Workers' Compensation Program

If you become ill or are injured because of your job, you may be entitled to Workers' Compensation benefits. This coverage includes the cost of all reasonable medical care and/or hospital bills, wage compensation benefits if you are temporarily disabled, permanent disability benefits and vocational training.

For life threatening emergencies, call 911 from a campus phone or 805-756-2281 from a cell phone and your call will be directed to the University Police Department.

If you become injured or ill, you must notify your supervisor immediately. Your supervisor will complete the Work Related Injury/Illness Form and provide to you the Claim Form DWC 1 within 24 hours of their knowledge of your injury/illness.

All CSU work related injuries/illnesses are managed by a third party adjustor, Sedgwick CMS. The adjustor assigned to our campus is Ginger Pierce. Ms. Pierce is required to contact the injured worker and supervisor after each injury to obtain additional information. Your cooperation in answering her questions and providing pertinent details is critical in the review and acceptance of your workers' compensation claim.

For work-related injuries/illnesses that require medical treatment (including those incurred by Student Assistant employees):

These facilities must be used unless an employee has a Predesignation of Personal Physician form (DOCX) (Spanish version: Designación Previa De Un Médico Particular (DOCX)) and/or Predesignation of Personal Chiropractor or Acupuncturist form (DOCX) (Spanish version: Notificación Sobre Quiropráctico O Acupunturista Personal (DOCX)) on file with the Workers' Compensation Analyst in Human Resources prior to an injury. Predesignation forms can be found on the Human Resources Forms page. After inital treatment, employee must use own leave for follow-up doctor appointments. Student Assistant employees may NOT be treated at the campus Health Center.

For injuries/illnesses that require medical treatment:

All Initial Treatment

MED STOP (Map)
283 Madonna Road, Suite B
(next to See's Candy in Madonna Plaza)
805-549-8880
Hours: M-F 8a - 8p; Sat/Sun 8a - 4p

After MED Stop Hours

Sierra Vista Hospital Emergency Room (Map)
1010 Murray Avenue
805-546-7651
Open 24 hours

These facilities must be used unless an employee has a Predesignation of Personal Physician form (Spanish version) and/or Predesignation of Personal Chiropractor or Acupuncturist form (Spanish version) on file with the Workers' Compensation Analyst in Human Resources prior to an injury. Predesignation forms can be found on the Human Resources Forms page. After inital treatment, employee must use own leave for follow-up doctor appointments.

Workers' Compensation forms and the Work Related Injury/Illness Procedure, may be obtained on the forms page. For additional information or questions, please contact:

Kathryn Villarreal
Workers’ Compensation Analyst
Telephone: 805-756-5427
FAX: 805-756-5444
Email: kvilla02@calpoly.edu

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