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​​​​​​​​5.2.8 Work Related Injury or Illness

​​​​​​​All staff are responsible for individual safety.  Employees are required to report pr​omptly—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.  For serious injuries call 911.​​  If the injured or ill pers​on requires medical ​​attention​, the person in charge should review the Wellcomp list of medical providers on the website: Select Option ( or call 800-544-8150 to arrange to send that person to a convenient medical facility that treats workers compensation injuries. ​​​

In the event of a work-related injury or illness, the employee must be given the Workers' Compensatio​n Claim Form (DWC 1) within twenty-four (24) hours of the location's knowledge of the injury or illness. 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 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 Employ​​er's Report of Occupational Injury or Illness (Form 5020)​. Form 5020 along with the DWC 1 must be submitted via fax to 866-842-1709 or email at​. ​ In addition, 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​.

​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 Workers Compensation.​

3-8-2021​, 3-19-21​, 3-22-21