CLAIM RESOURCES

Policyholders receive a claims binder with the following items:

Facts For Injured Workers Flyers
Notice to Employees--Injuries Caused By Work Poster (DWC 7)

First Aid Criteria: Definition of a First Aid Claim

FORMS
Care West Claims Protocol
Supervisor Injury/Illness Report
State of California Employers First Report of Injury (5020)
State of California Employees First Report of Injury (DWC1)
Declination of Treatment (Form 0902-02)
Authorization to Obtain Medical Records (Form 70350-PEG)
Physician's Assessment (Form 0902-04)
Description of Employee's Job Duties (DWC RU-91)

More forms can be acquired by contacting (209) 549-3020 with the quantitiy and form name/number.
Forms can also be downloaded online by clicking here.