workers' compensation

Workers' compensation is the oldest social insurance program; it was adopted in most states including California, during the second decade of the 20th century. It is a no-fault system, meaning that injured employees need not to prove the injury was someone else's fault in order to receive workers' compensation benefits for an on-the-job injury.

links, forms & resources

contact information

Click on the corresponding button to download Workers' Compensation Claims Contacts that describe your employment:

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useful links

The following are useful links to Workers' Compensation related resources:

relevant documents

All relevant documents are pulled from the documents library for your convenience. To access all documents available on this website, please visit the documents library:

Please note that most of the following document can only be accessed on the Personnel Department's network.

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DOCUMENT TITLE	TYPE
Workers' Comp Claim Form and Notice of Potential Eligibility (DWC-1)	Form
Employer's Report of Occupational Injury or Illness (Form 5020)	Form
Pre-Designated Physician Form	Form
Pre-Designated Physician Form (Spanish)	Form
Injury Status Report	Report
Quick Reference Workers' Compensation Guide	Guide
How To Report an Injury	Guide
Temporary Modified Duty Program FAQs	Guide
Time of Hire Pamphlet	Resource
Time of Hire Pamphlet (Spanish)	Resource
Workers' Compensation Medical Provider Network (MPN) Information	Resource
Workers' Compensation MPN 101 Civ ADR Initial Notification	Resource
Workers' Compensation MPN 101 LAPPL ADR Initial Notification	Resource
Workers' Compensation MPN 101 Non-ADR Initial Notification	Resource
Fraud Poster & Fraud Hotline (213)473-9050 or (877)742-5352	Resource
Notice to Employees - Injuries Caused by Work Poster	Resource