How do you file a claim?

NOTIFY SAFETY AT (951) 955-3520 OR AFTER HOURS (951) 313-9589

EMPLOYEES: Report the injury or illness to your Supervisor or Manager immediately. 

ADR LEMU: Please complete this ADR LEMU New Injury Packet and submit a copy per the instructions on the cover page.

SUPERVISORS: Call the Injury Intake Center at (888) 826-7835 and complete the New Injury Packet (Fillableand submit a copy to Workers' Compensation Division at ( 

DECLINING TREATMENT / DOES NOT WANT TO FILE A CLAIM: Complete the Declination Packet and send a copy to the Workers' Compensation Division at (, maintain a copy for your records and provide a copy to the employee.

REQUEST FOR TREATMENT AFTER AN EMPLOYEE HAS DECLINED TREATMENT: Please follow the FILE A CLAIM process and submit the ORIGINAL DECLINATION PAPERWORK with the New Injury Packet (Fillable) to the Workers' Compensation Division at (

What if...

AUTO ACCIDENTS Please note, employees injured while DRIVING as part of the Ride Share Program or while driving while engaging in County business, in a personal or County vehicle, should be offered medical treatment and . The claims adjuster will review Please also complete the County of Riverside Confidential Vehicle Accidents/Incidents Report (Safety Form 942.6) and send to Safety as well as the Workers' Compensation Department.

FACTS FOR INJURED WORKERS This provides a brief overview of the benefits provided through the Workers’ Compensation system. It also explains other programs unique to the County of Riverside and County of Riverside employees.

GUIDEBOOK FOR INJURED WORKERS This is the State's Guidebook to help injured workers understand the status of their workers' compensation benefits and what actions are being taken on their workers' compensation claim.

RETURN-TO-WORK REFERRAL FORM The County of Riverside is committed to returning employees to work as soon as possible. For this reason we have created the Return to Work program to coordinate physician opinions with employment/work opportunities. If the physician finds the employee can return to work in a modified or alternate capacity, please fill out this form and send it to the Return to Work Coordinator in the Workers’ Compensation Division.