In compliance with California Workers’ Compensation Law, an employer must report all work-related injuries or illnesses arising out of and in the course of employment and covered by the California Workers’ Compensation System. To comply with this law, all supervisors should complete the necessary forms below within 24 hours of an incident occurring and adhere to the workers’ compensation procedures for supervisors.
Learn more about supervisor procedures and responsibilities.
Step 1: Supervisor's First Report FormStep 2: Incident Report FormInjury Reporting Procedure Workflow
Employees are covered for any injury/illness arising out of or in the course of employment. All job-related injuries or illnesses should be immediately reported to the employee’s supervisor and Risk Management at risk.management@csusb.edu.
Employees should complete the Workers' Compensation (DWC-1) Claim Form to initiate the claims process.
Note: Employees opting to complete the DWC-1 PDF form should send the form as an encrypted email to riskmanagement@csusb.edu.
Learn more about employee procedures and responsibilities.
Workers' Comp InsuranceOnline DWC-1 Claim FormDownload DWC-1 PDF
Procedures
Medical Facilities
Medical treatment is authorized by Risk Management when necessary. CSUSB has designated Healthpointe, Kaiser on the Job (any location), and Desert Urgent Care as medical facilities to provide medical treatment for injured employees. If an injury happens after normal business hours, notify the supervisor on duty. If a supervisor is not available, contact University Police to report and visit one of the below 24-hour medical facilities. If the injury was severe, call 911.
Contact Information
Note: If the Campus is closed for an extended period of time, employees may fax the completed DWC-1 Form to Sedgwick CMS at (916) 851-8089.
CSUSB Workers' Compensation Program Specialist
Jorge Chilin
Phone: (909) 537-3939
Email: jorge.jimenezchilin@csusb.edu
Sedgwick Claim Management Services (CMS)
Third Party (TPA) for the CSU Workers’ Compensation Program Alyssa Keller, Sedgwick CMS
Phone: (916) 852-2955
Fax: (916) 851-8089Email: alyssa.keller@sedgwick.com