5.2.8 Work Related Injury or Illness
All staff are responsible for individual safety. If an injury is serious, call 911. Employees are required to report promptly—within twenty-four (24) hours at most—to the person in charge any accident, injury, or illness that is work-related even if the injury does not appear to be serious.
Clinical Consultation Process: To assist in responding appropriately to work-related injuries, the archdiocese has contracted with Sedgwick to provide clinical consultation by telephone with a registered nurse at 855-578-1451 option 2. An injured or ill employee-- with or without the assistance of the person in charge -- should call the nurse. The nurse will make an initial assessment of the injury; answer clinical questions; and provide the most appropriate care recommendations. When the call is finalized, the nurse will initiate the claim reporting process for the location.
In addition, within twenty-four (24) hours of the location's knowledge of the injury or illness, the person in charge must give the employee the
Workers' Compensation Claim Form (DWC 1) . The employee must complete the DWC 1 and return it promptly to the person in charge. The person in charge must complete the employer portion of the form. The DWC 1 along with the Form 5020 must be sent to Sedgwick's paperless system via fax to 5020/DWC at 844-346-1322 or email to Sedgwick Paperless Workers Comp Mailbox at ADLA-WCDocs@sedgwick.com.
For persons in charge additional information about the clinical consultation process is available in this 8-minute training video.
Note: If an employee has already received emergency, urgent or occupational care, the clinical consultation process is not available. In that event, the location must initiate the claim reporting process without clinical consultation for the injured employee (see below).
Process Without Clinical Consultation: If the clinical consultation process is not used, the person in charge must report the claim to Sedgwick within twenty-four (24) hours of his or her knowledge of the injury or illness, whether or not the injury or illness causes time lost from work or requires medical treatment, by completing and submitting the
Employer's Report of Occupational Injury or Illness (Form 5020). In addition, the person in charge must give the employee the Workers' Compensation Claim Form (DWC 1) to complete and return promptly. Then, the person in charge must complete the employer portion of the form. Both Form 5020 and the completed DWC 1 must be submitted via fax to 866-842-1709 or email to Sedgwick New Claim Setup at email@example.com.
Additional guidance is in the Workers Compensation Instruction Sheet - English and Workers Compensation Instruction Sheet - Spanish. See also the Facts About Workers' Compensation in English and Spanish, Employer's Report of Occupational Injury or Illness (Form 5020), Workers' Compensation Claim Form (DWC 1).
Immediate report of serious illness or death to Cal/OSHA: If a serious injury, serious illness, or death of an employee occurs in a place of employment or in connection with any employment, California requires the employer to report immediately -- within eight (8) hours -- to the nearest District Office of the Division of Occupational Safety and Health (Cal/OSHA); see
Reporting Work-Connected Injuries. For additional information see Responding to an Injury.
Return to Work: If an employee is released to work with restrictions, the person in charge may provide transitional work (light duty) whenever appropriate and/or engage in the interactive process to discuss reasonable accommodations. Contact the
Human Resources Department for an evaluation and recommendation.
Making knowingly false or fraudulent material statements or material representations for the purpose of obtaining or denying workers' compensation benefits or payments is a felony that can result in fines and/or imprisonment.
The archdiocese may not be liable for payment of workers' compensation benefits for any injury or illness that arises from a staff member's voluntary participation in off-duty, recreational, social, or athletic activity that is not part of the staff member's work-related duties.
Additional information on how to respond to an injury, illness, or accident can be found in
Health and Safety. Contact the Insurance Department at 213-637-7430 for assistance or further details on how to report a work-related injury or illness.
See also Workers Compensation.3-8-2021, 3-19-21, 3-22-21, 5-10-2023