California Resources
California MPN workers’ compensation resources for injured employees
Complete written employee notification (English and Spanish)
How to access the Sentry Insurance Group MPN (English and Spanish)
Continuity of care policy (English and Spanish)
Transfer of ongoing care policy (English and Spanish)
Workers’ compensation notification pharmacy benefits network (English and Spanish)
Compensación para trabajadores recursos para empleados lesionados de la MPN de California
Complete la notificación escrita para empleados (inglés y español)
Cómo acceder a la MPN de Sentry Insurance Group (inglés y español)
Política de continuidad de la atención (inglés y español)
Transferencia de la política de atención continua (inglés y español)
Red de beneficios de farmacia de notificación de compensación para trabajadores (inglés y español)
California MPN workers’ compensation resources for policyholders
Sentry Insurance Group policyholders are automatically enrolled in the Sentry Insurance Group MPN #3197 unless they expressly opt out.
You must post these notices and forms in a conspicuous location frequently visited by the employees at each business location within the state, and/or printed and provided to the employee at the time of hire and/or at the time of injury.
Notice to employees—injuries caused by work (DWC-7)
You’re required to post the DWC-7 in both English and Spanish in a location that’s clearly visible to employees in their workplace. This poster provides employees with information regarding workers’ compensation benefits and the California medical provider network (MPN). This must be posted in each of the employer’s California locations. Please complete the fillable fields with the information in the downloadable instructions.
Time of Hire Notice
Provide a Time of Hire Notice to all current employees if it wasn’t previously provided. You should also give the notice to new employees at the time they’re hired. The Time of Hire Notice provides employees with general information about workers’ compensation and the benefits available to injured workers. Please complete the fillable fields with the information in the Time of Hire instructions.
View Time of Hire Notice instructions
Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
Provide the DWC-1 claim form to an employee upon notice of a claimed injury. This form initiates the claims process for the injured employee. You must complete this form within one working day of when you became aware of an employee’s work-related injury or illness. Submit a copy to the insurance carrier, provide a copy to the employee, and keep a copy for your own records.
Employer’s report of occupational injury or illness (DLSR-5020)
You must complete this form within five days of being notified of a work-related injury or illness that results in lost time beyond the date of incident or requires treatment beyond first aid. Fatalities must be reported within 24 hours.
View Employer's report of occupational injury or illness (DLSR-5020)
California pharmacy benefit network resources
Workers’ compensation notification pharmacy benefit network posters
Post these, along with the DWC-7 posters, in a location that’s clearly visible to employees in their workplace. These posters provide employees with information regarding the workers’ compensation pharmacy benefit network.
Workers’ compensation notification pharmacy benefit network
Give this pamphlet to employees when they’re hired and when an injury occurs. It provides information on the pharmacy benefit network, information on locating participating pharmacies, and contact information if they have questions.
Pharmacy benefit network first fill card
Give this card to an injured employee at the time of injury or when the injury is reported to you. They’ll need to show this card to the pharmacy when obtaining prescriptions for their work-related injury. This is a temporary card; their permanent card will come in the mail. Using this card will allow initial prescriptions to be obtained at no cost to the injured employee.
Complete written employee notification
The complete employee notification doesn’t need to be posted in the workplace. We’ll send it to your employee when an injury is reported to us.
Change of workers’ compensation carrier and medical provider network
California employers who used a California MPN with a prior carrier should give employees this document that lets them know about Sentry MPN.