Workers Compensation- Notice to Employees - (posted 9/2016)

     notice to  employees

IF a work injury occurs

California law guarantees certain benefits to employees who are injured or become ill because of their jobs.

Any job related injury or illness is covered. Types of injuries and illnesses covered includes, but may not be limited to,

strains, sprains, cuts, cumulative or repetitive fractures, illnesses and aggravations. Some injuries from voluntary, off

duty, recreational, social or athletic activity may not be covered. Check with your supervisor or claims administrator if

you have questions.

All work related injuries must be reported to your supervisor immediately. If you wait too long, you may lose your

right to benefits. Your employer is required to provide you a claim form within one working day after learning about

your injury.

It is a misdemeanor for an employer to discriminate against workers who are injured on the job or who testify in another

employee’s case. Any such employee may be entitled to compensation, reinstatement and reimbursement for lost wages

and benefits.

Workers Compensation Benefits include

MEDICAL CARE - All medical treatment - without a deductible or dollar limit. Within one working day after

you file a claim form, treatment must be authorized, consistent with the applicable treating guidelines, for

your alleged injury up to ten thousand dollars ($10,000) until the claim has been accepted or rejected. Costs

are paid directly by the claim administrator, so you should never see a bill. For dates of injury on or

after1/1/04 there is a limit on some medical treatment.

You may be eligible to treat with your personal physician should you become injured on the job. If eligible, you must

notify your employer in writing before you are injured. If you have questions please contact your employer who is

required to provide written information regarding workers’ compensation benefits to all new employees.

MEDICAL PROVIDER NETWORKS - Your employer may be using an MPN, which is a selected network of healthcare

providers to provide treatment to workers injured on the job. If you have predesginated a personal physician prior to

your work injury, then you may receive treatment from your predesignated doctor. If you have not predesignated and

your employer is using an MPN, you are free to choose an appropriate provider from the MPN list. If you are treating

with an non-MPN doctor for an existing injury, you may be required to change to a doctor within the MPN.

PAYMENT FOR LOST WAGES - If you’re temporarily disabled by a job injury or illness, you’ll receive tax-free income,

subject to state limits, until your doctor says you are able to return to work. Payments are two-thirds of your average

weekly pay, up to a maximum set by state law. Payments aren’t made for the first three days unless you’re hospitalized

as an inpatient or unable to work more than 14 days.

If the injury or illness results in permanent disability, additional payments will be made after recovery. If the injury

results in death, benefits will be paid to surviving dependents.

SUPPLEMENTAL JOB DISPLACEMENT BENEFIT - You may be entitled to a Supplemental Job Displacement Voucher, if

your employer is not able to return you to work within 60 days after temporary disability ends. SJDB is a nontransferrable

voucher payable to a state approved school.

In the event of a work injury

1. Be sure first aid is given.

2. If emergency medical treatment is needed call 911.

3. See that the injured employee is taken to a doctor or hospital, if necessary.

4. Report all injuries immediately to your supervisor or  TARANJIT CHAHAL at (530) 741-6979  Employer Representative Phone Number

5. Contact your employer representative or claim administrator if you have questions about workers’ compensation. You may also contact an

Information and Assistance Officer at the State Division of Workers’ Compensation at 1(800) 736-7401 or (916) 928-3158

6. Hear recorded information and a list of local offices by calling toll-free 800 736-7401 or visit

Claims Administerd by:                                          Emergency Numbers:                                

Claims Administrator: Keenan & Associates                                                                         Ambulance: 911

Address: 2882 Prospect Park Drive, Suite 200                                                                        Fire Department: 911

City, State, Zip Code: Rancho Cordova, CA 95670                                                                Police: 911

Phone Number: (916)859-7160                                                                                               Hospital 911

Carrier/Self Insured: Northern Ca Comm Colleges Self Insur. Athority (NCCC-SIA)-PIPS

Policy expiration date: Yearly renewal each July 1st - If this policy has expired contact the labor commissioner (213) 620-6630

MPN Toll Free Number: 1(800) 654-8102

MPN Website:

MPN Effective Date: N/A

MPN's Address: P.O. Box 4328, Torrance, CA 90510

Anyone who knowingly files or assists in the filing of a false workers’ compensation claim may be fined up to $150,000 and sent to prison for up to five years. (Insurance Code Section 1871.4)


If a work injury occurs

Workers’ Compensation Benefits include

In the event of a work injury

Claims Administered by: Emergency numbers:


Article ID: 87280
Wed 9/18/19 11:11 AM
Fri 10/30/20 8:49 AM