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Workers' Compensation

If you are experiencing a life-threatening medical emergency, call 911.

Work-related, industrial injuries or illnesses must be reported to your direct supervisor and the Workers' Compensation (WC) Team by emailing workerscomp@wsdk8.us and/or calling 714-894-7311 ext. 1012. The 24-hour CompanyNurse Hotline, 877-518-6702, is available to triage your injury and refer you to the appropriate level of care. A live medical professional will advise self-care instructions or refer you to a medical provider for treatment, if needed.

If immediate medical attention is needed, Huntington Beach Hospital is the designated 24/7 ER service. It is located at 17772 Beach Blvd., Huntington Beach, CA 92647. Phone number: 714-843-5000.

The designated walk-in clinic is any open Akeso. The nearest Akeso location is 17122 Beach Blvd, Suite 104, Huntington Beach, CA 92647. Contact phone number: 714-964-4448.

Treatment by your personal physician for an industrial injury or illness is eligible with specific criteria outlined in the Pre-designation of Personal Physician Letter. The Pre-designation of Personal Physician Form must be completed and signed by the employee and physician. The completed form must be submitted to the WSD - Business Services Division, attention Anne Pham, to be valid.

Westminster School District's Workers' Compensation third-party administrator is Keenan & Associates under the Protected Insurance Program for Schools (PIPS). Contact Anne Pham at 714-894-7311 ext. 1012 or workerscomp@wsdk8.us to submit and file your workers' compensation claim packet.

Standard Forms for WC Claim Packet

Full WC file/packet - To print for Employee

  1. Employee Checklist and Instructions

  2. CompanyNurse 24-hour Hotline Flyer
  3. Employee Statement of Injury

  4. Worker's Compensation Claim Form (DWC)

  5. Akeso Treatment Authorization Form - Direct Supervisor's signature required

  6. PRIME Employee Notification of Rights Materials (MPN)

  7. Cadence Prescription ID Card - Valid with WC Claim Number

  8. Employee Assistance Program (EAP) Flyer

  9. Guidelines for Workers' Compensation Absences - Notify your direct supervisor and workerscomp@wsdk8.us and call in absences to AESOP/Frontline Substitute Management System

  10. *Acknowledgement or Receipt of Workers' Comp Forms

  11. Witness Statement

  12. Medical Treatment Declination

*Required forms must be submitted to Business Services Division at workerscomp@wsdk8.us with Anne Pham, 714-894-7311 ext. 1012.

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