This website is a resource to help you set up and maintain The Hartford's California Workers' Compensation Medical Provider Network at your workplace.
New MPN Employee Notification Documents and Processes
The State of California provides the following guidelines to help you understand the new MPN process:
- MPN Employee Notifications are only required at time of injury or when the injury is reported.
- MPN Employee Notifications also required when transferring claims into a MPN.
- MPN Employee Notices for initial roll out and employee time of hire are NO LONGER REQUIRED.
Print the DWC-7 state-required posting notice. Most of the MPN information has been filled out for you. Please fill in the remaining items. The MPN effective date is the date on your workers’ compensation policy. Refer to your policy to fill in the writing company on the “Workers’ compensation insurer” line, and for your policy expiration date. Click here to find the nearest information and assistance officer. When complete, post the DWC-7 form in a place frequented by your employees.
Upon hiring a new employee:
1. Provide the "Time of Hire Pamphlet."
At time of injury:
1. Provide the "DWC-1 Employee Claim Form and Notice of Potential Eligibility."
2. Provide the “Complete Written Employee Notification.”
Additional Contact Information
Toll-free telephone number: 866-758-7256
Fax number: 916-293-5025
Toll-free telephone number: 866-401-9222 x2304195
Address: P.O. Box 14475, Lexington, KY 40512
If you need a copy of a Medical Provider Network document provided to you by your employer or claims administrator, such as Continuity of Care, Transfer of Care, Complete Written MPN Employee Notification or Independent Medical Review Notification, please call: 866-401-9222, and ask to speak with your claim handler.
Helpful Links and Documents
- Employer MPN Guide – Read the Employer MPN Guide. It explains the CA MPN and your role in its implementation.
- CA Department of Industrial Relations, Division of Workers’ Compensation
- CA Department of Industrial Relations – MPN FAQs
- CA DWC MPN
- I&A Offices – Go here to find the Information and Assistance Office near your location
- Find a Network Health Care Provider – Use this online tool to find a network treating doctor, specialist, or other health care provider in your area.
- How to File a Claim – This document provides useful information on reporting a workers' compensation claim.
- Predesignation Form
- Predesignation Form (Spanish)
- Utilization Review Procedures