Worker's Compensation Administrator
Keenan & Associates
2882 Prospect Park Dr., Ste. 200
Ranco Cordova, CA 95670
P.O. Box 1538
Rancho Cordova, CA 95741
916-859-7160
916-859-7166 fax
Claims Examiner: Cheryl McKimmy
Claims Analyst: Dana Stone
Link to their website: Keenan & Assoc.
What Do I Do If I'm Injured At Work?
Step 1: Fill out a Supervisor's Report of Injury Form
This must be completed for any employee injury. Its purpose is to document the incident and assess what can be done to ensure this won’t happen again.
Step 2: If medical assistance, complete and take the Treatment Referral Form with you
The employee is to fill out the EMPLOYEE SECTION then give to the Medical Provider to determine upon treatment if the injury is FIRST AID or REPORTABLE CLAIM. The medical provider will mark their section then fax to me.
Step 3. Occupational Health in Yuba City is our Medical Nework Provider. You need to take the Occupational Health Authorization Form and Occupational Health Map . Site Administrator needs to sign the authorization.
Step 4: If injury/accident was not treated like a First Aid, fill out Worker's Compensation Claim Form DWC 1
This is the official state form needed to report an injury. DWC1 must be given to injured employee within one working day of claim. Site Administrators & Assistant(s) may fill out EMPLOYER portion.
I will need a copy to complete the online process and the 2nd page is for employee, it explains potential eligibility.
Step 5: Use Prime RX Card for any prescriptions from injury.
This form prevents the employee from paying for prescriptions out of pocket or through their insurance. The cost is sent directly to Keenan. If the employee does pay for their medication, you may be reimbursed by Keenan & Associates.
