California Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State

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Description

Workers' compensation laws are designed to ensure payment by employers for
some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. Worker's compensation legislation requires the employer to furnish a reasonably safe place to work, suitable equipment, rules and instructions. State workers' compensation statutes vary by state. The Federal Employment Compensation Act covers non-military federal employees or those workers employed in some significant aspect of interstate commerce.


The compensation acts require that notice of the fact of injury be given to the employer, or to the compensation board or commission, or to the insurance carrier, or to all of them. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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FAQ

Certificate of Workers' Compensation Insurance The certificate must be written by an insurance company licensed through the California Department of Insurance. CSLB must be listed as the Certificate Holder. The contractor's business name and license number must be listed. The policy number must be listed.

Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.

Section 342 of Title 8 of the California Code of Regulations requires that employers immediately report to Cal/OSHA any fatality or serious injury or illness of an employee occurring in a place of employment or in connection with any employment.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.

Notify your employer about your occupational injury within 30 days of the accident. Seek medical treatment from an approved provider in your employer's workers' comp insurance network. Complete the DWC-1 Claim Form provided by your employer where you describe the accident and injury.

Deadlines are crucial when filing for workers' comp. In California, a workplace injury must be reported within 30 days of the incident and a workers' compensation claim must be filed within one year. Simply stated, when it comes to filing forms for work-related injuries, the sooner the better.

California law permits compensation for a wide range of disability resulting from job related mental stress. Psychological stress may produce mental disorder, physical disorder or both.

Steps in the California Workers' Compensation Process A work-related injury occurs. ... Notify your employer and submit a claim form. ... Determine your primary treating physician. ... Receive initial medical care. ... Await the claims administrator's decision. ... Continue your medical treatment.

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California Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State