The purpose of a Workers’ Compensation program is to ensure prompt medical treatment and payment of benefits for any employee who sustains a work-related injury or illness in the course and scope of their employment.

These benefits may include medical care, temporary disability, permanent disability, supplemental job displacement and death benefits. If you are injured at work no matter how minor the injury may be, please contact AMC Call Connect at 1-844-691-4111 to speak with a triage nurse who will help you advise of the proper care for your injury. Please also notify your Supervisor so they may initiate any necessary claim paperwork.

If you are in need of a medical treatment, you will be asked to fill out a Workers Compensation Employee Claim form (DWC1). Employees are not required to file a claim for every incident but a claim must be filed in order for any related medical treatment to be paid under Workers’ Compensation. If medical treatment is needed, the triage nurse will either offer you the option of treatment through the Teleheath program or direct you to an authorized clinic. Unless you have a completed Pre-Designation form on file, your medical treatment must be through the Medical Provider Network. Click here for the MPN Form (English and Spanish).

Once you seek treatment, you will be given a work status form that provides information on any possible work restrictions. It is your responsibility to get this notice back to your District Office as soon as possible after you are seen. Your District Office Claims Coordinator will track your work status, and work with your supervisor to find appropriate modified duty while you recover from your injury. You will be given a new work status every visit and it is your responsibility to get the work status report to your District Coordinator, even if you have been released to full duty by your treating physician.

Failure to keep your district current on your physical status during an injury can cause delays in treatment or temporary disability payments. Most importantly, a current work status is essential for assigning safe temporary assignments.

We are here to assist you:
Our goal is to make it easy on you as you go through the Workers’ Compensation process so you can focus on recovery. Our dedicated advocacy program is an additional resource to help guide you through each step of the process. If at any time you have questions or are in need of assistance, please click here to contact Jaxine Anderson or our office at (530)823-9582 Ext. 205.

Important Documents

To help guide you through the Workers' Compensation program

Workers’ Comp. Employee Claim Form DWC-1

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Predesignation Form

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Employee Notification for Rights – MPN Spanish 2019

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Employee Notification of Rights MPN 2019

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Employee Card AMC CallConnect Nurse Triage English

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Employee Card AMC CallConnect Nurse Triage Spanish

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