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Daniel Moon

From: Chris Kim
Sent: Wednesday, October 07, 2015 8:57 PM
To: ACI.ALL
Subject: MEMORANDUM # 106 - A ( New Workers' Comp - Everest National Insurance
Company )
Attachments: DWC 7 Notice (Notice to Employee) (ACI).pdf; MPN Notice for EE (EN-SP) (ACI).pdf;
MPN Implementation Notice Instructions (ACI).pdf; Predesignation of Personal
Physician (ACI).pdf

To: ACI ALL
< New Workers’ Comp Everest National Insurance Company (ENIC) >

Please note that ACI has renewed a new Workers’ Comp Insurance company through Everest National Insurance
Company (ENIC) effective 9/1/2015.
We are providing you with electronic delivery of California Claim Kit, MPN Packet and Requirement for each jobsite.

Postings:
1. DWC 7 Notice (Notice to Employee): – Post this in each trailer or jobsite and field managers carry with them
as well. This should also be posted just like all the other Federal/State Notices.
2. MPN Notice for EE: – First, Print this ENTIRE documents, and post a copy right next to
anywhere that you are also placing the first attachment (DWC7). Second, any time you need to give an EE the
WC claim forms and documents, you also need to provide your EE a complete copy of this document as well. So
project field managers should carry around copies of this as well.

Notice to EE (All ACI):
1. MPN Implementation Notice Instructions: – This is a new hire notice for all ACI employees
2. Predesignation of Personal Physician: – This is a new hire notice for all ACI employees

MPN Map (ACI Jobsites):
1. Website: www.talispoint.com/cvty/cvtympn
2. Enter the Each project site’s zip code.
3. Select General Acute Care Hospital.
4. Click Find Providers button.
5. Print out the Provider’s Name and Map (at least 3~5 copies) then post where the conspicuous place.

Alternate Everest MPN:
https://www
va.talispoint.com/talispoint/search.pl?mode=distance&mode_name=Address%20Search&submit=1&action=new_searc
h&source=search&last_mode=distance&last_mode_name=Address%20Search&control_id=V35RD6F9A8&session_id=VR
JXBM8HO4&account=EVEREST&unit=EVEREST&label=everest&mode=distance&mode_name=Address%20Search&netw
ork=EVEPPO&network_parent=EVEREST&network_template=FRH&file=1NSQM2F1 80906
1233.txt&gm_fileout=OVSU0AI7 80906 1233.htm&savevar=network~SESSION~LIST|

It is very important that each jobsite print and post the completed Posting Notice(s) and MPN Map(s) in a place where
the conspicuous area which any employee can easily access during company work hours. Failure to post these required
notices may result in penalties from the state

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