Workers' Compensation (California MPN)

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.
All California Employers are still required to adhere to California Regulations pertaining to the DWC-7 posting, Time of Hire Pamphlets, and Pre-designation Forms.

STEP 1

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.

DWC-7 (ENG and SPAN)
 

STEP 2

Upon hiring a new employee:

1. Provide the "Time of Hire Pamphlet."

Time of Hire Pamphlet (ENG and SPAN)
 

STEP 3

At time of injury:

1. Provide the "DWC-1 Employee Claim Form and Notice of Potential Eligibility."

DWC1 Claim Form (ENG and SPAN)

2. Provide the “Complete Written Employee Notification.”

Complete Written MPN Employee Notification (ENG and SPAN)
 

Additional Contact Information

To contact the Medical Access Assistant(s):
Toll-free telephone number: 866-758-7256
Email: TheHartfordMAA@Primehealthservices.com
Fax number: 916-293-5025
 
To contact the Medical Provider Network:
Toll-free telephone number: 866-401-9222 x2304195
E-Mailbox: CAMPN.Claim@thehartford.com
Address: P.O. Box 14475, Lexington, KY 40512‚Äč

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

 
 
URAC Accredited Workers' Compensation Utilization Management, Expires October 1, 2020