Workers’ Compensation Claim Reporting The Office of Risk Management Office of Audit, Compliance, Risk and Privacy (ACRP) Workers’ Compensation Claim Reporting For Winter Closure 2016 The Office of Risk Management November 28, 2016 Nicole Guevara, Return to Work Consultant Vanessa Cordova, Administrative Associate – Workers’ Compensation Claims

How to report Workers’ Comp claims for Winter Closure 2016 Call Zurich to report the claim within 24-hours of occurrence: Contact number: 800-987-3373 Provide them the same information as on the 5020 form: http://www.stanford.edu/dept/Risk-Management/docs/forms/5020.html If you do not have all the info, provide what you do know (including contact info for the injured worker) - Zurich will investigate Follow the usual procedures for completing Workers’ Comp paperwork: Provide Zurich with the following site code information: Comp Med: 1770 Dean of Research: (See attached list of site codes) R&DE: (See attached list of site codes) LBRE: Please give sub-group name, no site code needed ITS: 1928 Libraries: 1530 University Human Resources: 1890 Step Direction 1. Give the SU17 to the injured/ill person and supervisor/University contact for their completion and signature within 24 hours of the occurrence (except in situations where stress or mental illness are part of the condition). 2. Fax or “secure:” email the SU-17 to Risk Management attention to Vanessa Cordova at: VCordova@stanford.edu or 650-723-9456 and fax to EH&S at 650-725-9218. 3. Complete DWC 1 form per the instruction page and hand or mail it to the employee within 24 hours of the occurrence along with the Notice of Potential Eligibility pages. 4. Fax or “secure:” email the DWC 1 form to Risk Management attention to Vanessa Cordova at: VCordova@stanford.edu or 650-723-9456. 5. Once the paperwork is completed, it should be given to you (or the usual Workers' Compensation contact person for the various departments).  This will make sure the appropriate people are back in the loop. Please send the completed original paperwork in the usual manner to me through ID mail (Office of Risk Management MC: 6207). Public Safety: 1842 SOM: Please give department name, no site code needed Stanford Management Company: 1850 VP Undergraduate Education & VPUE Undergrad Advising Programs: 1900 VPUE/BING Overseas Study Program (BOSP): 1155 Offices of the President and Provost: 1001

Contact the Office of Risk Management Questions We’re here to help! Contact the Office of Risk Management Nicole Vargas Guevara Return to Work Consultant nsvargas@stanford.edu 650-721-6101 Vanessa Cordova Administrative Associate, Workers’ Compensation Claims vcordova@stanford.edu 650-723-7400

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