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Claims & MPN Information

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Home     |    Claims    |    Workers Compensation Claims & MPN Information

Before an Injury

Welcome to LWP Claims

Workers’ Compensation Benefits at a Glance

How LWP Assists You and Your Employees

Mandatory Postings

Medical Provider Network Information- English

Notice to Employees – Injuries Caused by Work – English

Fraud Poster English / Fraud Poster Spanish

Instructions for Creating a Medical Panel

Medical Provider Network Informaiton- Spanish

Notice to Employees – Injuries Caused by Work – Spanish

Supplemental Notice – Medical Access Assistant (MAA)

Time of Hire Packet

Time of Hire Packet

Incident Reporting Portal

Incident Reporting Portal Request Form

COVID-19 Claims Resources

COVID-19 Occurence Report Form

LWP SB1159 FAQs

After an Injury

What to Do When an Injury Occurs

Employers’ Report of Injury (Form 5020)

What to Do When an Injury Occurs

Employers’ Report of Injury – Form 5020

Employers’ Report of Injury (Form DWC1)

Instructions for Completing the DWC 1 form

Worker’s Compensation Claim Form- DWC1

Investigation

Supervisors Report of Injury or Illness – English

Supervisors Report of Injury or Illness – Spanish

Sending the Employee to the Medical Provider

Sending the Employee to a Medical Provider (Platinum MPN)

Employer’s Approval for Medical Attention

Tangram Insurance Services Workers Compensation program

Optum First Fill Card (English and Spanish)

140 2nd Street
Suite 230
Petaluma, CA 94952

707.781.7381

Our Programs

  • Animal Welfare
  • Captives
  • Cyber
  • Entertainment
  • Janitorial and Building Services
  • Kidnap, Ransom & Extortion
  • Personal Care and Assisted Living
  • Portable Sanitation
  • Propane and Fuel Dealers and Distributors
  • Security Guards
  • Social Services

 

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Animal Welfare
Captives
Cyber
Entertainment
Janitorial & Building Services
Kidnap, Ransom & Extortion

Personal Care & Assisted Living
Portable Sanitation
Propane and Fuel Dealers and Distributors
Security Guards
Social Services