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ABOUT SULAIR > HUMAN RESOURCES > POLICIES/PROCEDURES

SULAIR Human Resources

Workers' Compensation (WC) Questions and Answers

Does Risk Management have a website for Workers’ Compensation information?

Yes. http://www.stanford.edu/dept/Risk-Management/docs/workcompben.shtml

 What if the condition is related to stress or mental health?

  • Alert Human Resource Officer (HRO) immediately
  • SU-17: complete only if the HRO feels it would not aggravate the situation
  • If they are filing a claim for work-related mental stress or psychiatric disability, please have them contact their personal physician for a referral even if they have not completed an Employee Personal Physician Pre-designation form
  • DWC-1: fill out as follows:
    • Line 1 – print employee’s name only
    • Lines 11, 12 – enter appropriate dates
    • Lines 16, 17, 18 – sign and enter appropriate information
    • Keep instruction cover page for reference
    • Make a photocopy of original claim form and keep as reference for your records
    • Give original and the two information pages to the employee. Tell them that if they wish to see a doctor they should complete the Employee Section, sign it, and return to you
    • If returned to you, make photocopies. Send original and appropriate copy to Risk Management, mail code 6207. Distribute remaining copies as noted on the Instruction page
  • 5020: complete as usual if they sign and return the DWC-1. Send original to Risk Management, mail code 6207.

 

What if the employee was not able to return to work and they were not given the SU-17 and DWC-1 before they left?

These forms must then be mailed no later than 24 hours after the employer received notification of the injury.

  • SU-17: print the employee’s name only in section A. If the Supervisor Section can be completed and signed within the 24-hour window, do so. If, not, print the supervisor’s name, department, title, extension, and mail code in Section C. Whether or not the Supervisor Section is completed, make two photocopies, keep one photocopy for your file and mail the other to Risk Management, mail code 6207. Mail the original to the employee.
  • DWC-1: fill out as follows:
    • Line 1 – print employee’s name only
    • Lines 11, 12 - enter appropriate dates
    • Lines 16, 17, 18 – sign and enter appropriate information
    • Keep instruction cover page for reference
    • Make two photocopies of original claim form. Send copy to Risk Management, mail code 6207. Keep the other copy as reference for your records
    • Mail original and the two information pages to the employee along with the SU-17. Provide a self-addressed stamped envelope and a letter asking them to fill out the enclosed forms, sign them, and mail them back to you
    • When the original DWC-1 and SU-17 are returned, make photocopies and distribute as noted on the Instruction page of the DWC-1 and also on the bottom of the SU-17. Send originals and appropriate copies to Risk Management, mail code 6207
  • 5020: complete as usual and send it with the photocopies of the SU-17 and DWC-1 to Risk Management, mail code 6207

May an employee see any doctor of their choosing?

No. However, if they pre-designated their personal physician before the injury, they may see him or her for treatment. This is done by completing the Personal Physician Pre-designation form (http://www.stanford.edu/dept/Risk-Management/docs/forms/predesig6_04.pdf). Their personal physician must have treated them and maintained their medical history and records before their work injury. If they wish to change doctors in the first 30 days, the claims administrator must select a new physician within five days of their request. (If the employee gave Stanford the name of their personal chiropractor or acupuncturist in writing before they were injured, they may switch to the chiropractor or acupuncturist upon request.) If they still need medical care after 30 days, they can switch to a doctor of their own choice after notifying their Claims Examiner.

 

If they did not pre-designate their personal physician (in writing) before the injury, all medical care for the first 30 days of treatment must be obtained from Alliance Occupational Medicine (2 locations), 2737 Walsh Avenue, Santa Clara, CA 95051, (408) 228-8400 and 315 S. Abbott Avenue, Milpitas, CA 95035, (408) 790-2900 or Workforce Medical, 201 Arch Street, Redwood City, CA 94062, (650) 556-9420. For life-threatening emergencies, obtain treatment at the Acute Care Center within the Emergency Room at Stanford Hospital and Clinics, (650) 723-5111.

 

If they are filing a claim for work-related mental stress or psychiatric disability , please have them contact their personal physician for a referral.

 

SLAC employees' medical care will be coordinated through SLAC Medical.

 

Does Stanford have a designated place for employees to receive medical treatment for work related injuries/illness?

Yes. If they did not pre-designate their personal physician (in writing) before the injury, all medical care for the first 30 days of treatment must be obtained from Alliance Occupational Medicine (2 locations), 2737 Walsh Avenue, Santa Clara, CA 95051, (408) 228-8400 and 315 S. Abbott Avenue, Milpitas, CA 95035, (408) 790-2900 or Workforce Medical, 201 Arch Street, Redwood City, CA 94062, (650) 556-9420. For life-threatening emergencies, obtain treatment at the Acute Care Center within the Emergency Room at Stanford Hospital and Clinics, (650) 723-5111.

 

If they are filing a claim for work-related mental stress or psychiatric disability , please have them contact their personal physician for a referral.

 

SLAC employees' medical care will be coordinated through SLAC Medical.

 

What if the employee doesn’t know if they will see a doctor?

  • SU-17: complete and send to Risk Management, mail code 6207
  • DWC-1: fill out as follows:
    • Line 1 – print employee’s name only
    • Lines 11, 12 – enter appropriate dates
    • Lines 16, 17, 18 – sign and enter appropriate information
    • Keep instruction cover page for reference
    • Make two photocopies of original claim form. Send copy to Risk Management, mail code 6207. Keep the other copy as reference for your records
    • Give original and the two information pages to the employee. Tell them that if they wish to see a doctor they should complete the Employee Section, sign it, and return to you
    • If returned to you, make photocopies. Send original and appropriate copy to Risk Management, mail code 6207. Distribute remaining copies as noted on the Instruction page
  • 5020: complete as usual if they sign and return the DWC-1. Send original to Risk Management, mail code 6207.

    What if I think they should see a doctor and they are unwilling?

    • SU-17: complete and send to Risk Management, mail code 6207
    • DWC-1: fill out as follows:
      • Line 1 – print employee’s name only
      • Lines 11, 12 - enter appropriate dates
      • Lines 16, 17, 18 – sign and enter appropriate information
      • Keep instruction cover page for reference
      • Make two photocopies of original claim form. Send copy to Risk Management, mail code 6207. Keep the other copy as reference for your records
      • Give original and the two information pages to the employee. Tell them that if they wish to see a doctor they should complete the Employee Section, sign it, and return to you
      • If returned to you, make photocopies. Send original and appropriate copy to Risk Management, mail code 6207. Distribute remaining copies as noted on the Instruction page
    • 5020: complete as usual if they sign and return the DWC-1. Send original to Risk Management, mail code 6207.

     

    What if the employee doesn’t want to file a claim at this time?

    • SU-17: complete in the customary manner and send to Risk Management, mail code 6207
    • Have employee write a note stating they do not wish to file a claim at this time and sign it
    • Make a copy for department’s file and send original to Risk Management, mail code 6207
    • DWC-1: fill out as follows:
      • Line 1 – print employee’s name only
      • Lines 11, 12 – enter appropriate dates
      • Lines 16, 17, 18 – sign and enter appropriate information
      • Keep instruction cover page for reference
      • Make two photocopies of original claim form. Send copy to Risk Management, mail code 6207. Keep the other copy as reference for your records
      • Give original and the two information pages to the employee. Tell them that if they wish to see a doctor they should complete the Employee Section, sign it, and return to you
      • If returned to you, make photocopies. Send original and appropriate copy to Risk Management, mail code 6207. Distribute remaining copies as noted on the Instruction page
    • 5020: complete as usual if they sign and return the DWC-1. Send original to Risk Management, mail code 6207.

     

    What if the employee is not losing time or planning to see a doctor?

    A SU-17 must be completed for any accident involving a Stanford University employee, student, visitor, contractor, etc. It must be processed within 24 hours. These forms are available at:

    http://www.stanford.edu/dept/Risk-Management/docs/workcompben.shtml

    Submit original plus one (1) copy to Risk Management, mail code 6207.

     

    What if the employee is losing time or on restricted duty?

    • Complete the SU-17, DWC-1, and 5020 as usual
    • Complete the SU-16 when the employee returns to work if they were losing time, or when the employee is off restricted duty. If the employee loses time or goes on restricted work again for the same injury, a separate SU-16 needs to be submitted. The “Date of Injury” is always the original date of injury. If they have not returned to work or off restrictions by 12/31, then a SU-16 must be submitted for the days in the current year. Enter “continuing” in the “Date Returned to Work” field. Once they have returned or off restrictions in the new year, submit another SU-16 with only the new year’s days entered. Enter date returned in the “Date Returned to Work” field.

    What if the employee is still off work or on restrictions at the end of the calendar year?

    If they have not returned to work or off restrictions by 12/31, then a SU-16 must be submitted for the days in the current year. Enter “continuing” in the “Date Returned to Work” field. Once they have returned or off restrictions in the new year, submit another SU-16 with only the new year’s days entered. Enter date returned in the “Date Returned to Work” field. Always use the original date of injury.

     


 

 

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Last modified: February 4, 2008

       
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