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CLM-2025-0189

Closed

Carpenter laceration from table saw during framing operations. Required 12 stitches at UC Davis Medical Center. Employee returned to modified duty after 3 days.

$4,200

total incurred

Date of Loss

Sep 22, 2025

Date Filed

Sep 22, 2025

Policy

Workers Compensation

WC-2026-005678

Loss Type

Workers Comp — Laceration

Financial Summary

Total Incurred$4,200
Deductible$0
Amount Paid$4,200
Open Reserve$0
100% paid$0 remaining

Location of Loss

Pacific Ridge Builders Shop — 4210 Power Inn Rd, Sacramento, CA

Activity Timeline

Injury occurred

Sep 22, 2025 at 1:15 PM

Carpenter Mike Torres suffered laceration to left hand from table saw during framing cut. Blade guard was in place but material kicked back.

Medical treatment

Sep 22, 2025 at 2:30 PM

Transported to UC Davis Medical Center. Received 12 stitches. No tendon or nerve damage.

Claim filed

Sep 22, 2025 at 5:00 PM

DWC-1 form submitted same day. OSHA log updated.

Employee returned to work

Sep 25, 2025 at 8:00 AM

Modified duty — light work, no power tools for 2 weeks. Cleared by treating physician.

Full duty release

Oct 6, 2025 at 12:00 AM

Stitches removed. Employee cleared for full duty with no restrictions.

Final payment

Oct 15, 2025 at 12:00 AM

All medical bills paid. Total incurred: $4,200. No lost time beyond 3 days modified duty.

Claim closed

Oct 20, 2025 at 12:00 AM

Claim closed with no remaining reserve. Final cost: $4,200.

Claims Adjuster

Robert Hernandez

State Compensation Insurance Fund

(916) 555-0331r.hernandez@scif.com
Ref: SCIF-WC-2025-08874

Related Policy

Workers Compensation

Policy #: WC-2026-005678

Effective: Jan 1, 2026Jan 1, 2027

Premium: $34,200/yr

active

Key Dates

Date of LossSep 22, 2025
Claim FiledSep 22, 2025
Last ActivityOct 20, 2025
Days Open354