1. Disaster Service Worker Volunteer Program
November 2018

2. Provide Program history Describe Program benefits and components
Explain requirements for workers’ compensation claim submissions
Resources available on the DSW Volunteer Program web page including:
Regulations
Guidance document
Workers’ compensation forms and claim submission tools

3. History Nation at war –Pearl Harbor Legislative action
Fear of mass attack on CA Coast
Large numbers enlisted in military
Volunteers recruited/trained who served without reservation and without pay
How encourage volunteers when no compensation?
Legislative action
Certified War Councils (renamed Disaster Councils) as “accredited”
Allowed registration of volunteers as DSWs
Required Loyalty Oath subscription
Provided workers’ compensation
Offered limited liability protection
Program originated in early1940s during WW ll.
Fear of major invasion along the West Coast and large #s enlisted in military to serve.
‘People’ resources depleted due to war efforts
Volunteers heavily relied upon, recruited and trained to perform hazardous duties.
No expectation of compensation – then serious injuries with no compensation
How encourage volunteers when no compensation?
Legislation needed to address issues in volunteer recruitment and retention.
War councils certified as accredited for the purpose of registering volunteers as DSWs.
Oath requirement ensured loyalty to the US and CA.
Registration allowed injured volunteers to be eligible for WC benefits providing security from financial loss due to disaster service injuries.
Legislative action also offered limited immunity from liability.
Public Law , Volunteer Protection Act of 1997, ESA GC 8657

4. Program Benefits Workers’ Compensation Liability Protections
∗ Disability benefits ∗ Medical care
∗ Supplemental job displacement
∗ Death benefits
DSWVP versus other workers’ compensation plans
Same coverage, same legal authorities.
County/city saves funds to use for other needs.
Claim expenditures impact local budgets.
Liability Protections
Good Samaritan laws – state and federal
Volunteer Protection Act of 1997 (Pub.L. No )
Statutes of local jurisdiction
Consult legal counsel to determine laws applicable to your situation.
Immunity from liability - personal injury or property damage sustained by DSW volunteers or third party cited in:
Gov. Code §8657(b), Gov. Code §8657(a), Civil Code §1714.5(b), CCR
Refer to DSWVP Guidance pages for more details.

5. Program Components Administration DSW Volunteer
California Governor’s Office of Emergency Services (Cal OES)
State Legislature
State Compensation Insurance Fund (State Fund)
Accredited Disaster Councils (ADCs) & Authorized Designees (ADs)
DSW Volunteer
Disaster Service: Eligible & Excluded Activities
Registration
Oath Authority
Supervision
Training
Activation
File Retention & Recordkeeping
Workers’ Compensation Claims

6. Program Administration
Cal OES
Approves disaster council
accreditation and regulations
Delegates registration/oath authority to state agencies
Manages DSW appropriation
Reviews claims, authorize settlements, issue checks
Complies with federal Medicare reporting
Educational outreach, plan review, DSW documents
Ref: ESA GC ,
Ref: ESA, GC ,
Different Branches within Cal OES are responsible for the Disaster Council Accreditation Program and the DSWVP with regards to regulation revisions.
Cal OES Director has legal authority to delegate program administration.
Fund tracking and perform projections to monitor appropriation throughout fiscal year in anticipation of deficiencies.
DSW staff analyze claim documents for benefit eligibility, review proposed settlements to finalize claims, and schedule checks for payment.
Effective 2011-all workers’ compensation payers must comply with Medicare reporting requirements. Non-compliance: penalty $1000 per day per claimant
Miscellaneous work assignments related to Program responsibilities.

7. Program Administration (continued)
State Legislature
Approves DSW appropriation annually in state budget
Mechanism in place to request additional funds.
Uses General Fund to pay workers’ compensation claims
State Fund
Processes claims, calculates benefits
Communicates with Cal OES throughout claim cycle
State Legislature – funds to pay disability benefits, medical expenses, and other wc benefits.
Mechanism in place for unexpected emergency expenses to request additional funds from Department of Finance.
Deficiencies due in large part to catastrophic claims & settlement distributions.
State Fund
DSW claims require additional documents than traditional WC plans; still must meet statutory time lines.
Benefits calculated same as employee plans per labor code.

8. Program Administration (continued)
ADCs and Authorized Designees (ADs)*
Cities and counties create disaster councils by ordinance.
Councils must be accredited by Cal OES to register volunteers Govt Code §8610
Certified as accredited requires:
Emergency Ordinance
DSW Resolution
Master Mutual Aid Agreement
Responsibilities
Registration ⇨ Supervision ⇨ Training
Activation ⇨ Recordkeeping ⇨ Claim Submissions
*Government entities delegated Program authority by ADC. .
Certification requirements:
Emergency Ordinance must:
Provide for a Disaster Council
Specify Chairperson or director
Recognize an emergency organization
State compliance w/ESA
DSW Resolution - authority to register volunteers
MMAA
Responsibilities:
Each of these pertains to all government agencies administering a DSW Program and will be discussed separately in later slides.

9. Who Can Be A DSW Volunteer?
Individuals physically and mentally capable of performing disaster service duties
ADC or authorized designee (AD) determines if health and/or criminal background required.
NOTE: No Program reimbursement for any associated costs.
Persons employed, unemployed, or retired
Minors (under 18) with parental or legal guardian written consent
ADC or designated authority makes decision
to use minors as DSW volunteers.
When deciding, ADC may consider:
cost of these services – who and how
interpretation of results
frequency of repeating
With respect to background investigation, also consider classification of volunteer and who in contact with during duty,.
For example: SAR mission searching for missing child versus volunteer working in EOC setting.
Using MINORs: discretion of ADC or other local restrictions
secure written consent for minor to participate
restrict use of minors in high risk activities

10. A DSW Volunteer Is an Individual:
Registered with:
Accredited Disaster Council (ADC)
all 58 counties and most cities
Authorized Designee (AD) of ADC
Government entities
Cal OES or authorized state agency
NGOs, non-profits, volunteer organizations,
tribal entities CAN’T register volunteers as DSWs.
Receives no pay
Activated by registering agency
Impressed into service (rare)
Auxiliary Firefighter
E XCLUDES: Volunteer Fire Fighters Spontaneous Unaffiliated Volunteers
Auxiliary FF: trained and recruited to augment fire departments and have no WC insurance.
Volunteer FF: have their own WC protections.

11. Disaster Service - Eligible Activities
Authorized by CA Emergency Services Act (ESA) during:
State of War emergency
Proclaimed emergencies
Search and rescue missions
Activities to mitigate imminent threat of
extreme peril to life, property, resources
Official out-of-state deployments with Cal OES approval
Official mutual aid assistance
Training
Travel to and from incident site
REF: GC Sections 8558 &
CCR §2570.2(b)(1)
DSW duties associated with the classification during official activation.
Local emergency to mitigate -sandbagging efforts by volunteer to prevent a local emergency from being proclaimed
Ex: weather reports, heavy rainfall over a short duration (flash floods), waters approaching city
Not Covered: clear spring day, no threat to public safety and DSW volunteers repairing road or bridge to prevent reoccurrence with next flood season.

12. Disaster Service – Excluded Activities
Day-to-day operations
Activities typically associated with emergency response agencies
Ex: single structure fires, car accidents,
crowd control for concerts
Preparedness/Planned Activities
Educational fairs, outreach, first aid booths
Equipment maintenance
Ceremonies, community events
Smoke detector installations
Meetings
Self Activation
Travel to and from the training site
Planned Events
If volunteer used in day-to-day, preparedness, & non-emergency activities: NO Coverage.
Volunteers ‘activated’ for many events, BUT not all events covered.
Plan in advance how protect volunteers for non-emergency activities, e.g. private insurance, waiver
Under very unique conditions which can’t be replicated in the classroom, field, etc.
Self Activation: never covered; may deploy according to SOP/EOP, which is not self –deployment.

13. Registration Required: Name & address of applicant Classification
If applicant is a minor, parent or legal guardian
must give written consent.
Classification
13 approved (CCR § )
More than one may be entered
Date enrolled (date Loyalty Oath signed)
Loyalty Oath subscription
Self-certification IF ADC approves (Civil Code §2015.5) OR
Officer administered e.g. elected officials, county/city clerks, notary public, Cal OES Director
Name of registering govt agency w/signature and title of authorized person (CCR (a)(4))
No fee may be charged for oath administration.
Check DSW web page to ensure using current form!
Minimal information needed to properly register volunteer as a DSW.
Opportunities to register: meetings and trainings; however, meetings are not an eligible activity and registration must occur before training commences as retroactive registrations not covered.
ADC makes determination as to which oath subscription is implemented.
Optional information to include such as specialty, emergency contact, license , phone number.

14. Registration Form ENGLISH Version ADC decides if:
Completed by ADC or authorized designee.
Registration Form
ENGLISH Version
Completed by applicant.
Parent sign & date:
IF volunteer is minor
Registration form now in both English and Spanish located on DSW web page.
May customize form to meet registering agency’s requirements but must retain regulatory (highlighted) fields.
If volunteer is a minor, parent/guardian must sign giving permission to participate.
Minor aged volunteer subscribes to oath.
ADC decides if:
Volunteer self-certifies OR
Official administers

15. Supervision ADC or AD responsible for:
Deciding who acts in supervisory capacity and how duties performed
Paid staff or volunteers?
Onsite or offsite?
Determining criteria
Use materials for paid staff in same position
Identify core curriculum of required courses
Develop duty statement
Providing injury claim instruction
Knowledge of required documents and timelines
SOP with sample claim packet
Use volunteers in positions such as team leaders and SAR coordinators.
When determining criteria, consider prior experience and training.

16. Training May include: Classroom courses and exercises
ADC or AD decides training requirements and approach.
May include:
Classroom courses and exercises
Participants as ‘victim or survivor’ register as DSWs
Certification for specific classification
Out-of-State must be Cal OES approved
Must:
Approve in advance by ADC or authorized agency
Document to verify participation
Supervise
Commensurate with classification
√ Diff levels of training specific to classification
OST: Approved by Cal OES Executive
Out-of- state training conducted in a manner geographically and functionally specific to cross-border emergency response may also be considered a covered activity.”

17. Activation
ADCs or ADs define emergency response activation procedures and provide training so volunteers understand their assigned duties.
Examples of activation procedures:
Written instruction, e.g. SOP, EOP, activation guidelines
Emergency radio announcements
Pre-determined text messages
Notification from supervisor or authorized person
Defined activation processes, which are taught and exercised, result not only in trained and confident volunteers but also avoids the potential of self-deployment.

18. File Retention & Recordkeeping
Filing of Loyalty Oath
State Agency – within 30 days
County – Clerk or official department personnel file
City – Clerk
Other Public Agency -designated Officer/Employee of the agency
Records
Keep registrations current
Store hardcopy or electronic format
E-format requires written statement verifying original used to scan, attach in database, etc.
Destroy five years after service ends
Ref: GC §3105
Records need to be available for inspection by Cal OES and State Fund.

19. Worker’s Compensation Claims
Required Documents
State Fund 3301 – Claim Form
State Fund 3267 – Employer’s Report
DSW Volunteer Registration
Loyalty Oath Subscription
Written Incident Report
If injury due to training, must also provide
Written Training Pre-Authorization
Training Sign-In Verification
Claim package must include these documents. I review documents to determine claim eligibility under Program Regulations before I notify State Fund to begin claim processing.
More paperwork required than traditional WC.
Forms same as traditional WC forms for paid employees with slight modification for required Program information
Employee = volunteer
Employer = ADC or supervising agency

20. State Fund 3301 – Claim Form Injured DSW Volunteer
Completes Employee section
ADC/Supervising Agency
Provides to volunteer w/in one day of injury knowledge
Completes Employer section
Provides copy of completed form to volunteer
Mails original to State Fund within five calendar days after receipt from DSW volunteer
WC Claim Report 3301 must be provided to injured volunteer within 24 hours of knowledge of the injury.
Sometimes the volunteer may not report injury immediately.
Example: Person injured on July 1 may not report it until July 7, injury may have worsened – that is when 24 hour clock begins
Signed by both volunteer and supervising agency
Volunteer brings copy of completed 3301 to medical appointment
Important to adhere to WC timelines when submitting documents to avoid penalties.

21. State Fund 3301 Worker’s Compensation Claim
Injured DSW Volunteer completes
Lines 1- 7
Line 8 (optional)
Line 9 Volunteer’s signature
ADC or Supervising Agency completes
Lines Supervisor
Line Pre-filled
Line Pre-filled
Line Supervisor’s signature
Line Supervisor’s title
Line Phone number
Employee/injured volunteer:
Slide shows line by line how to complete the form
If the volunteer is unable to sign, a legal guardian can sign or the injured person can sign when able. If unable to obtain signature, State Fund will contact volunteer later when processing claim
Employer/supervising agency:
Complete in full with signature and title

22. State Fund 3267 – Employer’s Report
ADC/Supervising Agency
Completes within five calendar days of injury notification
Mails original to State Fund OR
Calls 24 hour Claims Reporting Center at:
(888)
DO NOT wait for completed State Fund 3301
DO NOT have volunteer complete
Employer’s Report 3267 is completed by Employer only (supervising agency or authorized designee) within 5 days of injury notification.
Important points to remember:
Not completed by volunteer
Do not give copy to volunteer
Do not wait for volunteer to return the 3301
Volunteer may not return or file claim
Still required to submit 3267, mail original copy to State Fund
Another way to report claim:
Call 24 hr. State Fund Claims Reporting Center and provide claim info over phone
Meets WC requirements and convenient if injury occurs in the field and no access to forms

23. State Fund 3267 Employer’s Report
ADC or Supervising Agency completes
Lines 1-3 Line 1a pre-filled
Lines pre-filled, 5 N/A
Line 6 Pre-filled
Lines 7-10
Lines If unknown, leave blank
Lines 17-26
Lines May have partial information
Lines 30-34
Line 35 Regular job– not DSW duties
Lines If unknown, leave blank
Lines 40-43
Don’t forget to complete backside.
Supervising agency or authorized designee:
Complete as thoroughly as possible. If information unknown, leave blank
Lines 35 & 41 Regular job, retired, unemployed - not DSW duties/classification
Signature and title of authorized person at bottom of form

24. Written Incident Report
Brief account of incident
Completed by supervising authority
Submit via agency letterhead, fax,
Brief narrative of incident:
Completed by the supervising authority and not the volunteer
Can be submitted by agency letterhead, fax, or
May include witness statements or a police report if car accident or injury caused by a third party

25. Training Documents If injury due to training:
Written Training Pre-Authorization:
Includes date, location, event name, objectives, supervisor’s name and title
Approved in advance
Commensurate with DSW classification
Training Sign-In Verification, roster or similar item to prove participation:
Volunteer’s name
Time in/time out
Supervisor’s name
Date
Event name
Two additional documents required if injury due to training:
Training pre-authorization documentation
Training log in/sign in documentation
Pre- authorization can be memo on the ADC or designee’s letterhead or copy of ADC’s meeting minutes:
Authorization needs to be obtained in advance of activity
Event name w/ supervisor information
Date
Location
Objectives of classroom instruction, exercise, etc.
Training Sign-In roster confirms volunteer was participating in authorized training at time of injury.
Verification needed to ensure the training:
Approved
Documented
Supervised
Aligns with volunteer’s classification and scope of duties

26. Sample Training Documents
Request for training authorization
Can put multiple trainings on one request
Authorization from ADC or authorized designee
Can have multiple responses on one reply
Sign-in sheet or log
Common reasons why claims are denied:
No Registration or Oath
Refuses to submit 3301 claim form
Declines medical treatment
Not engaged in an eligible activity when injured (ex. performing clerical work, distributing flyers)
Pre-existing medical condition
Failure to provide medical documents to State Fund

27. DSW CLAIM ASSEMBLY and DISTRIBUTION
REMINDERS:
Submit documents within time lines. DO NOT wait until you have all documents before submitting. Retain copies of all documents in file for injured DSW volunteer.
Refer to the Disaster Service Worker Volunteer Program (DSWVP) web page for Cal OES and State Fund contact information.

28. DSW Volunteers & Mutual Aid Assistance Claims Submission
Requesting Agency
needs
DSW volunteers
Both Agencies provide copies
of all documents to each other.
Requesting Agency
Mail original 3267, 3301 to State Fund & fax/
copies to Cal OES.
Fax/ incident report to State Fund & Cal OES;
Fax/ training docs, if applicable, to State Fund &
Cal OES
Sending Agency
Fax/ Registration w/Oath to State Fund & Cal OES
Sending Agency
deploys
DSW volunteers
DSW volunteer
injured under
Requesting Agency’s
supervision
Who
submits
paperwork?
Who is
responsible for
paperwork?
Shows claim submission process when volunteer is injured during deployment or authorized training in jurisdiction outside of where registered.
Paperwork and process same
Both Agencies work together to provide copies of documents to each other
Requesting Agency
Complete 3267
Provide 3301 to injured DSW volunteer
Complete Incident Report
Sending Agency
Provides DSW Registration & Oath
Both Agencies
coordinate efforts
to complete & submit
required forms

29. DSWVP E B P A G E Reminder:
Download Regulations and Guidance documents (at a minimum) as these resources should be referenced frequently
Check the web page monthly for updates and additions

30. Thank you! Don Glueckert Hilda Vargas
Program Lead Program Manager
(916) (916)
DSWVP Regional Points of Contact
Coastal – Memoree McIntire
Inland – Kim Nielsen
Southern - Sonia Brown
DSWVP Regulations, Guidance & Related Documents: