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Form 5020 online Oregon: What You Should Know

Do not use this form for legal purposes. DO NOT FIND OUT WHICH PART OF YOUR BODY was injured or how it was injured. Do not seek health information from anyone, including your doctor because it is not protected health information. If you have any questions regarding the information in the California Workers' Comp Law. . . Contact the LCC Regional Office on the telephone numbers provided below or call the LCC Employee Injury Branch at .  Part of Body — Contact Primary Health Care Provider. If the injury was sustained in either the back, shoulder, pelvis, hip, or any of the other body parts listed above, your primary health care provider (such as your primary care physician) may be able to provide direct evaluation.  For an injury sustained in the head or face, your primary health care provider may provide evaluation and instructions on treatment. It is generally best to have the primary medical provider contact all the appropriate primary care providers (such as your doctor, dentist, chiropractor, rheumatologist, etc.). The primary, or most appropriate, medical provider must contact the LCC Employee Injury Branch first.  The LCC employee injury representative will contact all listed medical providers for your treatment. If your primary health care provider is contacted for treatment, then the LCC employee injury representative will contact the primary health care provider directly in regard to your health insurance.  If there are injured employees who have insurance, the insurance company will reimburse the LCC employee injury representative. If the primary health care provider refuses to provide evaluation, the LCC employee safety representative will contact the primary health care provider, for evaluation and/or treatment. If you are unable to find a primary care provider who has been contacted by the LCC employee safety representative, this information can be obtained from the following sources: The California Department of Labor Health Insurance Division Office — 24 hours a day: The California Department of Industrial Relations Worker's Compensation Division The State of Oregon — Medical Licensing California Workers' Comp — Patient Protection Act (PPA) — Employee Safety & Liability Division The LCC Employee Injury Branch (LYCÉE).

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