Managed Care Information

California

This 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 following notice and post in a conspicuous location frequented by employees during the hours of the work day:

DW7 – Notice to Employees – Injuries Caused by Work

All employees should receive a copy of this pamphlet:

Time-of-Hire Pamphlet (Spanish version)

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:

DWC 1 – Workers’ Comp Claim Form & Notice of Potential Eligibility

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:

MPN #2397 – Covered Employee Notification (Spanish version)

MPN ID# 2397 | Medical Access Assistant Phone Number 1-844-752-1144

California managed care forms in other languages:

Physician Look-Up

Mitchell ScriptAdvisor Quick Reference Guide

Submit Forms to

  • claims3@guard.com
  • 570-825-0611 (fax)
  • Berkshire Hathaway GUARD
    P.O. Box 1368
    Wilkes-Barre, PA 18703-1368

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