employee section and sign their portion of the Claim for Workers’ Compensation Benefits form (DWC-1) and return to the supervisor.
  5. By completing the online incident report, this action, timely notifies EH&S of work-incurred hospitalization or death.

Supervisors: Reporting an employee's work-related injury, illness, or accident

If an employee is injured or develops a job-related illness as a result of employment at UC Irvine, they are to inform their supervisor, obtain medical attention, and complete the Incident Report and the Claim for Workers’ Compensation Benefits form.

The reporting process:

  1. Ensure employee is aware of their reporting obligation.
  2. If necessary, assist employee in obtaining medical care.
  3. Assist employee with submitting an online Incident Report.
  4. Supervisor/department representative must provide the Claim for Workers' Compensation Benefits form (DWC-1) within one working day to the employee.
    1. If employee is NOT pursuing a workers' compensation claim, employee keeps the DWC-1 for their records.
    2. If initiating/pursuing a claim, the employee will complete employee section and sign their portion of the Claim for Workers’ Compensation Benefits form (DWC-1) and return to the supervisor.
  5. Environmental Health & Safety Unit (EH&S) must be notified of a work-incurred hospitalization or death.

SUPERVISOR FOLLOW-UP

  • Show your employees you care
  • Educate your employees about their duty to report incidents or accidents
  • Pave the way for a smooth return to work
  • Provide transitional work to keep employees working and connected to the workplace
  • Cooperate with Sedgwick in their investigation of claims
  • Be sure to act immediately when you become aware of a possible claim

Common Workers' Compensation Questions

Definitions

Required benefits include:

  • Medical Treatment
  • Temporary Disability Benefits
  • Permanent Disability Benefits
  • Supplemental Job Displacement Benefit/Voucher
  • Death Benefits

The Division of Workers’ Compensation (DWC) monitors the administration of workers’ compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits. DWC’s mission is to minimize the adverse impact of work-related injuries on California employees and employers.

False claims and false denials - Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers' compensation benefits or payments is guilty of a felony and may be fined and imprisoned.