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Injured Workers' Responsibility

In order for the County of San Joaquin to provide medical treatment that is reasonably required to cure or relieve the effects of a work related injury/illness, the following steps shall be followed:


Step 1:
Immediately, report your injury/illness to your Supervisor/Manager.


Note: Injured workers must report their injury/illness to their Supervisor/Manager, whether or not they are seeking medical treatment or have lost time from work. Proper documentation of the incident will alleviate any questions or concerns if the injured worker should seek medical treatment at a later date. 


Step 2:
Injured workers requesting medical treatment must obtain a “Request for Medical Treatment” form, from their Supervisor/Manager who will sign and date the form. The injured worker will take the request to a medical provider of their choice, provided they treat work related injuries/illnesses and are familiar with the various workers’ compensation reporting requirements.


Step 3:
The following forms must also be completed to begin processing your claim, please see your Supervisor/Manager.


Forms required:


(1)  Employee Request for Medical Treatment, S&T 201 - NCR Form 
(2)  Employee’s Claim for Workers’ Compensation Benefits, DWC1 - NCR Form
(3)  Notice of Leave of Absence for Temporary Disability Indemnity Payment, Form 29 - E-Form  
(4) Request for Leave of Absence, RLOA (leave 3 days or more)

Note: Workers’ Compensation Leave runs concurrently with Family Medical Leave Act (FMLA)

Temporary Disability Payments will begin when your workers’ compensation claim is approved by the Third Party Administrator (TPA). Risk Management will coordinate the disbursement of the Temporary Disability Payments. Amounts are based on the employee’s average weekly wage.

Please note that claims which involve lost time from work require a three day waiting period before the start of Temporary Disability Payments. If an injured worker is off work more than 7 days or requires immediate hospitalization this waiting period will be waived.

Doctor’s work status reports, and disability notes will determine the length of the workers’ compensation leave period upon approval of the TPA. In order to prevent any interruptions or benefits due the injured worker, it’s the injured worker’s responsibility to provide any and all doctor’s reports, disability, leave from work notes to their Supervisor/Manager. There are no provisions under Workers' Comp for reimbursement of leave accruals used for physical therapy and/or follow up office visits.

If an injured worker initially declined medical treatment due to a work related injury/illness, and later it is determined that they feel the need to seek medical treatment, the injured worker should follow (Step 2) above.

Questions concerning your Workers’ Compensation benefits, contact the Risk Management Department,  Workers’ Compensation Team . 

 Temporary Disability Indemnity Payments (TDI) 



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Human Resources Division

44 North San Joaquin Street
Third Floor Suite 330
Stockton, CA 95202
Phone: (209) 468-3370
Fax: (209) 468-0508