How to File a Workers Compensation Claim Form in California (DWC1 Form)
Guidance and Information for Injured Workers Filing a Claim Form in California
Notify Employer of InjuryYour employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn*t give you the claim form you can download it from the forms page of the DWC website or contact the Information and Assistance Unit.
Fill Out Claim FormComplete only the *employee* section of the form and send it to your employer right away. Be sure to sign and date the claim form and keep a copy for your records. Return the claim form to your employer in person or by mail. If you mail the claim form, use certified mail * return receipt requested * so you have a record of the date it was mailed and the date it was received. If you don*t return the completed form to your employer you may risk your right to benefits.
Claim Form Tips--If your injury is a cumulative trauma (i.e. due to repetitive work), you can list the "Date of Injury" section as a date range. Example: Date of Injury: 1/1/2017-1/1/2018
--List the exact address of where injury occurred. If cumulative trauma injury, list your employer's address
--Clearly list all body parts related to the injury under Section 6. Example: Back, Upper Extremities, Lower Extremities, Internal, Psychological, Sleep
What Happens Next?Your employer should fill out the *employer* section and forward the completed claim form to the insurance company. You should receive a copy of the completed claim form from your employer. If you don*t, request a copy and keep it for your records.
Generally, the insurance company has 14 days to mail you a letter telling you the status of your claim. If you don*t receive this letter, call the insurance company to find out the status of your claim.