REPORTING A WORK-RELATED INCIDENT
If an employee is injured or develops an illness during the course and scope of their employment at UC Irvine, including campus and UCI Health, the employee should inform their supervisor and get medical attention, if needed. The University is required by law to provide workers’ compensation benefits to employees free from retaliation if they are injured or become ill due to work related requirements.
HOW TO FILE A WORKERS’ COMPENSATION CLAIM AND OBTAIN CARE
CAMPUS
ACTIONS FOR EMPLOYEE
- Report Your Injury or Illness to Your Supervisor
Inform your supervisor (within 24 hours of the injury/illness) of your work-related injury or illness in one of the following ways:- In person
- By telephone
- By email
- Obtain Medical Care
If necessary, obtain immediate medical attention.IF YOUR INJURY OR ILLNESS IS LIFE THREATENING, DIAL 911 IMMEDIATELY OR GO TO THE NEAREST EMERGENCY ROOM
If your injury or illness is not life threatening, treatment may be provided at one of the following clinics by having your supervisor or department administrator contact the clinic directly to authorize treatment.
See AlsoCongratulations Anteater Engineering Class of 2024!UCI Human Resources | Talent Connect Change ManagementNewport Urgent Care
(949) 752-6300
1000 Bristol Street North, Suite 1-B Newport Beach, CA 92660-2906
View map and detailsUCI Medical Center Occupational Health Clinic
(714) 456-8300
101 The City Drive South Orange, CA 92868View map and detailsKaiser Occupational Health Center, Irvine
(949) 932-5899
Alton/San Canyon Medical Offices, Floor 1
6670 Alton Pkwy, Irvine, CA 92618
View map and detailsKaiser Occupational Health Center, Santa Ana
(714) 830-6660
Harbor-MacArthur Medical Offices
3401 S Harbor Blvd, Santa Ana, CA 92704
View map and detailsLong Beach Memorial Hospital Occupational Services
(562) 933-0085
1720 Termino Avenue, Long Beach, CA 90804
View map and details - Attend Follow-Up Appointments with the Worker’s Compensation Clinic
- Keep the Workers’ Compensation Unit and Your Supervisor Informed
Inform the UCI HR Workers’ Compensation Unit and your supervisor of any updates following each physician visit(s), when lost time transpires, when work restrictions are assigned, or if you have concerns and/or your condition worsens. - Accommodations and Return to Work
Your department will consult the UCI HR Disability Management Specialist regarding return to work. If your department is unable to provide modified alternate temporary work, it may be necessary for you to work within another department. After an appointment with the worker’s compensation provider, your supervisor will be notified of your work status. If the work status indicates work restrictions, and your department is unable to accommodate, the Disability Management Specialist will be notified and will look for a temporary alternate placement. In the event a temporary alternate location is not identified, the next reasonable accommodation would be a leave of absence.
ACTIONS FOR SUPERVISOR
- Employee section:
- Line 1 - employee n
- Employer section:
- line 12 - date when employee notified employer of incident.
- line 13 - the date on which the form was provided to the employee.
- line 17 - your signature
- line 18 - your title
- line 19 - your telephone number
- Make one copy of the partially completed DWC-1 form for your records and give the original to your employee.
- The employee is not obligated to return the DWC-1 form; however, if they do, they are notifying their employer that they are pursuing workers' compensation benefits. If the employee does return the form, the supervisor must complete:
- Employer section, line 14 - date when employer received claim form from employee.
- Email the form to Workers' Compensation unit at wcdm@uci.edu.
- Make a copy for your records and send the original, signed form to:
UCI Human Resources
ATTN: Workers' Compensation Unit
111 Theory
Suite 200
Irvine, CA 92697-4600Your employee should only complete DWC-1 if they are filing a claim for workers' compensation benefits, including obtaining medical care from one of our doctors.
UCI HEALTH
ACTIONS FOR EMPLOYEE
- Report the Injury or Illness to Your Supervisor
Inform your supervisor (within 24 hours of the injury/illness) of your work-related injury or illness in one of the following ways:- in person
- by telephone
- by email
- Obtain Medical Care
If necessary, obtain immediate medical attention.IF YOUR INJURY OR ILLNESS IS LIFE THREATENING, DIAL 911 IMMEDIATELY OR GO TO THE NEAREST EMERGENCY ROOM
UCI Medical Center Occupational Health Clinic
(714) 456-8300
101 The City Drive South Orange, CA 92868View map and detailsIf after hours or on the weekend, go to the nearest emergency room (ED). If seen in an emergency room, follow up with Occupational Health the next business day.
- Complete a DWC- 1 Claim or Incident Report
UCI Occupational Health (Orange) will provide a Workers’ Compensation Claim Form (DWC-1) for you to complete if you are obtaining medical treatment and pursuing a Workers’ Compensation claim.If you are NOT pursuing a Workers' Compensation claim, and not obtaining medical care, then you are only required to submit an incident report with Occupational Health for reporting purposes. UCI Occupational Health will email the incident report to mcwcdm@hs.uci.edu.
- Attend Follow-Up Appointments with UCI Occupational Health
- Keep the Workers’ Compensation Unit and Your Supervisor Informed
Inform the Workers’ Compensation unit and your supervisor of any updates following each physician visit(s), when lost time transpires, when work restrictions are assigned, or if you have concerns and/or the condition worsens. - Accommodations & Return to Work
Your department will consult the Disability Management Specialist regarding return to work. If your department is unable to provide modified alternate temporary work, it may be necessary for you to work within another department.After your appointment with Occupational Health, your supervisor will be notified of your work status. If your work status indicates work restrictions and your home department is unable to accommodate, the Disability Management Specialist will be notified and will look for a temporary alternate placement. In the event a temporary alternate location is not identified the next reasonable accommodation would be a leave of absence.
BENEFITS
MEDICAL AND HOSPITAL CARE
All authorized medical expenses are fully covered if care is received at one of the approved clinics. You are entitled to receive all medical and hospital treatment reasonably required to cure or relieve your work-related injury. There is no deductible or dollar limit. The insurance claims administrator pays these fees directly to the physician or health care facility, so you do not receive a bill.
DISABILITY PAYMENTS
Temporary Disability
These payments will be made according to state law and University policy. If hospitalized or unable to work more than three consecutive days you may be eligible to receive income equal to two-thirds of your average pay, up to a legal maximum per week. You may also be entitled to supplemental income. Contact your supervisor or the UCI Employee Experience Center (EEC) 949.824.0500 for further information.
Permanent Disability
If your injury results in permanent impairment that reduces your ability to compete in the labor market, you may be entitled to permanent disability indemnity benefits.
DEATH BENEFITS
If a work-related injury or illness results in death, benefits may be paid to your qualified dependents as provided by state law.
