How Do I Report a Claim?

California law requires employers to report a claim within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death.

For More Information on Emergency Situations and CAL/OSHA: Click Here

Report A Claim

Actions The Employer Must Take Within One Working Day Of The Injury Date:

  1. Call Preferred Employers Insurance Company (888) 472-9001 to report the injury.
  2. Make an appointment for the injured employee with a doctor from the MPN Network.
  3. Provide the injured employee with Employee Notice that they must use an in-network Doctor.*
  4. Provide the Claim Form to the injured worker. (DWC-1)
  5. Report Injury/Illness on OSHA Log Form 300

Once the injury is reported, a claim number will be assigned and a copy of the completed First Report of Injury Form 5020 will be forwarded to you, the employer. A Claims Adjustor will contact the injured worker, you the employer and the doctor to confirm injury and disability, if any. In the mean time, you should begin to plan for the employee’s return to work once they are medically able to do so.

*Go to your account at Preferred Customer Connect and select “Find A Doctor.”