Workers Compensation Information

Events, Injuries, and Illnesses Covered by Workers' Compensation

You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over). You may not be entitled to workers' compensation benefits for any injury that arises from your voluntary participation in any off-duty, recreational, social, or athletic activity that is not part of your work-related duties.

FOR EMERGENCIES PLEASE CALL 911

employee responsibilities

Immediately Inform Your Supervisor

Immediately inform your supervisor if you have a work injury or illness, accident, or near-miss. Reporting your injury promptly helps to prevent delays in receiving benefits, including the medical care you may need to prevent further injury.

Seek Medical Attention

For Medical Emergencies, go to the nearest Emergency Room.

If you need medical attention for an injury that is not an emergency, call and make an appointment at one of the following Kaiser Permanente On-the-Job San Rafael:

San Rafael Medical Offices:

99 Montecillo Road, MOB-2

San Rafael, CA 94903

Telephone: 415.444.2900

Communicate

Keep your supervisor and the Leave Manager updated on your status, recovery, and medical appointments. Submit all Work Status Reports provided to you during your medical appointment to your supervisor and humanresources@dominican.edu.

What to Expect After You File Your Claim

Learn what to expect after filing a workers comp claim by visiting Zurich Claims Reporting Tips and FAQs

Supervisor responsibilities

Assist Employee in Getting Medical Attention

Injured employees who have been determined to be 100% disabled by a medical provider are NOT allowed to work in any capacity.

Medical clearance is required before an employee returns to work. HR will notify the Supervisor of the employee’s return-to-work status.

The medical provider of an injured employee may impose restrictions and/or modifications on the employee. HR will work with the employee and the supervisor to determine if these restrictions and/or modifications can be accommodated.

Notify Human Resources

Immediately report workplace injury or illness, accident, or near-miss to Human Resources
Complete the Workers' Compensation Claim Kit within 24 hours.
Ensure employee completes Part 2 of the Claim Kit and submits the DWC-1 Form to Human Resources.

Address/Report the Hazard

Investigate the accident:

If repairs and/or maintenance are needed, please file a work order with Facilities immediately.
Do not discard equipment or furnishings that may have been involved in the incident.
Restrict people from the hazard area.
Remove equipment from service, but do not discard.
Take pictures as appropriate.

Complete Required Forms

Complete the Workers' Compensation Claim Kit within 24 hours of reporting your injury illness.
Find more information here: Workers' Compensation Policy Information
Complete DWC-1 Form and submit to Human Resources at humanresources@dominican.edu

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