Phone: (844) 581-0828
For life-threatening medical emergencies, call 911
Preferred method: Submit the claim information online here
E-mail: claims@pieinsurance.com
In the e-mail, include the following information:
What to do if an injury occurs
Provide a claim form (DWC form 1) within one working day of finding out about an injury or illness.
Complete form DLSR 5020 and send to the claims administrator within five days of knowing about the injury or illness.
Stay involved and maintain an open dialogue with the employee – don’t assume the claims administrator is taking care of everything.
Prominently display the notice where each employee is likely to see the notice on a regular basis.
California Posting Notices - English and Spanish
CorVel Medical Practitioner Network
The DWC-1 Claim Form is the standard California workers’ compensation claim form used by employees to formally report a workplace injury or illness and initiate a workers’ compensation claim.
The Employer’s Report of Occupational Injury or Illness (Form 5020) is a mandatory California workers’ compensation reporting form used by employers to report a workplace injury or illness to their insurer and to the state.
The notice must be given at the time of hire, before the employee starts performing work.
No payment is due for the first 3 days of disability unless the disability lasts longer than 14 days or the employee is hospitalized as an inpatient for treatment required by the injury, then the first 3 days will be paid retroactively. For purposes of calculating the waiting period, the day of the injury is included unless the employee was paid full wages for that day.
California Department of Industrial Relations
