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CALIFORNIA FORMS & PROVIDER LIST

Click on the links below to access some of the most commonly used forms.

Contact Info:

S & C Claims Services
9075 W. Diablo Dr. Suite 140
Las Vegas, NV  89148

Danny Thorn
430 North Vineyard Avenue, Suite 230
Ontario, California 91764
Office: (909) 843-9160
Toll- Free: (800) 362-5198
24 Hour Emergency: (800) 289-4502
Fax: (909) 843-9156

Employer's Report of Injury or Illness (Form 5020)

Workers' Compensation Claim Form (DWC 1)

Wage Request Form

California Provider List

Fill out using Adobe Acrobat Reader and then sign and fax to us at (909) 843-9156

 

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