California

1. It is necessary for the employer to fill out the required form 5020 and notify us immediately via Firstreport@benchmarkadministrators.com. Form DWC-1 must be signed by the injured worker and then returned to us but don’t let this delay reporting of the accident. Please also forward any medical reports and notices from the doctor (work/disability slips).
2. Contact a preferred urgent care facility by telephone prior to sending the injured worker.
3. Initial medical can be done by a local urgent care or industrial medical clinic. If possible, notify the urgent care that you have an injured worker coming and that Benchmark Administrators is the claims administrator. A list of providers in the Medical Provider Network (MPN) can be found through the link on this page.
4. If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist the injured worker with any insurance related information that the medical provider may require.
   • If possible, the injured worker must return to your office or job site after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.

Network By Design:

Network By Design is an MPN, or medical provider network--a group of health care providers, designated by an employer, to treat the work related injuries of its employees. Use of an MPN can greatly reduce claims costs and is therefore an important part of an effective workers' compensation program. The MPN established for Benchmark’s insurance program is Network By Design.

Network By Design - MPN Notification Distribution Instructions:

Provide the injured worker with a copy of the Employee MPN Notification document. The notice must be given in English, and also in Spanish to Spanish-speaking employees. English and Spanish versions of the MPN Notice can be downloaded from www.benchmarkadministrators.com.

Network By Design - MPN Physician Locator:

If you have questions concerning a physician or clinic, or have problems with the website, please call Gio Fuentes at (800) 362-5198 between 8 a.m. and 5 p.m., Monday through Friday.

SB-1159 Mandatory Covid-19 Reporting

• 2020-2022 COVID-19 Reporting Requirement
• NON COVID Report Form

After the 5020 is filed with us, any additional information received (DWC-1/Medical Bills-Reports etc.) should be sent to:

Benchmark Administrators
P.O. Box 46350
Las Vegas, NV 89114
Telephone (909) 843-9155
Toll free (800) 362-5198
Fax (909) 843–9156

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891
Customer Service Representatives are on staff 24 hours per day to assist you with reporting a claim. Please have the injured worker’s information available as well as the accident description.