Claims Materials

California Claims Materials

• California Claims Kit Checklist
• Claims Management
• Employee’s Claim for Workers’ Compensation Benefits DWC-1
• First Report of Injury Form 5020
• Medical Service Order form California
• MPN Handout English
• MPN Handout Spanish
• MPN Implementation Instructions
• MPN Poster English
• MPN Poster Spanish
• Notice to Employees Poster for Injuries Caused on the Job (DWC 7)
• WCAB Office Information Sheet
• Workers’ Compensation Temporary Prescription ID Card
• Time of Hire Pamphlet – English
• Time of Hire Pamphlet – Spanish

Utah Claims Materials

• Employer’s Report of Injury – Utah
• Information for Employers for Workers Compensation – Utah
• Information for Injured Workers – Utah
• Information for Injured Workers (Spanish) – Utah
• Injured Worker’s Right and Responsibilities – Utah
• Injured Worker’s Right and Responsibilities (Spanish) – Utah
• Medical Services Order Form – Arizona, Colorado, Utah
• Workplace Safety and Health
• Workplace Safety and Health – Spanish
• Workers’ Compensation Notice Poster – Utah
• Workers’ Compensation Notice Poster (Spanish) – Utah
• Workers’ Compensation Temporary Prescription ID Card