Workers' Compensation Claims
The City of Stockton is "self-insured" for Workers' Compensation benefits. This means the City pays benefits directly to injured employees, rather than purchasing an insurance policy that would pay benefits.
All employees of the City are eligible to receive Workers' Compensation benefits if injured or made ill by their job. There is no qualification period for eligibility, such as working a minimum time period or a minimum number of hours per week. If an employee believes he or she was injured on the job, a claim for benefits can be filed with the employee's supervisor.
Effective December 15, 2012, the City of Stockton implemented a Medical Provider Network (MPN) Program. This has been implemented in an effort to control the costs of Workers' Compensation claims. City Employees who are not in sworn Public Safety positions will automatically be enrolled into an Integration Program if they have a Workers' Compensation Claim. This program will ensure that employee's pay is made whole through the use of accrued leave balances, until these balances are exhausted. Employees who do not wish to participate may opt-out, but this decision is final and the employee would not be allowed to opt back in or vice versa.
Workers' Compensation Forms
- Completed Workers' Compensation Forms Matrix
- Employee Workers' Compensation Claim Form (DWC-1)
- Form 5020 - Employer's Report of Occupational Injury or Illness (only to be filled out if the online 5020 system is unavailable)
- How To File a Workers' Compensation Claim
- Medical Treatment Authorization Form
- MPN Pamphlet
- Notice to Employees - Injuries Caused By Work (DWC-7; English)
- Notice to Employees - Injuries Caused By Work (DWC-7; Spanish)
- Opt-out Form (Temporary Disability Integration)
- Pre-Designation of Medical Physician Form
- Receipt of Workers' Compensation Claim Information
- Supervisor's Investigation Report
- Workers' Compensation Handbook
CorVel Corporation is the local Third Party Administrator who handles the City of Stockton's Workers' Compensation Claims. Contact information for CorVel Corporation can be found on the Human Resources Department Contact Us page.
State of California - General information about the California Workers Compensation System
City of Stockton's MPN information: City of Stockton MPN
This City of Stockton web page last reviewed on --- 3/16/2015