Stanford University Risk Management Department

Stanford University
Workers' Compensation Benefits

News in Workers

Initial Injury/Exposure Reporting Check List

Frequently Asked Questions (Including Stress Claims)


On this page: Initial Injury/Exposure Reporting: Related Forms: See Also:


You may be entitled to workers' compensation benefits if you are injured or become ill because of your job. Workers' a compensation covers most work-related physical or mental injuries and illnesses. An injury or illness can be caused by one event (such as a hurting your back in a fall) or by repeated exposures (such as hurting your wrist from doing the same motion over and over).


Medical Care: Doctor visits, hospital services, physical therapy, lab tests, x-rays, and medicines that are reasonably necessary to treat your injury. You should never see a bill, although there is a limit on some medical services.

Temporary Disability (TD) Benefits: Payments if you lose wages while recovering. For most injuries TD benefits may not be paid for more than 104 weeks within five years from the date of injury.

Permanent Disability (PD) Benefits: Payments if your injury causes a permanent disability.

Supplemental Job Displacement Benefit: A nontransferable voucher payable to a state approved school if your injury arises on or after 1/1/04 and results in a permanent disability that prevents you from returning to work within 60 days after TD ends, and your employer does not offer you modified or alternative work.

Death Benefits: Paid to dependents of a worker who dies from a work-related injury or illness.

Transportation Reimbursement: Medical travel expenditure (upon written request) and all other necessary and reasonable care ordered by your doctor.

Benefits such as temporary, permanent, and death benefits are all payable at a rate based on 2/3 of your average weekly wage, and subject to state minimum and maximum amounts in effect on your date of injury. These benefits are paid every two weeks while you are eligible.

The State Law excludes disability payments for the first three days off (including weekends) unless you are off work more than 14 days or become hospitalized. Stanford's policy is to waive the waiting period and pay full salary for the remainder of the day in which the injury occurred and the three-day State required waiting period, plus two additional days. This five-day period is not charged to sick leave or vacation. After the five-day period, accumulated sick leave and/or vacation may be used to supplement Workers' Compensation benefits, thus continuing income equivalent to full pay. Stanford Disability and Leave Services (DLS) processes and coordinates all disability leaves of absence (LOA) with Payroll, including those for workers’ compensation, as part of the Stanford salary continuation program. Thus, the employee’s DLS representative needs to be informed about all Workers’ Compensation LOAs in order to calculate, coordinate and administrate accurately and in a timely manner all pay for which the employee is eligible. DLS can be reached at Employees may request clarification from Administrative Guide memos 2.1.6, 2.1.7, 7.2.1, 7.6.1 and 2.3.5.

If you have any questions concerning your claim for benefits, please feel free to contact Risk Management at (650) 723-7400. SLAC employees may contact the Safety Department at extension 4533.

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If You Get Hurt

Get Medical Care. If you need emergency care, call 911 or 9-911 within Stanford’s phone system for help immediately. If you need first aid, contact your employer.

Report Your Injury. Report the injury immediately to your supervisor. Don't delay. There are time limits. If you wait too long, you may lose your right to benefits. Your employer is required to provide you a claim form (State Form DWC-1) within one working day after learning about your injury. SLAC employees MUST report the accident/exposure to the SLAC Medical Department, extension 2281, you will then be asked to complete a claim form.  Within one working day after you file a claim form, your employer shall authorize the provision of all treatment, consistent with the applicable treating guidelines, for your alleged injury and shall be liable for up to ten thousand dollars ($10,000) in treatment until the claim is accepted or rejected.

 Where To Seek Medical Attention. Unless you have previously predesignated your personal physician (in writing) all medical care for the first 30 days of treatment should be obtained from Stanford University Occupational Health Center (SUOHC), 480 Oak Road, Phone: (650) 725-5308 Fax: (650) 725-9218, hours from 8:00 AM to 5:00 PM. For urgent medical care after SUOCH hours go to the Acute Care Center within the Emergency Room at Stanford Hospital and Clinics the phone is (650) 723-5111. For life threatening emergencies go to the nearest Emergency Room or the Acute Care Center within the Emergency Room at Stanford Hospital and Clinics the phone is (650) 723-5111.

For your convenience, here is a link containing an optional form that you can use to predesignate your personal physician and give to your employer. Predesignation of Personal Physician Form

If you predesignated your personal physician before injury you may see him or her for treatment. Your personal physician must have treated you and maintained your medical history and records before your work injury. You must tell your employer, in writing, the name and address of your personal physician or medical group before you are injured and your physician must agree to treat you for your work injury. If you wish to change doctors in the first 30 days, your claims administrator must select a new physician within five days of your request. But if you gave your employer the name of your personal chiropractor or acupuncturist in writing before you were injured, you may switch to the chiropractor or acupuncturist upon request. If you still need medical care after 30 days, you may switch to a doctor of your own choice. Different rules apply if your employer has an Health Care Organization (HCO) or has a Medical Provider Network (MPN). Contact your employer for more information on your HCO or MPN.

Discrimination: It is illegal for your employer to punish or fire you for having a work injury or illness, for filing a claim, or testifying in another person's workers' compensation case. Should discrimination be proven, you may be entitled to reinstatement with back pay, higher benefits and expenses up to limits set by State law.

If medical care is not being provided by your employer you have several options. First, contact your claims administrator to find out the status of your claim. If the claim hasn’t been accepted yet, you may go to your group health plan for care, find a doctor, clinic or hospital that will bill the claims administrator directly, or use public health services.

You have the right to disagree with decisions affecting your claim. If you have a disagreement, contact your claims administrator first to see if you can resolve it.

You can get free information from a state Division of Workers' Compensation Information & Assistance Officer. Hear recorded information and a list of local offices by calling toll-free (800) 736-7401. Local Offices: San Jose 408 277 1292; San Francisco 415 703 5020. You may also go to the DWC web site at

You may consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee may be taken out of some of your benefits. For names of workers' compensation attorneys, call the State Bar of California at (415) 538-2120 or go to their web site at You may get a list of attorneys from your local information and assistance officer or look in your yellow pages.

Anyone who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony and may be fined or imprisoned.

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Note to Employees and Supervisors

  • Initial Injury/Exposure Reporting Check List is a link listing what is needed to initially report an injury/exposure.
  • Disability and Leaves Services (DLS) must be contacted in order to facilitate payment of Disability benefits when employee will be losing time beyond the date of injury.
  • SU-17 completed for any accident involving a Stanford University employee. Must be processed within 24 hours. This form is available through this web site. Fax to Risk Management at (650) 723-9456. Submit original to Risk Management, Mail Code 6207.
  • SU-17B  completed for any accident involving a visitor, contractor, etc. Must be processed within 24 hours. This form is available through this web site. Fax to Risk Management at (650) 723-9456. Submit original to Risk Management, Mail Code 6207.
  • State Form DWC-1 provided to Employee for notification of their right to file a Workers’ Compensation claim. Before providing to employee, partially complete as directed on instruction cover sheet and make one copy. Form must be provided to employee within 24 hours. Employee completes and signs top section if they want to file a claim for a work related injury or illness when one or more workdays is lost or when treatment is provided in a medical facility. This form is available through this web site. It is also available from Risk Management at phone: (650) 723-7400. Fax copy of the DWC-1 given the employee to (650) 723-9456. Once signed by employee, submit original and one copy to Risk Management, Mail Code 6207.
  • CAL OSHA 5020 completed for employees when one or more workdays are lost or when treatment is provided in a medical facility. This form is available through this web-site. Submit original to Risk Management, Mail Code 6207.
  • SU-16 completed when the employee has lost one or more full days of work or had restricted work activity due to a work-related injury or illness. Submit to Risk Management on-line once employee has been released to full work duties.


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Last modified: Friday, 26-Jul-2013 11:29:08 PDT update
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