Worker's Compensation
A safe working environment is our number one priority. However, should an accident or injury occur, we want to ensure that our employees receive prompt effective medical treatment. Our goal is to assist injured employees in making a full recovery and returning to their job as soon as possible.
Workers' Compensation coverage is provided for all employees in the event a work-related injury is sustained. Concenta and the Kaiser Occupational Health Center contract with doctors & hospitals to respond to the special requirements of on-the-job injuries or illnesses.
If you have questions, please contact our Worker's Comp Coordinator:
Reina R. Gonzalez
gonzalezre@mhusd.org
408-201-6015
If you should experience a work-related injury or illness, you should:
- Notify your immediate supervisor
- Complete a Santa Clara County Schools' Insurance Group Report of Employee Incident/Injury Form (see site secretary)
- If treatment from a physician is needed, an additional form (DWC-1) will need to be completed (see site secretary)
All work status reports from the treating physician, must be sent to the Human Resources Department.
Additionally, the District has a Return to Work Program for individuals whose injuries require restrictions or modified duties for a temporary time period. The site supervisor and the Human Resources Department will determine whether or not it is possible to accommodate restrictions.
If there are any questions regarding the Workers' Compensation Program, contact the Human Resources Department at (408) 201-6020.
Reporting an Incident/Injury
An employee comes to you and states he/she was injured
- Have the employee call Company Nurse at 1-877-518-6702 Code SCS13.
- Give the employee the form titled: Santa Clara County Schools' Insurance Group Report of Employee Incident/ Injury
- Employee is to fill out Part 1 of this form completely
- Administrator is to fill out Part 2 and sign/date
- If the employee plans to go to the doctor, employee will need to fill out the form titled: Employee's Claim For Workers' Compensation Benefits (DWC-1) This form starts the Workers' Compensation time clock ticking.
- All forms must be completed and sent to the Human Resources Department (fax: 201-6026) Attention: Reina R Gonzalez on the day of the incident, and the original sent in the pony mail.
- The employee is required to go to one of the following:
Kaiser Permanente San Jose Medical Center
Occupational Health Center
275 Hospital Parkway, Suite 565
San Jose, CA 95129
Phone: 408-972-6800
After Hours: 408-972-3088
Concentra
190 Leavesley Road
Gilroy, CA 95020
Phone: 408-848-0444
Concentra
1887 Monterey Highway
San Jose, CA 95112
Phone: 408-288-3800
You must call the HR Department (201-6015) prior to seeking medical care.
SUMMARY
- Report of Employee Incident/Injury completed, fax to 201-6026 or email to gonzalezre@mhusd.org and send original to the HR Department attention: Reina R. Gonzalez
- Complete DWC-1 (if necessary), email over the report and then send original to the HR Department attention: reina R. Gonzalez
- By filling out Workers' Compensation forms, the injury does not automatically become a claim.
Let's work together to prevent injuries before they happen!
EMPLOYEE SAFETY
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