WORKERS' COMPENSATION (CA)
- Group #: FHDA-01 (self-funded)
- District Contacts:
Human Resources: 650-949-6224
Foothill Health Services: 650-949-7243 or 650-949-7117
De Anza Health Services: 408-864-8732
- Kaiser On-The-Go Contact Information
- Workers' Compensation Notice
- Employee/Student Employee Injury Claim Process
- Claims Administration:
Sedgwick CMS Company
P. O. Box 14535
Lexington, KY 40512-4535
Phone: 877-809-9478
Fax: 859-280-4950
Injured workers whom have been treated by U.S. HealthWorks should continue to be treated by the physicians at U.S. HealthWorks. New injuries will be directed to Kaiser Occupational Medicine Clinic effective May 1, 2017. Please find the clinic information below:
Kaiser ON-THE-JOB Occupational Health Center
10050 N. Wolfe Road
Suite SW1 - 190
Cupertino, CA 95014
Phone: (408) 236 - 6160
General phone number: (800) 464 - 4000
Monday – Friday: 8:30am - 5:00pm
Closed for lunch: 12:30pm - 1:30pm
Closed weekends and Holidays
Additional Information
Facts about Workers' Compensation
Workers' Compensation Medical Leave Allowance Earning Codes : codes 254, 255,and 256 (Applicable only for contract employees)
FORMS:
To receive treatment at Kaiser Occupational Medicine Clinic- FHDA's designated WC clinic:
WC Treatment Authorization Form
WC Treatment Clinic Information(Cupertino Location)
WC Treament Clinic Information(Within California) Last Updated: Feb'24
To be completed by the injured worker (The worker may be assisted by Benefits Unit staff):
State of California Employer's Report Form (Form 5020)
Workers' Comp Report of Injury Form
To be completed by the injured worker's supervisor: