Workers' Compensation

As part of the CSU Risk Management pool, Workers' Compensation coverage is provided in the event of a CSUSB employee injury/illness on the job or due to the job. 

An injury/illness occurring due to employment is considered a Workers' Compensation injury and as such there is no cost to the employee for medical care. 

The CSUSB campus workers' compensation manager is Marjorie Callaghan (ext. 5138) SH-110.

The current CSU contracted Workers' Compensation administrator is "WARD NORTH AMERICA (WNA)"

CSUSB Employee's Claim Process for 

Workers' Compensation Benefits

• Employees should immediately notify their supervisor (or Public Safety at ext. 5165 if after hours) of a work related injury/illness.

• Within one (1) working day of receiving notice or knowledge of an injury the supervisor/designee must provide a claim form to the injured worker. (DWC-1 Form)

• The form must be provided to the employee in person or by first class mail.

• Claim forms are deemed filed when it is personally delivered to CSU, mailed to CSU by registered  mail with return receipt requested or upon receipt of CSU'S  dated copy when mailed by first class mail.

• Within one (1) working day of receipt of claim form, CSU shall date claim form (line 11). 

• Provide copy of form to injured worker and campus Workers' Compensation manager. Please do not send your Workers' Compensation form to EHS!

• When the claim form is filed with CSU, self imposed penalties for late payment or benefits, jurisdiction of workers' compensation appeals board and discovery period is activated.

• Penalties may be assessed by State Audit unit for failure to comply.  (From $100 up to $5,000 for each offense).

     For any further questions or assistance in completing the form, please call Marjorie Callaghan (ext. 5138). 

• If you need to go to the Supervisor's Injury/Illness Prevention Report (SIPR) form please click here. 

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