5400-5413
LABOR CODE
SECTION 5400-5413
5400. Except as provided by sections 5402 and 5403, no claim to
recover compensation under this division shall be maintained unless
within thirty days after the occurrence of the injury which is
claimed to have caused the disability or death, there is served upon
the employer notice in writing, signed by the person injured or
someone in his behalf, or in case of the death of the person injured,
by a dependent or someone in the dependent's behalf.
5401. (a) 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.
As used in this subdivision, "first aid" means any one-time
treatment, and any followup visit for the purpose of observation of
minor scratches, cuts, burns, splinters, or other minor industrial
injury, which do not ordinarily require medical care. This one-time
treatment, and followup visit for the purpose of observation, is
considered first aid even though provided by a physician or
registered professional personnel. "Minor industrial injury" shall
not include serious exposure to a hazardous substance as defined in
subdivision (i) of Section 6302. The claim form shall request the
injured employee's name and address, social security number, the time
and address where the injury occurred, and the nature of and part of
the body affected by the injury. Claim forms shall be available at
district offices of the Employment Development Department and the
division. Claim forms may be made available to the employee from any
other source.
(b) Insofar as practicable, the notice of potential eligibility
for benefits required by this section and the claim form shall be a
single document and shall instruct the injured employee to fully read
the notice of potential eligibility. The form and content of the
notice and claim form shall be prescribed by the administrative
director after consultation with the Commission on Health and Safety
and Workers' Compensation. The notice shall be easily understandable
and available in both English and Spanish. The content shall include,
but not be limited to, the following:
(1) The procedure to be used to commence proceedings for the
collection of compensation for the purposes of this chapter.
(2) A description of the different types of workers' compensation
benefits.
(3) What happens to the claim form after it is filed.
(4) From whom the employee can obtain medical care for the injury.
(5) The role and function of the primary treating physician.
(6) The rights of an employee to select and change the treating
physician pursuant to subdivision (e) of Section 3550 and Section
4600.
(7) How to get medical care while the claim is pending.
(8) The protections against discrimination provided pursuant to
Section 132a.
(9) The following written statements:
(A) You have a right to disagree with decisions affecting your
claim.
(B) You can obtain free information from an information and
assistance officer of the state Division of Workers' Compensation, or
you can hear recorded information and a list of local offices by
calling