Notice to Employee - Injuries Caused by Work
Workers’ Compensation Benefits
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 illness. 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). Coverage may not be provided for any injury arises from your voluntary participation in any off-duty, recreational, social or athletic activity that is not part of your work-related duties.
Workers' Compensation Benefits Include:
- Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat your injury. You should never see a bill. For injuries occurring on or after 1/1/04, there is a limit on some medical services.
- Temporary Disability Benefits: Payments if you lose wages while recovering.
- Permanent Disability Benefits: Payments if your injury causes a permanent disability.
- Vocational Rehabilitation: Services and payments if your injury prevents you form returning to your usual job or occupation. This benefit applies to injuries that occurred prior to 1/1/04.
- Supplemental Job Displacement Benefit: A nontransferable voucher payable to a state approved school if you are injured on or after 1/1/04, the injury results in a permanent disability, you don’t return to work within 60 days after Temporary Disability ends, and your employer does not offer modified or alternative work.
- Death Benefits: Paid to dependents of a worker who dies from a work-related injury or illness.
Naming Your Own Physician before Injury
You may choose the doctor who will treat you for a job injury or illness during the first 30 days after the injury. You must tell your employer, in writing, the name and address of your personal physician before you are injured. For instructions, see the written information about workers’ compensation that your employer is required to give new employees at the new employee orientation.
If You Get Hurt
Get Medical Care
If you need first aid, contact your employer. If you need emergency care, call for help immediately. Emergency phone numbers:
- Ambulance: 911
- Fire Dept: 911
- Police: 911
- Doctor: 911
- Hospital: 911
- Other: 911
Report Your Injury
Report the injury immediately to your supervisor or to: Employer representative Xiaodong Zhu Phone number (707) 664-2664
Don’t delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you a claim form within one working day after learning about your injury. Within one working day after an employee files a claim form, the employer shall authorize the provision of all treatment, consistent with the applicable treating guidelines, for the alleged injury and shall continue to provide treatment until the date that liability for the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000).
See Your Primary Treating Physician (PTP)
This is the doctor with overall responsibility for treating your injury or illness. If you named your personal physician before injury (see above), you may see him or her for treatment in certain circumstances. Otherwise, your employer has the right to select the physician who will treat you for the first 30 days. You may be able to switch to a doctor of your choice after 30 days. Special rules apply if your employer offers a Health Care Organization (HCO) or after 1/1/05, has a medical provider network. Contact your employer for more information.
Discrimination
It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person’s workers’ compensation case. If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state.
Questions?
Learn more about workers’ compensation by reading the information that your employer is required to give you at new employee orientation. If you have questions, see your employer or the claims administrator (who handles workers’ compensation claims for your employer).
Sonoma State University Workers' Compensation Administrator
Sedgwick Claims Management Services, Inc.
P.O.Box 2078
Oakland, CA 94504-0078
Telephone: 1-800- 225-2998
Fax: 510-817-3332
Information and Assistance
You can get free information from a state Division of Workers’ Compensation Information & Assistance Officer. The nearest Information & Assistance Officer is at:
50 D Street
Santa Rosa, Ca
Phone (707) 576-2452
Hear recorded information and a list of local offices by calling toll-free (800) 736-7401. Learn more online.
False Claims and False Denials
Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony and may be fined and imprisoned.