HOW TO FILE A CLAIM
File a claim form to protect your rights and start the workers’ compensation process. 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 California's Division of Workers' Compensation website or contact its Information and Assistance Unit.
How to fill out a 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.
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.
How to fill out a 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.
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.
