Workers Compensation

Instructions

• Information to Know
• Claim Reporting Instructions

Business Insurance Requirements

• Requirements for Certificate of Liability Insurance

California Forms

• California Form (DWC 1) & Notice of Potential Eligibility
• Notice to California Employees (DWC7)
• EK Health MPN Notice (Bilingual)

Certificate Requests

• Certificate Request Form

High Risk and Foreign Travel

• Foreign Travel Questionnaire
• Hazardous Activity Questionnaire

Injured Worker

• Important Workers’ Comp Info
• Claim Reporting Instructions
• Notice to Medical Providers
• Injury Illness Report
• Prescription Fill Info
• Right of Refusal of Medical Aid
• CA only – DWC-1 Form
• CA only – New Hire Notice (bilingual)

Report Medical Claim

• Notice to Medical Providers
• RXBridge First Fill Temporary Pharmacy Card