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State Fund is California's largest provider of workers' compensation insurance and a vital asset to California businesses. State Fund supports California's entrepreneurial spirit and plays a stabilizing role in the economy by providing fairly priced workers' compensation insurance making California workplaces safe, and restoring injured workers.



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Employer Requirements

As an employer, you are required by law to provide your employees notice about their workers’ compensation benefits, MPN providers, and where to seek treatment for workers’ compensation injuries. State Fund policyholders can use the materials below to meet those obligations. The chart below lists the mandated materials and when employers should distribute them.

Individual Form Links
You can view and download each individual form by clicking on the link(s) below.

Required Materials

Policy Inception

Time of Hire

Time of Injury

Notice to Employees DWC 7 (Replaces State Fund Forms e13708 and e13709, English & Spanish)
Notice to Employees DWC7 Must be posted at every worksite in a location that is easily visible to your employees. Must be posted in both English and Spanish where there are Spanish-speaking employees.
Before posting the notice, enter the following information below:
MPN Website: http://www.statefundca.com/mpn MPN Effective Date: 02/01/2016
MPN Identification Number: 2432
MPN Access Assistant: (855) 521-7082; Fax Number: (571) 446-2070
MPN Contact Person: (888) 626-1737
Claims Administrator: State Compensation Insurance Fund; Phone: 1 (888)-782-8338
Workers’ compensation insurance carrier: State Compensation Insurance Fund
DWC’s Information & Assistance Office: www.dir.ca.gov/dwc/ianda.html

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Employee’s Guide to The State Fund MPN by Harbor Health e3851 (Replaces State Fund form e13176, English & Spanish)
Must be provided to employee at time of injury or, where there is existing injury, and when transferring care into the MPN. Must be provided in both English and Spanish if the employee primarily speaks Spanish.

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New Employee’s Guide to Workers’ Compensation e13286

 

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Workers’ Compensation Claim Form e3301 with instructions

 

 

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Employer’s Report of Occupational Injury or Illness e3067
Must be completed and submitted to State Fund no later than 5 days from the date of knowledge of a work injury or illness.

 

 

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PENALTIES
Per Title 8 California Code of Regulations (CCR) section § 9881 all California Employers are required to display this poster at every worksite in a location that is easily visible to your employees. Must be posted in both English and Spanish where there are Spanish-speaking employees. Non-compliant employers face potential penalties up to $7,000.00.

Claims Kit
For your convenience, we’ve grouped the forms needed to report a claim into a single downloadable Claims Kit (PDF).

Call Us
If you have additional questions, please call our Customer Service Center at 888-STATEFUND (888-782-8338).

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