Updated MPN Information As an employer you are responsible for informing your employees about the medical treatment and benefits available to them if a job-related injury or illness occurs. As a State Fund policyholder, you have access to workers’ compensation posters and brochures designed to make it easier for you to distribute the information.
Recently, providing your injured employee with the required information became more simplified. Now, when a job-related injury or illness occurs, you need to provide only the Workers’ Compensation Claim Form (3301/DWC-1) and our MPN brochure (form 13176).
A job-related injury or illness is one of the three times you must provide medical-benefit notification. The other two occurrences are: a new State Fund policy and/or new MPN, and at the time of new hire. The following list summarizes the required forms and publications:
- New Policy With State Fund and/or New MPN:
- Notice to Employees (13708 English, Rev. 03/05)
- Notice to Employees (13709 Spanish, Rev. 06/05)
Post both of these notices immediately, after writing the name of the MPN physician on both versions. Keep the notices posted in a conspicuous location at all times.
- Employee’s Guide to the State Fund Medical Provider Network (13176 English/Spanish, Rev. 06/06)
Distribute this brochure to existing employees before implementation of the approved MPN.
- New Hire:
- New Employee’s Guide to Workers’ Compensation (13286 English/Spanish, New 05/06)
- Employee’s Guide to the State Fund Medical Provider Network (13176 English/Spanish, Rev. 06/06)
Provide these brochures to each new employee at the time of hire.
- Job-Related Injury/Illness:
- Workers’ Compensation Claim Form (3301/DWC-1, Rev. 07/04)
- Employee’s Guide to the State Fund Medical Provider Network (13176 English/Spanish, Rev. 06/06)
Provide the claim form and MPN brochure to each injured employee at the time of injury. The State Fund claims adjuster will send your injured employee additional information about workers’ compensation benefits.
Please remember that you must distribute only the most current version of the forms and publications. Destroy any prior versions. To request a printed supply of the most current version for distribution, you can call our Customer Service Center.
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