Workers’ Compensation information and forms for the state of CA

Workers’ Compensation Insurance can seem complicated to administer. There are many forms and various specific state regulations concerning postings and employee notification. To get the help you need to ensure employees understand coverage’s and how to report a work place injury, select the link located below.

• 221-10000 – Claim Kit Cover Letter
  Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
• 221-10001 – Take Control of Workers' Compensation Costs
  This guidance will help ensure the best outcome for you and your employees following a work related injury.
• CA ImpInstr – Important Insured Instructions
  Helpful instructions for each document in the claims kit.
• WC8357n – Workers' Compensation Notice
  Required to be conspicuously posted at the employer's place of business so all employees have access to it.
• WC9217e – Workers' Compensation Notice (Spanish)
  Spanish version - Required to be conspicuously posted at the employer's place of business so all employees have access to it.
• WC9493a – Whistleblowers Are Protected
  Required to be conspicuously posted at the employer's place of business so all employees have access to it.
• WC8359k – Employer's Report of Occupational Injury or Illness
  This form is completed by the employer to report an on the job injury or accident involving an employee.
• WC8222e – Workers' Compensation Claim Form
  This form is completed by the employer and employee to report an on the job injury or accident involving an employee. A copy must be provided to the employee at the time of injury.
• WC9947 – How to File a Workers' Compensation Claim Form
  How to File a Workers' Compensation Claim for employees. A copy must be provided to the employee at the time of injury.
• WC9236f – Written Notice to New Employees (English) (Time of Hire Pamphlet)
  Employer must provide this notice to new employees at time of hire.
• WC9271f – Written Notice to New Employees (Spanish) (Time of Hire Pamphlet)
  Employer must provide this notice to new employees at time of hire.
• WC9909 – Injured Worker Fact Sheet (English)
  Employer must provide this notice to new employees at time of hire.
• WC9915 – Injured Worker Fact Sheet (Spanish)
  Employer must provide this notice to new employees at time of hire.
• MPN EE Notice – MPN Employee Notification
  Required to be conspicuously posted at the employer's place of business so all employees have access to it, and must be distributed to employees if they are injured at work.