Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.


Agribusiness Mailing Address for Claims Related Mail
1100 Locust St., Dept 3010
Des Moines, IA, 50391-3010
Phone: (800) 228-6700
Fax: (800) 842-1482

Some Nationwide companies are not licensed in this state.

 

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California Compliance Information

Posting Requirements

Reporting Of Claim By Employer

Penalties for Late Reporting

Physician Selection


Posters and Publications

POSTER - Notice to Employees Poster Poster must be printed on legal size (8 1/2 x 14) paper. (English and Spanish) Required


BROCHURE - Facts about Workers' Compensation (Time of Hire Pamphlet from CA DWC) Required

BROCHURE - Facts about Workers' Compensation(Time of Hire Pamphlet from CA DWC) (Spanish) Required


Forms

Employer's Report of Occupational Injury or Illness Required


Notice of Employee Death Required

Workers' Compensation Claim form (Employee) Required

Notice of Personal Chiropractor or Personal Acupuncturist

Notice of Personal Chiropractor or Personal Acupuncturist (Spanish)

Predesignation of Personal Physician

Predesignation of Personal Physician (Spanish)






Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

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