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UCLA Home / Campus Services / Finance / Insurance & Risk Management

Article ID: 1003276         Send us your feedback about this article  View the print friendly version of this article
When There is a Workers' Compensation Injury

  1. Get the Injured Employee Medical Attention
    • OHF at 67-120 Center for Health Sciences at 10833 Le Conte Avenue. Call (310) 825-6771
      • 7:30 a.m. to 4:30 p.m. Monday - Friday
    • After OHF Hours use Emergency Medicine Center/EMC
      • 757 Westwood Plaza (ER entrance Gayley Ave, north of Le Conte)
    • Severe Injuries call 911*
      • Severe injuries and/or hospitalized overnight require an immediate call to Environment Health & Safety at (310) 825-9797.
       
  2. Complete: "UCLA Incident Report & Referral for Medical Treatment"
    • Employee and Supervisor complete and sign the top two sections. Send the form with the employee to OHF. The Doctor will fill out the bottom section. The Employee should bring back a completed copy. Please try to accommodate any temporary work restrictions. If you have questions call Transitional Return to Work Coordinator at (310) 794-6955.
  3. Give Employee, if the Injury is more than First Aid:
    • Workers' Compensation Claim Form (DWC-1) & Notice of Potential Eligibility
    • When an Injury Occurs Pamphlet
    • Complete the Workers' Compensation Claims Form (DWC-1) & Notice of Potential Eligibility
      • Supervisor completes the bottom section 9 through 17 and signs the form.
      • The Employee fills out the top section.
      • Give the Employee a completed-signed copy.
      • Keep a copy of the completed form for your department.
      • Send a copy to Payroll/Personnel
      • and... 
  4. Report Injuries within 24 hours to Insurance & Risk Management Fax(310) 794-6957 completed forms: UCLA Incident Report & Referral for Medical Treatment and Claim Form DWC 1

 After 5 p.m. Claim Report line  (310) 794-6948
 Workers' Compensation Coordinator  (310) 794-6952
 Workers' Compensation Manager  (310) 794-6954
 Transitional return to Work Coordinator  (310) 794-6955

Insurance & Risk Management
Email: info@irm.ucla.edu | Phone: (310) 794-6948 | Fax: (310) 794-6957 | Mail Code: 135248
Address
10920 Wilshire Boulevard, Suite 860
Los Angeles, CA 90024
   Office Hours
Monday – Friday 8 a.m. to 5 p.m.
Saturday & Sunday Closed

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