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Formularios

article icon date lunes, 30 de diciembre de 2024
English
  • Formulario de solicitud audiovisual
  • Hoja de portada de FAX para reclamos
  • Reclamo del empleado para beneficios por compensación de los trabajadores (Inglés/Español)
  • Guía del Empleado sobre la MPN de State Fund
  • Primer Informe del Empleador sobre Lesiones - ESTADOS
  • Primer Informe del Empleador sobre Lesiones - CDCR
  • Primer Informe del Empleador sobre Lesiones - Departamento de Hospitales Estatales
  • Guía del Empleado para la Compensación de los Trabajadores del Estado de California
  • Formulario de Gastos Médicos por Kilometraje
  • Nueva Guía del Empleado para la Compensación de los Trabajadores del Estado de California
  • Nueva Guía del Trabajador para Servicios ante Desastres de la Compensación de los Trabajadores 
  • Aviso a los empleados
    • Sitio web de la MPN: www.statefundca.com/sfmpn
    • Fecha de entrada en vigor de la MPN: 27/07/2020
    • Número de Identificación de la MPN: 3136
    • Asistente de Acceso de la MPN: (888) 782-8338, Fax (800) 371-5905
    • Persona de contacto de la MPN: (877) 636-0606
    • Administrador de reclamos: State Compensation Insurance Fund; Teléfono: (888) 782-8338
    • Compañía de seguros de compensación de los trabajadores: State Compensation Insurance Fund
    • Oficina de Información y Asistencia de la DWC: www.dir.ca.gov/dwc/ianda.html
  • Formulario de pedido de materiales de seguridad
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