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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.




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 DWC 7 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:
State Fund MPN Website: www.statefundca.com/sfmpn
MPN Effective Date: 07/27/2020
MPN Identification Number: 3136
MPN Access Assistant: (888) 782-8338, Fax (800) 371-5905
MPN Contact Person: (877) 636-0606
Claims Administrator: State Compensation Insurance Fund;
Phone: (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 State Fund MPN 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 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.

 

 

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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.

Claim Kit

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

Call Us

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

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