1. 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

2. How to report Workers’ Comp claims
for Winter Closure 2016
Call Zurich to report the claim within 24-hours of occurrence:
Contact number:
Provide them the same information as on the 5020 form:
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:” the SU-17 to Risk Management attention to Vanessa Cordova at: or and fax to EH&S at 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:” the DWC 1 form to Risk Management attention to Vanessa Cordova at: or 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

3. 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
Vanessa Cordova
Administrative Associate, Workers’ Compensation Claims

4. THANK YOU!
HAVE A GREAT DAY!!