A school district, being a dynamic environment, sometimes experiences accidents to employees. Should you experience a work related injury, please contact your supervisor immediately to fill out the appropriate forms.
Employee's instructions in the event of a workplace injury:
**DWC-1 Claim Form (Employee section numbers 1 thru 9 only) (effective 9/1/2021)
Mitchell ScriptAdvisor First Fill - Temporary Prescription Card (effective 9/1/2021)
**Employee must have contacted the Company Nurse Hotline and completed these 3-forms to initiate a claim. Please return all completed forms to your immediate supervisor, and/or send to Carol Gerken in the MBUSD Business Services office (EMAIL: email@example.com or FAX: 310-303-3823)
Supervisor's instructions in the event of a workplace injury:
Workers' Compensation Leave Update, Effective 7-1-22
As of July 1, 2022, any employee who misses time from work to attend a medical appointment to treat a
work-related injury will not be entitled to receive Temporary Disability or wage-loss benefits.
A ruling of the Sixth District Court of Appeals in Skelton v. WCAB found that Temporary Disability Indemnity
is intended to provide wage replacement only during a period where the employee is incapable of working.
For this reason, any employee who attends a medical appointment for a work-related injury during work
hours will be required to use sick-leave, vacation time or unpaid time off.
The exception to this rule would be the need for the employee to attend a Medical Legal Appointment
such as a Qualified Medical Exam or Agreed-upon Medical Exam.
Please contact firstname.lastname@example.org if you have any questions on this update.
MANDATORY WORKPLACE WORKERS' COMPENSATION POSTERS/FLYERS: Please post the following on all staff information bulletin boards or the like:
|Pre-Designation Form - Workers' Compensation|