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Workers' Compensation


Policy

Workers’ Compensation Insurance Benefits are designed to guarantee medical care for injured workers and to help pay for lost wages caused by the injury if the employee is unable to work and is temporarily or permanently disabled. Mt. Diablo Unified School District (“District”) contracts with a third party administrator (LWP) for the management of its claims.

 

What To Do If You Are Injured At Work (Employee)

  • Report your injury to your supervisor or office manager immediately.
  • Complete an  Employee Report of Injury  form.
  • If you wish to seek medical treatment, complete DWC 1 form and have your supervisor sign it.
  • Review “Workers’ Compensation What To Do If You Are Injured at Work” brochure for a list of our health care providers.
  • Submit all forms as a PDF document immediately to workerscomp@mdusd.org or fax to 925-680-2505. Originals must follow via District pony mail.
  • Once you have seen one of the doctors from our healthcare providers list, the work status report needs to be sent to workerscomp@mdusd.org or faxed to 925-680-2505.

Please note if you do not plan to open a workers’ comp claim and just need to make a report of injury check box #9 on the Employee Report of Injury form and do not complete a DWC1 form. You have one year to file a claim from the date of injury.

 

What To Do If Your Employee Is Injured At Work (Supervisor)

  • Once you have received notice of an employee injury provide the employee with the Employee Report of Injury form and DWC 1 form to complete. The DWC 1 form is only completed if employee is opening a claim and is going to the doctor.
  • Explain to the employee that they have the right to file a Workers’ Comp Claim and receive medical care.
  • Give the employee the blue brochure entitled “Workers’ Compensation What To Do If You Are Injured at Work” for a list of our healthcare providers.
  • Complete the Supervisor Report of Injury form. If a DWC 1 form is completed by employee, the supervisor needs to complete questions #12, 13, 14 and sign the form.
  • Submit all forms as a PDF document immediately to workerscomp@mdusd.org or fax to 925-680-2505. Originals must follow via District pony mail.