Workers' Compensation

Incident Reporting Procedure

In an emergency, urgent medical care should be sought immediately. If medical treatment is required, please see our section on Medical Treatment Authorization and Facilities, and immediately contact the Workers’ Compensation Office at 805.893.4440.

Instructions

  1. Call 1.877.682.7778 (toll free, 24 hours a day) to report the injury.
  2. Complete the INCIDENT REPORT FORM *
  3. Fax the completed form immediately to the Workers’ Compensation Office at 805.893.8521.

*The Incident Report form must be completed and submitted to the Workers’ Compensation Office within 24 hours of the University’s first notice of incident. It is the responsibility of the employee and supervisor (or department representative) to complete and submit this form to the Workers’ Compensation Office. If the employee is unable to complete or sign the form, the supervisor or department representative must complete it on their behalf.

IMPORTANT

Immediately contact Environmental Health & Safety (EH&S) at 805.893.3194 if any of the following occurs:

  • Worker fatality
  • Inpatient hospitalization
  • Loss of any body part (e.g., fingertip)
  • Serious injury

These incidents must be reported to OSHA within 8 hours of the event.

Further Information

If the employee’s injury or illness is medically determined to meet the State of California definition of injury as a workers’ compensation claim, the Workers’ Compensation Office will mail the employee a Workers’ Compensation Claim Form (DWC-1) with complete instructions.

Sedgwick CMS (Claims Management Services) administers the University’s workers' compensation claims. A Sedgwick CMS claims administrator will investigate the injury, and determine acceptance of the claim. If a representative from Sedgwick CMS contacts you, please provide any information requested. This includes departmental files, job description, or time records.

Reporting an injury or submission of a claim form does not imply automatic approval of the claim. Claims are approved by Sedgwick CMS for UCSB.

Please contact the Workers’ Compensation Office at 805.893.4440 for further information.