Tag Claim Form

Tag Claim Form

Claim Form

Tags: , , Labor Code

Labor Code Section 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 case of death to his or her dependents.