If you are self-insured, file the form electronically with the Department of Industrial Relations. If you are an insured employer, the report must be filed with your workers’ compensation carrier. The insurer must file a copy of the employer’s Form 5020 report with the Department of Industrial Relations immediately upon receipt.

In 2016, the Department of Insurance issued a decision notifying all insured employers and policy holders that they must file Form 5020 - Employer’s Report of Occupational Injury or Illness in all cases for which any medical care is provided or any medical cost is incurred, including cases involving only “first aid.”2 In response, the Workers Compensation Insurance Rating Bureau (WCIRB) via WCIRB Bulletin No. 2016-25 now instructs insurance companies to notify insured employers and policy holders of this requirement.

• Insured employers and policy holders are now required to file Form 5020 even in cases of “first aid.”

However, this Department of Insurance edict only concerns the filing of Form 5020 - Employer’s Report of Occupational Injury or Illness and does not mandate delivery of a claim form to workers (DWC-1) in cases of first aid. Additionally, this edict by the Department of Insurance does not extend to self-insured employers since self-insured employers are not insured and therefore are not governed by the Department of Insurance.

These requirements are separate from, and in addition to, the requirements related to reporting serious incidents or death (see ”Report Serious Incident or Death” for more information).

If the employee subsequently dies as a result of the previously reported illness or injury, you must send an amended Form 5020 - Employer’s Report of Occupational Injury or Illness to your insurance carrier or the Department of Industrial Relations within five days of learning of the death.

1. Title 8, California Code of Regulations sec. 14001.

2. Insurance Commissioner Decision and Order Reg-2016-00018