Dealing with a workplace injury can be pretty confusing and stressful for employees and employers alike. However, having an understanding of the required California workers’ compensation forms can help streamline the process. There are several key forms that need to be completed to initiate a workers’ comp claim and ensure proper care for the injured employee.
What is Workers’ Compensation?
Workers’ compensation provides medical, disability, and other benefits to employees who suffer job-related injuries and illnesses. It is a form of insurance paid for by employers that covers medical expenses, lost wages, and rehabilitation costs for injured workers. California employers are required to have workers’ comp insurance.
California Workers’ Compensation Forms
When an employee is injured on the job in California, there are certain workers’ comp forms that must be completed. Being familiar with these documents, their purpose, and timelines for submission is crucial for both employees and employers. Here are some of the main California workers’ compensation forms.
1. DWC-1 – Employee’s Claim Form
This is the form an injured employee uses to formally initiate a workers’ comp claim. It collects basic information about the employee, employer, and injury details. Employees should complete and submit this form to their employer right away after a work injury occurs. Employers then have one working day to provide a copy to their insurance company.
2. 5020 – Employer’s Report of Occupational Injury or Illness
The 5020 form is used by employers to report any workplace injury or illness that results in lost time beyond the date of the incident or requires medical treatment beyond first aid. It provides details about how the injury occurred and must be submitted to the insurance carrier within five days of learning about the incident.
3. DWC-AD – Declaration of Readiness to Proceed
This form is used to resolve any disputes about an employee’s workers’ comp claim. Either the employee or employer can file it when there is a disagreement about issues like the injury itself, recommended treatment, ability to return to work, compensation rate, etc.
4. Wage Statement
A wage statement provides information about an employee’s income over the past 12 months. It enables the insurance company to accurately calculate potential benefits owed for temporary disability or permanent disability. Employers must submit it within 14 days of learning about an injury likely to cause disability over 7 days.
5. QME Process Forms
If an employee’s treatment or ability to work remains in dispute after going through the DWC-AD process, a qualified medical examiner (QME) may be appointed to provide an independent evaluation. There are various forms involved in requesting a QME panel and selecting the examiner.
6. Medical Provider Network (MPN) Forms
For employers who use an MPN for workers’ comp care, there are notification forms that must be provided to employees. These advise workers about their rights to treatment within the MPN and how to change physicians if desired.
Ensure Proper Reporting Through Your California Workers’ Compensation Forms
Submitting required workers’ compensation forms promptly helps avoid delays in investigations, medical authorizations, and benefit payments. Employees should report injuries right away and file a DWC-1. Employers must submit the 5020, wage statement, and other documentation within mandated timeframes. Understanding California workers’ comp forms protects both parties.
