Worker's Compensation is a state-mandated insurance plan designed to provide benefits and assistance to all workers who are injured as a result of their employment or who develop job-related illnesses. Benefits may include: medical costs, temporary disability, permanent disability, job displacement voucher or death benefits. The objective of the UCM Worker's Compensation Program is to assist in your quick recovery and return to work.
Report a Work Related Injury or Illness
Obtain Care
Questions?
- Check out - Workers' Compensation FAQ
Forms and Information
Request and Ergonomic Evaluation - Environmental Health & Safety
Request a Safety Investigation - Environmental Health & Safety
Request a Reasonable Accommodation - email benefits@ucmerced.edu
- Pre-Designation of Physician Form (Provided during all new hire consultation)
- Incident Report
- DWC-1 (claim form) & Notice of Potential Eligibility (NOPE)
- Work Status Report (Treating Facilities usually provide their versions of a work status)
- Extended sick leave (ESL) - Ballot Authorization
- Workers Comp Election Form
Questions? Contact benefits@ucmerced.edu
