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Requesting Workers Compensation Benefits
Submitting the Employee/Volunteer Report of Injury/Illness form does not mean workers’ compensation benefits is being requested. This form is used to assist with identifying the potential safety hazard and developing protocols to attempt to prevent the incident from reoccurring.
After receiving the Employee/Volunteer Report of Injury/Illness form, the Workers' Compensation Coordinator will follow up with the employee to confirm if medical treatment beyond first aid is needed.
If medical treatment exceeds first aid treatment at the initial or subsequent medical visits, Workers' Compensation will provide the employee with the State of California Workers' Compensation Claim Form (DWC-1).
First aid treatment may be appropriate treatment and is not considered a workers' compensation benefit even though first aid costs will be paid by the University.
Employee Request for Workers' Compensation Benefits
Please visit the Workers' Compensation Forms page to complete the Workers' Compensation Claim Form (DWC-1 and sign the Employee portion of the form. Be sure to describe the injury or illness completely and include the affected body part(s). Employees should remember to make a copy for their records.
If a form is mailed to you, please complete, sign and return the original to:
Human Resources Management
1000 East Victoria Street
Carson, CA 90747
Please remember to make a copy for your records. Or you may submit your form to our Workers' Compensation Secure Dropbox.
