The following information is intended for California Workers’ Compensation policyholders utilizing managed care. In such cases, a letter describing needed information and resources (similar to this page) is included with the policy.
Employers should complete the notice below and post in a conspicuous location frequented by employees during the hours of the work day.
All employees should receive a copy of this pamphlet.
According to California Labor Code, all employers are required within one working day of receiving notice or knowledge of injury to provide their employee with the following form:
Employers should also provide a copy of the form below to any ill/injured worker at the time of an injury or transfer of care:
California managed care forms in other languages:
Quick reference guide:
*Managed care for Workers’ Compensation is voluntary in some states. Services vary by state and are offered in accordance with all state laws and regulations. For New York, managed care is voluntary; a full list of authorized health care providers is available from the Workers’ Compensation Board. Employees may select or change their provider at any time without jeopardizing their medical or indemnity benefits.