EMPLOYERS | BROKERS | MEDICAL PROVIDERS | EMPLOYEES | STATE AGENCIES

Established in 1914 by the state legislature, State Fund is California's most reliable 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, helping California employers keep their workplaces safe, and restoring injured workers.

Claim Kit

For your convenience and to help you comply with the law, we compiled the forms you’ll need to file a claim in an electronic claim kit (PDF). The chart below lists the forms and when to distribute them. You can also view and download the individual forms below:

Forms to File A Claim	Policy Inception	Time of Injury
Workers’ Compensation Claim Form e3301 with instructions
Employer’s Report of Occupational Injury or Illness 3067 Must be completed and submitted to State Fund no later than 5 days from the date of knowledge of a work injury or illness.
Employee’s Guide to State Fund MPN e3851 Must be posted at every worksite in a location that is easily visible to your employees. Must also be provided to employee at time of injury or, where there is existing injury, and when transferring care into MPN.