Workers' Compensation

  If the injury is serious or life-threatening, call 911 first to care for the employee immediately.    
 Conditions may include, but are not limited to the following:  • Chocking  • Unconscious or severe disorientation  • Severe bleeding  • Lack of balance or inability to walk  • Hot, dry skin  • Seizures or convulsions  • Difficulty breathing  • Chest pain or discomfort  • Profuse sweating • Severe abdominal pain  • Any other problem you feel might be an emergency
    
   All injuries must be reported immediately or within 24 hours of the incident.

• Instructions to Report a Work-Related Injury 
• DWC1 - Workers' Compensation Claim Form
• 5020 - Employer's Report of Occupational Injury or Illness Form
• My Matixx Prescription Drug Card for Injured Worker
• Location Codes -Needed to complete 5020 Form
• State of California Workers' Compensation Information and Assistance Offices
• SB 1159 Covid-19 Reporting Form

• Church Mutual Nurse Hotline -powered by Medcor 
• Nurse Hotline Frequently Asked Questions (FAQ)
• Notice to Employees - Injuries Caused by Work (Poster DWC 7) 

Insurance Carrier: Church Mutual Insurance Company          2024 - Policy #: 0500054-07-687063
                          P.O. Box 357                                            
                          Merrill, WI  54452-0357
                          Phone: (800) 554-2642 (option 2)
                          Fax: (715) 539-4651
                         email: [email protected]