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.
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) |
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Employee’s Guide to State Fund MPN e3851 (Replaces State Fund form e13176, English & 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 |
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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.
For your convenience, we’ve grouped the forms needed to report a claim into a single downloadable claim kit (PDF).
If you have additional questions, please call our Customer Service Center at (888) 782-8338.