Guidance and Information for Injured Workers Filing a Claim Form in California
Notify Employer of Injury
Your 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 Form
Complete 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.
Our Rating is calculated using information the lawyer has included on
their profile in addition to the information we collect from state
bar associations and other organizations that license legal
professionals. Attorneys who claim their profiles and provide Avvo
with more information tend to have a higher rating than those who do
What determines Avvo Rating?
Experience & background
Years licensed, work experience, education
Legal community recognition
Peer endorsements, associations, awards
Legal thought leadership
Publications, speaking engagements
This lawyer was disciplined by a state licensing authority in .
Disciplinary information may not be comprehensive, or updated. We recommend that you always check a lawyer's disciplinary status with their respective state bar association before hiring them.