Worker's Comp

WORKER'S COMPENSATION (CA)
Self-funded Group #: FHDA-01 Contact: Human Resources: (650) 949-6225 Foothill Health Services: (650) 949-7243/7117 De Anza Health Services: (408) 864-8732 Website: www.sedgwickcms.com Sedgwick CMS Company P.O. Box 2065 Oakland, CA 94604 Facts about Workers' Compensation Workers’ Compensation Medical Leave Allowance Earning Codes: codes 254, 255, and 256 effective August 15, 2008	FORMS
	To be completed by the injured worker (The worker may be assisted by health services): State of California Employer's Report Form (Form 5020) Workers' Comp Report of Injury Form DWC-1 To be completed by the injured worker's supervisor: Supervisor's Claim and Safety Report

Last Updated: Thursday, March 26, 2009 at 10:53:57 AM
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