Report an Injury

At Care West Insurance Company, we make filing a new claim simple.  There are two different methods available to you for reporting a new claim and they are noted below.  If at any time you need assistance with this process, please call us toll free at 877-625-6566 between the hours of 8:00 AM to 5:00 PM PST.

• Report a claim through fax by completing the following two forms; 5020 and DWC1 and faxing to:             (209) 574-2839
• Report a claim through mail by completing the following two forms; 5020 and DWC1 and mailing them to:     P.O. Box 5038, Modesto, CA 95352

All other forms related to filing a claim are located on our Claim Forms & Information page.

NOTICE: California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death. In addition, every serious injury, illness, or death must be reported immediately by telephone or telegraph to the nearest office of the California Division of Occupational Safety and Health.