To file a claim against the County please complete the form below, print, sign and send to the address listed on the form. Complaints can be filed about the doctors who examine injured workers to help determine benefits (qualified medical evaluators).Subrogation in a workers' compensation case occurs when another party can secure a portion of your workers' compensation benefits. Attached is the employee claim for workers' compensation benefits. Please read and follow the instructions on the top of the form. How to fill out the Subrogation Workers Compensation Accident Form? 1. Gather necessary information regarding the accident. 2. They will lead you through every step of the claims process, including filling out a claim form with your employer. A Third Party civil lawsuit and a workers' compensation claim are separate injury claims that are distinct. Competent jurisdiction located in San Bernardino County, California.