ID Form 5020 2025

ID Form 5020: What You Should Know

The statement must be accompanied by the proper proof of Insurance.  Step 2. If the form can be submitted electronically, enter your social security account number on line 2.  In case of an electronic submission, enter all information including your Social Security and the name(s) of the employer, and the name(s) of the health insurances you are applying for. Step 3. If you are enrolling only the first time, enter the first name, last name, ZIP Code, and state (if applicable) on the line for the employee's employer. Step 4. Type of Coverage. For Workers' Compensation Insurance in Texas: Workers' Compensation Claim Form Note: In some situations, an Employee may not also be covered by his or her employer's policy. If you are unsure if the employee will be covered by his or her employer's insurance, you must use the Form 5020 only because it requires only information that is not provided on the form. For Workers' Compensation Insurance in California: (a) The names, addresses, and Social Security numbers (“SSNs”) of an employee who is eligible for workers' compensation under state law. If the employee is an employee of a covered employer, the information must be shown on the form (not on the Workers' Comp insurance record). As of June 1, 2014, most employees in California are automatically covered under Workers' Compensation.  (b) The names, addresses, and Social Security numbers of any individuals other than the employee, and, if they have dependents, the names and addresses of the parents for the dependents. This information must be shown on the form (not on the Workers' Comp insurance record).

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