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How to Report New Claims

Serious Injuries - Cal/OSHA Reporting Requirements for School Districts

Step 1:
Each Employee is responsible for immediately reporting their workplace injury/illness to their Supervisor.

Step 2:
If an EMERGENCY, DIAL 911 and get Employee treated, then contact Company Nurse On Call 24/7 Hotline at 1-888-375-9779 and give code “CSIG”.

Step 3:
If the Nurse determines medical treatment is needed, they will refer Employee to one of your district's designated Medical Facilities.

A. First Aid Advice Only The Nurse obtains information about the incident and will provide advice, which the Employee is to follow. The Employee may return full time to their regular position. If medical situation worsens or does not improve, the Employee is to call back Company Nurse for appropriate medical referral.

B. Medical Referral – If the Nurse determines medical treatment is needed, they refer Employee to your district's designated Medical Facility; Employee then goes to designated Medical Facility for treatment (unless they have pre-designated their personal physician prior to the injury).

Step 4:
Company Nurse transmits Supervisor's Report of Injury and Accident Investigation Form to District Claims Coordinator; District Claims Coordinator reviews and completes the Supervisor’s Report of Injury for missing data (i.e. wages, occupation, etc.) and completes New Claims Additional Information Required fax and sends fax to CCCSIG .

Step 5:
District Claims Coordinator emails the pre-populated Accident Investigation Form to the Supervisor. Supervisor completes their part and then emails or faxes the completed form to back to their District Claims Coordinator.

Step 6:
Employee returns copy of Work Status Slip to District Claims Coordinator:

    1. Release to full duty
    2. Released with Work Restrictions or limitations
    3. No release to work
    4. If work restrictions apply , the District Claims Coordinator will work to either modify the Employee's usual job or provide a Temporary Work Assignment , if possible and completing a Temporary Work Agreement for Work Related Injuries.

Step 7
CCCSIG will mail Employee a DWC-1 Workers' Compensation Claim Form to complete immediately to begin the claim process. State law requires that this form be provided to the Employee or a dependent within one (1) working day of receiving notice or knowledge of any injury being work-related.