Workers’ Compensation

Predesignation of Personal Physician Form
Time of Hire Employee Pamphlet with Designation of Personal Physician Form
Whistleblowers are Protected
WC Claim Form
How to File a WC Injury Claim
Refusal of Medical Treatment Form
Medical Provider Network (MPN) Notice to Employees
DWC-7 Form- Injuries Caused by Work

Where to go for medical care, listed by MPN branch

Asbury – 140 Asbury St, San Jose, CA 95110 (PDF)
Sequoia – 530 El Camino Real, Redwood City, CA 94063 (PDF)
Arques – 1193 E Arques Ave, Sunnyvale, CA 94085 (PDF)
Gilroy – 415 1st St, Gilroy, CA 95020 (PDF)
Almaden – 5353 Almaden Expy, San Jose, CA 95118 (PDF)
VDO – 6640 Vía del Oro, San Jose, CA 95119 (PDF)

MPN Network List: www.CorVel.com/ca-mpn-lookup

MPN assistance call 888-726-7835
This link allows you to put in the location and designate the type of facility that is needed.

WC Information and Assistance Unit
Website: www.dir.ca.gov/dwc/ianda.html
Phone: 1-800-736-7401

In Person local office:
San Jose
100 Paseo de San Antonio, Room 241
San Jose, CA 95113-1402
(408) 277-1292