Form 5020 MS 2025

Form 5020 MS: What You Should Know

This document will not be mailed. The electronic Form 5020 form may be printed, and then scanned, and then  tears made into 3 copies which are sent, as a series, to the following address: “Workers' Compensation” Risk Management Unit Alameda County Labor, Health and Human Services Department P.O. Box 1367 OAKLAND, CA 94607 Attention: Worker's Compensation Risk Management Unit Alameda County Labor & Health, Human Services Department P.O. Box 1367 Oakland, Ca. 94607 In the case of an employee who has died and has filed a Form 5020 for that employee(s), a copy of their Form 5020 will  be forwarded to the Workers' Compensation Risk Management unit for filing into the State Labor Bureau's database. If the employees/employers are located in Alameda County and have no other county jurisdiction where they  work, if the employee has not been compensated in their county for at least  1 year following the event that caused the injury, or if the injury was not considered to be part  of the employee's job, the Department will forward the completed Form 5020, with its  reference and an explanatory paragraph, to the appropriate county worker's compensation  risk management unit.  If the injury was considered to be part of the employee's job, the  Alameda County risk management unit will forward the completed Form 5020 with its  reference and an explanatory paragraph, to the State Workers' Compensation Office (SCO).  If any part of  the Form 5020 is not relevant to the claim being filed, the workers' compensation risk  management unit will forward the completed Form 5020 with its reference and an explanatory  paragraph, to the Department of Industrial Relations if the Form 5020  is to be used for administrative purposes. For those Alameda County employees who file a Form 5020 in the county, their  Form 5020 to be filed with the State Workers' Compensation Board in Alameda County will  be forwarded to the Department of Industrial Relations, to be filed in its official system with  the county workers' compensation risk management unit.

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