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Reporting Claims

March 5, 2021| |

Property & Liability Claims

Report the claim to ASCIP using the following methods: How to file a Claim with ASCIP :
  1. Email: claims_info@ascip.org. The Claims Operations team monitors this email address regularly.
  2. Telephone: Call ASCIP at (562) 404-8029 Monday-Friday from 8:00 a.m. to 5:00 p.m. to be directed to the Claims Department.
  3. After-hours claim reporting, please contact: Noel Waldvogel, Claims Manager claims_info@ascip.org For Emergency after-hours claims call: (916) 591-3598
When members initially report a liability loss to ASCIP, please attempt to have the following information available for the adjuster:
  • Name, address, and telephone number of person sustaining injury or property damage
  • Name, address, and telephone number of person reporting injury or property damage
  • Date the incident occurred
  • Time the incident occurred
  • Location, including street address, if applicable
  • Description of the injuries or property damage; include vehicle information, if applicable
  • Description of how the incident occurred
  • Names, addresses, and telephone numbers of any witnesses
  • Name of law enforcement agency, if notified, report number or “DR#” if possible
  • Contact information for your District’s Risk Manager or equivalent
  • Any other relevant facts, including weather conditions, condition of shoes, clothing, etc.
  • If District equipment contributed to the cause of the injury, make sure that the equipment is secured and available so that ASCIP can inspect it.

Workers' Compensation Claims

  1. Instruct the employee to immediately contact Company Nurse by calling (888) 770-0929, (Valley Insurance Program members please call (877) 854-6877).
  2. Within 24 hours of knowledge of injury, provide the injured or ill employee with:
    1. DWC-1 Claim Form
    2. MPN Informational Pamphlet
    3. Pharmacy First Fill Flyer
    4. Receipt of Workers’ Compensation Information Form. Once the employee returns the DWC-1 Claim Form, the employer must complete the employer section at the bottom of the form and return a copy to the claims administrator.
  3. Complete the Employer’s Report of Occupational Injury or Illness (Form 5020) and return a copy to your designated claims administrator. (Need to update)
  4. Serious injuries/illnesses must be reported to Cal/OSHA within 8 hours of knowledge.
  1. Instruct the employee to immediately contact Company Nurse by calling (888) 770-0929
  2. Within 24 hours of knowledge of injury, provide the injured or ill employee with:
    1. DWC-1 Claim Form
    2. MPN Informational Pamphlet
    3. Pharmacy First Fill Flyer
    4. Receipt of Workers’ Compensation Information Form. Once the employee returns the DWC-1 Claim Form, the employer must complete the employer section at the bottom of the form, and return a copy to the claims administrator.
  3. Complete the Employer’s Report of Occupational Injury or Illness (Form 5020) online.
  4. Serious injuries/illnesses must be reported to Cal/OSHA within 8 hours of knowledge.

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