(916) 786-5742 or (800) 231-5742
Report a Claim2022-01-11T17:43:00+00:00

REPORT A CLAIM

The JPIA’s Claims Staff Coordinates the defense and/or settlement of all covered claims by or against the districts. Crucial to their efforts is cooperation by the members in the form of early reporting of all incidents.

If you wish to report a Liability or Property claim please call (800) 231-5742, fax information to (916) 786-0209, or E-Mail to Claims.

After 4:30 or on weekends/holidays, please contact Sedgwick staff  Jim Stewart at (916) 548-8283, or Casey McClintock at (916) 607-6360.

You may email new Workers’ Compensation claims (5020, DWC-1, etc.) to Workers’ Comp Claims.

The JPIA’s Claims Staff Coordinates the defense and/or settlement of all covered claims by or against the districts. Crucial to their efforts is cooperation by the members in the form of early reporting of all incidents.

If you wish to report a Liability or Property claim please call (800) 231-5742, fax information to (916) 786-0209, or E-Mail to Claims.

After 4:30 or on weekends/holidays, please contact Sedgwick staff  Jim Stewart at (916) 548-8283, or Casey McClintock at (916) 607-6360.

You may email new Workers’ Compensation claims (5020, DWC-1, etc.) to Workers’ Comp Claims.

Liability and Property Program Claims Information

Liability and Property Program Claims Information

Workers’ Compensation Program Claims Information

California Workers’ Compensation Law requires that every employer provide its employees with workers’ compensation coverage. This coverage guarantees state-mandated benefits to employees injured on the job or incurring work-related illness or disease. If you are unable to decide if an injury is work related, report it to the JPIA for investigation.

All incidents should be reported to us immediately by using the link below, or by faxing the workers’ compensation forms to the JPIA at (916) 786-0209. DO NOT send reports of any kind directly to the Department of Industrial Relations, Workers’ Compensation Appeals Board, any attorney or physician.

You may email new Workers’ Compensation claims (5020, DWC-1, etc.) to Workers’ Comp Claims.

Should you wish to send the paperwork through a secured email, and you are a new user you will need to create an account first .

For existing users click on the link here. When creating the secured email, please send the email to _claimswc_wa@acwajpia.com

You can find more information on the claims process and important forms for both JPIA members and outside claimants below.

Frequently Asked Questions

Do I need to provide a DWC1 claim form if the clinic indicates the treatment qualifies as first aid?2021-10-13T19:49:55+00:00

No, but once treatment is beyond first aid, you then have 1 business day to provide the DWC-1 claim form.

What should I send with the injured employee when I send them to our Occupational Injury Clinic?2021-10-13T19:50:19+00:00

They should bring the medical referral card and the First fill pharmacy form.  Or you can call the clinic to let them know you are sending the injured employee and then just send the First fill pharmacy form with the employee.

What if the validity of the claim is questionable?2021-10-13T19:50:57+00:00

If you have a questionable claim, you need to let us know as we may need to formally delay the claim. This involves obtaining the injured worker’s statement and medical records.  It also involves obtaining employer statements.  We may also need a medical evaluation to make a compensability determination.

We have an injured employee who has been released back to modified duty which we can provide but the employee has declined the work. Can they refuse to work modified duty?2021-10-13T19:51:26+00:00

Yes, they can, but we will not pay temporary disability benefits and they will need to use their own sick leave.

What if the doctor releases an injured worker back to modified duty full time but we only have part-time modified duty, should we still bring them back?2021-10-13T19:51:53+00:00

Yes, even if you only have two hours of work it is always best to bring back the injured employee.  We will pay them a temporary partial disability or wage loss benefit.

How are prescriptions paid?2021-10-13T19:52:20+00:00

Medications for work injuries should be billed through MyMatrixx.  Employees need to be provided with the First fill pharmacy form before they are sent to the Occupational Injury Clinic.

We had an injured employee bring in a bill from his workers’ comp doctor advising him that he owes the difference of what workers’ comp paid and what was billed. What should I tell this employee?2021-10-13T19:52:44+00:00

Tell the employee to call the JPIA, providers are not allowed to bill the patient on an accepted work related injury.

If we have an injured employee working modified duty and they are complaining the modified work is increasing their symptoms, what should we do?2021-10-13T19:53:16+00:00

They need to get back into their doctor’s office immediately, you may need to pull them off the job until they are seen and then call your claims examiner.

Does workers’ compensation pay for time off to attend appointments?2021-10-13T19:53:45+00:00

No. Workers’ compensation only covers time off when a doctor states an employee is unable to work.  Employees will need to use sick or vacation time.

Why do I have to use my sick time when I attend medical appointments?2021-10-13T19:54:11+00:00

TD benefits are paid when your treating physician indicates you are medically temporarily disabled.  If you have returned to work and you are receiving your salary, then you are not medically disabled.

Do we pay for medical treatment during the delay process?2021-10-13T19:54:33+00:00

Yes, up to $10,000 subject to utilization review until the claim is denied.

What is Utilization Review (UR)?2021-10-13T19:55:07+00:00

UR reviews treatment requests by the treating physician determines medical necessity. UR will determine whether to approve the requested treatment. Claims Administrators are required by law to have a UR program.

How do I change my designated clinic?2021-10-11T22:35:09+00:00

Advise employees of the new clinic by updating your employment poster and send an email to the JPIA to advise of the new clinic information. When deciding upon a new clinic, the JPIA has a clinic evaluation check list and Guide to High-Value Physician Services in Workers’ Compensation on our website to assist employers with selecting a new initial care clinic. You may also consult with Occu-Med to get a list of clinics in your area.

Can employees pre-designate a physician?2021-10-11T22:34:24+00:00

Yes, but only before an injury occurs. If an employee desires to pre-designate a doctor, please provide the employee with the blue Facts About Workers’ Compensation pamphlet. The doctor is not required to sign the form, but they must supply other documentation that they are agreeing to be a pre-designated physician.

Are we required to notify our employees yearly of their right to pre-designate?2021-10-11T22:33:43+00:00

No, we recommend the “Facts About Workers’ Compensation” pamphlet be included in all new hire packets.

How much time do I have to report a serious injury to Cal Osha?2021-11-16T22:25:51+00:00

Immediately but no longer than 8 hours of the known injury/illness.

Resource:  8 CCR 342 Reporting Work-Connected Fatalities and Serious Injuries.

What is considered a serious injury or illness by CalOsha?2021-11-16T22:27:24+00:00

Definition of a serious injury is death, in patient hospitalization for reasons other than medical observation or diagnostic testing, amputation, loss of an eye or serious permanent disfigurement.

You are now required to report serious injuries sustained to a worker in a construction zone on a public highway.

Resource: JPIA Splash Alert, Cal/OSHA Adopts New Law Revising the Definition of a Serious Injury/Illness and Employer Reporting Requirements

Where can I locate my local CalOsha reporting site?2021-11-16T22:30:54+00:00

Refer to the link below. Just enter your zip code or city to find your local CalOsha reporting site.

https://www.dir.ca.gov/dosh/report-accident-or-injury.htm

When am I required to post my Osha300a log?2021-11-16T22:32:49+00:00

Posting is required from February 1 through April 30.

What should I do if an employee is injured but doesn’t wish to seek medical treatment?2021-10-13T19:49:13+00:00

Document date/time and what happened and have them sign that they are declining treatment.  On the website, under documents there is a form titled “Declination of medical treatment”.

Workers’ Compensation Program Claims Information

California Workers’ Compensation Law requires that every employer provide its employees with workers’ compensation coverage. This coverage guarantees state-mandated benefits to employees injured on the job or incurring work-related illness or disease. If you are unable to decide if an injury is work related, report it to the JPIA for investigation.

All incidents should be reported to us immediately by using the link below, or by faxing the workers’ compensation forms to the JPIA at (916) 786-0209. DO NOT send reports of any kind directly to the Department of Industrial Relations, Workers’ Compensation Appeals Board, any attorney or physician.

You may email new Workers’ Compensation claims (5020, DWC-1, etc.) to Workers’ Comp Claims.

Should you wish to send the paperwork through a secured email, and you are a new user you will need to create an account first .

For existing users click on the link here. When creating the secured email, please send the email to _claimswc_wa@acwajpia.com

You can find more information on the claims process and important forms for both JPIA members and outside claimants below.

Frequently Asked Questions

Do I need to provide a DWC1 claim form if the clinic indicates the treatment qualifies as first aid?2021-10-13T19:49:55+00:00

No, but once treatment is beyond first aid, you then have 1 business day to provide the DWC-1 claim form.

What should I send with the injured employee when I send them to our Occupational Injury Clinic?2021-10-13T19:50:19+00:00

They should bring the medical referral card and the First fill pharmacy form.  Or you can call the clinic to let them know you are sending the injured employee and then just send the First fill pharmacy form with the employee.

What if the validity of the claim is questionable?2021-10-13T19:50:57+00:00

If you have a questionable claim, you need to let us know as we may need to formally delay the claim. This involves obtaining the injured worker’s statement and medical records.  It also involves obtaining employer statements.  We may also need a medical evaluation to make a compensability determination.

We have an injured employee who has been released back to modified duty which we can provide but the employee has declined the work. Can they refuse to work modified duty?2021-10-13T19:51:26+00:00

Yes, they can, but we will not pay temporary disability benefits and they will need to use their own sick leave.

What if the doctor releases an injured worker back to modified duty full time but we only have part-time modified duty, should we still bring them back?2021-10-13T19:51:53+00:00

Yes, even if you only have two hours of work it is always best to bring back the injured employee.  We will pay them a temporary partial disability or wage loss benefit.

How are prescriptions paid?2021-10-13T19:52:20+00:00

Medications for work injuries should be billed through MyMatrixx.  Employees need to be provided with the First fill pharmacy form before they are sent to the Occupational Injury Clinic.

We had an injured employee bring in a bill from his workers’ comp doctor advising him that he owes the difference of what workers’ comp paid and what was billed. What should I tell this employee?2021-10-13T19:52:44+00:00

Tell the employee to call the JPIA, providers are not allowed to bill the patient on an accepted work related injury.

If we have an injured employee working modified duty and they are complaining the modified work is increasing their symptoms, what should we do?2021-10-13T19:53:16+00:00

They need to get back into their doctor’s office immediately, you may need to pull them off the job until they are seen and then call your claims examiner.

Does workers’ compensation pay for time off to attend appointments?2021-10-13T19:53:45+00:00

No. Workers’ compensation only covers time off when a doctor states an employee is unable to work.  Employees will need to use sick or vacation time.

Why do I have to use my sick time when I attend medical appointments?2021-10-13T19:54:11+00:00

TD benefits are paid when your treating physician indicates you are medically temporarily disabled.  If you have returned to work and you are receiving your salary, then you are not medically disabled.

Do we pay for medical treatment during the delay process?2021-10-13T19:54:33+00:00

Yes, up to $10,000 subject to utilization review until the claim is denied.

What is Utilization Review (UR)?2021-10-13T19:55:07+00:00

UR reviews treatment requests by the treating physician determines medical necessity. UR will determine whether to approve the requested treatment. Claims Administrators are required by law to have a UR program.

How do I change my designated clinic?2021-10-11T22:35:09+00:00

Advise employees of the new clinic by updating your employment poster and send an email to the JPIA to advise of the new clinic information. When deciding upon a new clinic, the JPIA has a clinic evaluation check list and Guide to High-Value Physician Services in Workers’ Compensation on our website to assist employers with selecting a new initial care clinic. You may also consult with Occu-Med to get a list of clinics in your area.

Can employees pre-designate a physician?2021-10-11T22:34:24+00:00

Yes, but only before an injury occurs. If an employee desires to pre-designate a doctor, please provide the employee with the blue Facts About Workers’ Compensation pamphlet. The doctor is not required to sign the form, but they must supply other documentation that they are agreeing to be a pre-designated physician.

Are we required to notify our employees yearly of their right to pre-designate?2021-10-11T22:33:43+00:00

No, we recommend the “Facts About Workers’ Compensation” pamphlet be included in all new hire packets.

How much time do I have to report a serious injury to Cal Osha?2021-11-16T22:25:51+00:00

Immediately but no longer than 8 hours of the known injury/illness.

Resource:  8 CCR 342 Reporting Work-Connected Fatalities and Serious Injuries.

What is considered a serious injury or illness by CalOsha?2021-11-16T22:27:24+00:00

Definition of a serious injury is death, in patient hospitalization for reasons other than medical observation or diagnostic testing, amputation, loss of an eye or serious permanent disfigurement.

You are now required to report serious injuries sustained to a worker in a construction zone on a public highway.

Resource: JPIA Splash Alert, Cal/OSHA Adopts New Law Revising the Definition of a Serious Injury/Illness and Employer Reporting Requirements

Where can I locate my local CalOsha reporting site?2021-11-16T22:30:54+00:00

Refer to the link below. Just enter your zip code or city to find your local CalOsha reporting site.

https://www.dir.ca.gov/dosh/report-accident-or-injury.htm

When am I required to post my Osha300a log?2021-11-16T22:32:49+00:00

Posting is required from February 1 through April 30.

What should I do if an employee is injured but doesn’t wish to seek medical treatment?2021-10-13T19:49:13+00:00

Document date/time and what happened and have them sign that they are declining treatment.  On the website, under documents there is a form titled “Declination of medical treatment”.