Report a Work Related Injury or Illness - for Employees
If you are injured or develop a job-related illness as a result of your employment at UC Merced, inform your supervisor, get medical attention, and complete the incident report and (if applicable) the workers' compensation claim form.
If a Work Related Injury or Illness Occurs
Call 911 for medical emergencies when life and limb are threatened or proceed to the nearest emergency medical facility.
- Report a work-related injury/illness immediately to your supervisor in person, by phone or by email even if you don't intend to seek medical treatment.
- You and your supervisor must both complete an Incident Report within 24 hours of the first notice of incident.
- Complete the “Employee Information” section of the Incident Report and return it to your Supervisor.
- Your supervisor completes the “Supervisor” section of the form and emails it to the Workers’ Compensation Office and Environmental Health & Safety.
- If you are unable to complete or sign the form, your supervisor or department representative must complete it on your behalf.
- If your injury or illness developed gradually, such as hearing loss, report it as soon as you learn it was caused by your job.
- If the incident occurs after normal business hours, you may report it by calling the 1-800 Workers’ Compensation Claim Reporting Hotline (1-877-682-7778). This is a National Intake Center that is utilized by UC systemwide and operates 24 hours a day, 365 days a year. Once an incident is reported to the National Intake Center, the center will send an email to the Workers’ Compensation office within 24 hours of the call.
If Medical Treatment is Sought
- If you require medical treatment, notify your supervisor or department representative. If they are not available, call the Workers’ Compensation office 209-259-8806 for your medical treatment authorization.
- In addition to the Incident Report ensure that the employee completes and signs the employee portion of the DWC-1 Claim Form and gives the form to you for further completion. Your supervisor will forward to the Workers' Compensation office. By returning the form you are actually filing a claim.
- If you have previously submitted a pre-designated physician form, obtain treatment through that medical provider. Otherwise, obtain treatment from a UC Merced designated Occupational Health Clinic.
- If the incident occurs after normal business hours and your supervisor or department representative are not available, you may go directly to one of the designated occupational health facilities.
If your medical provider issues you a prescription for a work-related injury/illness, you must contact the Workers’ Compensation office for a “first-fill” letter to get your first prescription filled. The University of California has a contract with Optum/Tmesys to administer the Pharmacy Benefit Network (PBN) for workers’ compensation claims. Optum/Tmesys utilizes specific pharmacies in their network.
For additional information, see the Pharmacy Benefit Network poster (English or Spanish) and pamphlet.
Work Status Report
The treating physician may state that you can return to work, return to work with modified duty due to work restrictions, or that you require time off work to heal. Whatever the recommendation by the treating physician, you must present a Work Status Report to your supervisor. This report is completed by the treating physician. If the supervisor is not available, email the Work Status Report to the Workers’ Compensation office. When you have been released from the physician’s care, the physician should indicate so on the Work Status Report. Present this to your supervisor or the Workers’ Compensation office.