The 2nd thing that a California investigator needs…

The 2nd document that a worker's compensation investigator should obtain from the claims adjuster before beginning their investigation is a completed Form 5020, known as the Employer's First Report of Injury or Illness.

Employer's First Report of Injury or Illness (Form 5020)

California law requires all employers to report to their claims administrator within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident or requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death. In addition to the completing of the 5020, every serious injury, illness, or death must be reported immediately by telephone or other means to the nearest office of the California Division of Occupational Safety and Health.  Once the Form 5020 is reported to the claims administrator, the claims administrator must report the information contained in the document to the California Department of Insurance via EDI (Electronic Data Interchange) per Title 8, California Code of Regulations Section 14002.

It is important for the investigator to note that this form contains confidential information that should only be disclosed to persons who are entitled to this information as per CCR Section 14300.35, 14300.30, & 14300.40.  The investigator should make sure they protect the confidential information from being disclosed to a party who is not permitted to view or learn of the information.

The Employer's First Report can provide the investigator a wealth of information to assist them in developing their investigation into the facts of the incident which resulted in injury or illness.  The form contains 39 boxes of information divided into three sections:  The Employer, The Injury or Illness, & The Employee.

In the employer section, the investigator should pay particular attention to box 4 and box 6.  Box 4 tells the reader of the document the nature of the employer's business.  Box 6 tells of the reader the type of employer (i.e. Private Employer or various public employers).  The nature of the employer's business (i.e. restaurant, hotel, construction company, etc.) will inform the investigator what range and types of employees the employer likely has working for them.  Knowledge of the employer type will assist the investigator in identifying possible special issues that will need to be investigated to provide the information to the adjuster so they may make the appropriate determinations on liability and benefit eligibility.  These issues may include (applicability of Educational Code Benefits, applicability of presumptions of injury for certain employee types, applicability of Labor Code Section 4850 benefits, etc.)

The second section is the injury or illness section (boxes 7-29).  This sections contains a wealth of information that can be used in the process of investigation.  Of course, I recommend the investigator verify the information contained in the document with the person who completed the document as well as independently corroborate the information from other sources.  This section tells the investigator and/or the claims adjuster the basic information relating date and time of injury, place of injury, whether or not there was any lost time, has the employee returned to work, when was the employer's first date of knowledge of the injury, whether or not any chemicals or equipment was involved in the injury, description of the activity the injured worker was performing at the time of injury, a description of how the injury or exposure occurred, the name of the physician or medical facility that treated the injured worker, and whether or not the employee was treated in the emergency room or if they were hospitalized overnight.  All of the information is crucial to the proper adjusting of a California Worker's Compensation claim.

The final section of the 5020 is the employee section (boxes 30-39).  The employee section provides basic demographic information for the injured worker that includes their name, date of birth, Social Security Number, address, phone number, employee status, usual work hours, occupational title, date of hire, salary/wages, and whether the injured worker is eligible for other means of compensation (i.e. tips, lodging, meals, bonuses).

The investigator should obtain a copy of this document from the employer if they did not receive one from the claims adjuster.

The Employer's First Report of Injury or Illness is one of the documents mandated by state law and regulation to be housed in a paper or electronic claim file and available for inspection by state regulatory audit agencies.

Should any of the readers have any questions about this document, please feel free to post your question to the blog or e-mail me directly.  Thank you for your interest in this subject.

Stay tuned for the next installment of this California Worker's Compensation Claim Investigator Series.  Should you wish to be notified of any new postings on this blog, please subscribe on the right hand column.

Leaving No Stone Unturned!

Ryan D. Clock, The Precision Detective

The 1st thing that a California investigator needs…

Welcome to the first installment of the California Worker's Compensation Blog Series for claims investigators and worker's compensation claims professionals,

" The 9 Things An Investigator Needs From Their Claims Adjuster "

The first thing an investigator needs to obtain from their claims adjuster or the employer if not available from the claims adjuster is the injured claimant's worker's compensation claim form or (DWC - 1) & Notice of Potential Eligibility .

DWC-1 (Click Here to View and/or Save Form for Reference)

California Labor Code Section 5401(a) states as follows:

"Within one working day of receiving notice or knowledge of injury under Section 5400 or 5402, which injury results in lost time beyond the employee's work shift at the time of injury or which results in medical treatment beyond first aid, the employer shall provide, personally or by first-class mail, a claim form and a notice of potential eligibility for benefits under this division to the injured employee, or in the case of death, to his or her dependents."

Labor  Code Section 5402(a) states that "(a) Knowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400."

The California Worker's Compensation Claim Form (DWC-1) is the cornerstone form of the California Worker's Compensation System.  The filing of this form is meant to start the process into determining whether a claimant's claim for benefits will be accepted.  The provision of the claim form by the employer to a suspected injured worker and that injured worker's submission of that completed claim form to the employee begins the 90 day period in which the claims administrator has the opportunity to investigate the facts of the claim and make a determination whether to accept a claim or deny a claim in whole or in part.

The claim form (DWC-1) can provide the introductory information into the nature of the claim being made by the claimant or injured worker.  The claim form package including the notice of potential eligibility is divided basically into three sections.  The first section is the Notice of Potential Eligibility.  The notice of potential eligibility contains information in English & Spanish addressed to the injured worker regarding their rights and responsibilities under California Worker's Compensation law and describes benefits that the injured worker may be eligible for.  The second section is the employee’s section of the actual claim form, sections 1 through 8.  This section is only to be completed only by the employee or their authorized representative.  The third and final section is the employer’s section, sections 9-18.  The employer is to complete this section only after the employee has completed sections 1 through 8.  The employer is then to return a fully completed document copy to the injured worker and then also provide a copy to the employer's claims administrator.

It is imperative for the investigator and claims adjuster to verify the information contained in the Employee's Claim Form to make sure it is correct.  I recommend that an investigator and/or claims adjuster discuss the contents of the form with the persons who completed the form to verify the forms accuracy.  I also recommend that if a recorded statement is being taken of the claimant, that the claimant acknowledge on the recording what parts of the form that they completed and to acknowledge in the negative or affirmative that they read and understand the document inclusive of the Notice of Potential Eligibility Language.  Furthermore, I also make it a habit to have the claimant acknowledge the anti-Fraud statement which states as follows:

“Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony”.


This may elicit a guilty conscience for those claimant’s who may be misrepresenting their claims in whole or in part and may cause them to rethink the filing of their claim.


Join me next week for the next installment in this series to find out the 2nd thing you need prior to starting your investigation.


Until then,


Ryan D. Clock, The Precision Detective

New California Worker's Compensation Investigation Blog Series Announced

In my experience as a California Worker's Compensation Senior Claims Examiner I have learned that having the most appropriate and the most correct information is imperative in order to begin and end an investigation into a worker's compensation claim.  As a result, I have come up with at least 9 things an investigator needs from the claims adjuster prior to completing their AOE/COE or other associated worker's compensation claims investigation.


Therefore, I will be beginning this week I will be writing a weekly blog series entitled,

" The 9 Things The Investigator Needs From Their Claims Adjuster "

So come join this Truth Slueth weekly as I unpack these 9 things by subscribing or following my blog.  You can do so by signing into blogger, subscribing to the RSS feed, or subscribing by e-mail below.


Along the way you will have opportunity to make comments and/or ask some questions about the week's topic.  We can share personal stories as well as personal challenges.  I may also be able to provide you some insight into the realm of the claims adjuster and insight into why they do the things that they do or why they do not do the things you would expect them to do.


You can find me on twitter at @PrecisionPI, on Facebook as Long Beach Private Detective.  My website is currently under construction, but you can find it at www.precisiondetective.com.  You can click on any of the tabbed links above to take you those sites directly.


I look forward to seeing you participate in this and future blog series and posts.  Should you require more detailed response to a questions or require a consultation, you can reach me by phone at 562-502-7053 or at GetTruth@PrecisionDetective.com.


Get Truth!


The Precision Detective, Ryan D. Clock (PI 26879)