New California Revised Pamphlets Posting Notices &
Claim FormsRequired as of October 8, 2010
As you may have heard, California has amended their MPN regulations effective 10/8/10. See the attachment below, which is Zurich’s CA MPN Communication Letter that they have provided to us for more information on this topic. This letter has information on how you will complete the new MPN section #4 of the DWC-7 State Posting Notice. If you are not enrolled in Zurich’s Medical Provider Network we do highly recommend that you do so. Instructions are in this letter to get you started.
Zurich has been sending the new posting notice to all of our new and renewal issued policies with CA locations since early September along with the New Hire Pamphlet referenced in the communication letter. You will need to complete the MPN information outlined for you in the attached letter along with your policy effective date and your MPN effective date if you are currently enrolled. Once completed please print each notice out on legal size paper and post them in a conspicuous place frequented by your employees.
Below, there is also an attached copy of the Revised DWC-1, Workers’ Compensation Claim Form & Notice of Potential Eligibility. Please note that this is a 5 part carbon copy in its original form and needs to be ordered by your office. You can obtain this form from the California Workers’ Compensation Institutes store along with extra copies of the New Hire Pamphlets. Simply go to www.cwci.org and click on store on the right hand side where you will locate ordering the information for each of these items. In the meantime you can use the attached DWC-1 form starting 10/8/10 if you do not have your stock of carbon copies by this roll out date. It is very important, however, if you use the attached DWC-1 that you make 5 copies of this form once completed by the EE and ER when you have a new workers’ compensation claim that you have reported on or after the roll out date. Please follow instructions very carefully on the DWC-1 form.