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Workers Compensation

Claim Filing Procedures

All employees and supervisors must follow these steps for work-related injuries:

Employees must notify their supervisor immediately.

Call the Company Nurse Injury Hotline at 1-877-518-6702
  • Provide WVMCCD as employer name
  • Provide search code: NCC02 even if medical treatment is not needed

A nurse will gather information, make a care recommendation, and advise the employee on the next steps. An injury report will be sent to the designated treatment facility prior to the injured employee’s visit.

If no medical treatment is needed, complete only the Incident Report form.

Company Nurse will process the Worker’s Compensation forms to Human Resources soon after the incident is reported. Additional information and signatures will be required by the employee and their supervisor. An HR representative will contact the supervisor to complete this process.

Program Facts

Below find important information regarding work-related injuries or illnesses. This information applies to full-time, part-time, student interns, volunteers, and hourly employees.

If the injury/illness is a serious medical emergency, call 9-911.

Report all non-emergency injuries or illness to your supervisor and Quyen Lenshoek at ext. 2128. lf medical treatment is needed, call Company Nurse. If you are aware of any unsafe working conditions, inform your supervisor.

All non-medical emergencies which require ongoing treatment, in-depth medical testing or a rehabilitation program must be authorized by your claims adjuster at Keenan and Associates and based upon medically evidence-based treatment guidelines. You have the right to be treated by a physician of your choice within the MPN (Medical Provider Network) after your initial visit. 

Telephone provider network support - (866) 700-2168

Injuries which occur during the course of a medical internship program should be initially treated at the medical facility where the student is interning. Follow-up care is covered within the MPN (Medical Provider Network).

If you prefer to designate your personal physician for work-related medical treatment, you must file a Pre-Designation Personal Physician form with Human Resources prior to a work incurred injury/illness.

Designated facilities for after-hours urgent medical care are:
Facility Address Phone
Good Samaritan Hospital 2425 Samaritan Drive | San Jose, CA 95124 (408) 559-2011
O'Connor Hospital 2105 Forest Avenue | San Jose, CA 95128 (408) 947-2500

Keep your supervisor informed of your status by providing reports on return medical appointments, limited/restricted duty and return to work releases.

Claim forms are provided to injured employees by Human Resources. Supervisors are also required to complete an injury report form. Human Resources then files a report with the workers' compensation carrier.

The Education Code provides up to 60 working days of paid industrial leave per incident. Once these benefits have been exhausted, workers who remain unable to return to work shall utilize their sick leave or vacation benefits.

For employees who need time off for medical appointments in connection with their work-related injury/illness, each appointment will be counted as one day and applied toward the above mentioned 60 working days of leave. Time off in excess of the 60 day provision is applied toward sick leave or vacation benefits. Doctor's verification of the appointment is required to be attached to the absence report.

Completed Absence Reports are required for any time off work in connection with work incurred injury/illness and sent to Human Resources. Leave will be charged to sick leave during the interim period when the District's workers' compensation carrier, Keenan and Associates, makes their determination. If your claim is accepted, your sick leave will be reinstated. Supervisors may complete the absence forms on your behalf for leaves of extended length to ensure accurate records are maintained.

If your Workers' Compensation claim is accepted and you have utilized 60 days of industrial leave and you return to work on a part-time basis, as recommended by your physician, you will be charged sick leave for medical appointments that are scheduled during your work hours. Therefore, you are encouraged to schedule appointments during non-work hours.

Documents

Claim FormCompany Nurse PosterCompany Nurse QaIncident Report V2017Medical Provider NetworkNew Hire PamphletNotice of Potential Eligibility 091610Physician Pre Designation Form 2017Supervisors Report of Employee InjuryWest Valley Mission CCD Pa Employee Notification Materials