HOW TO FILE A CLAIM
About the claim form: Filing a claim form is essential for protecting your rights to claim workers’ compensation benefits.
Once you report your injury, your employer must give or mail you a "DWC-1" 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, which also has an Information and Assistance Unit that can help you fill out the form.
It is a very short and simple form that requires you to fill out your name and contact information, your employer's information, along with a brief description of your injury (e.g., slip and fall injury led to broken right ankle and fractured ribs, hurt back and legs from lifting, carpal/cubital tunnel from typing) and body parts affected. The people in the system understand that you are not a doctor, and all you need to do is the best you can in describing your injury. However, please be aware that copies of this form will get distributed to your employer, insurance carrier, workers' compensation appeals board, and your attorney.
How to fill out the claim form: Complete only the “employee” section of the form and hand it in to your employer right away. Be sure to sign and date the claim form. Be sure to keep a copy for your records. You can 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, you can keep your employer accountable by requesting a copy of the completed form to keep it for your records.
If your employer fails to submit the claim form to the insurance company in a timely manner, you can attempt to figure out who your employer's insurer is to report your claim or contact an attorney to handle that process for you.
Generally, once your employer's insurer receives a copy of the claim form, the insurance company has 14 days to mail you a letter with an explanation of your benefits and status of your claim. If you don’t receive this letter, call the insurance company to find out the status of your claim.
Within 90 days, the insurance company is required to send you a notice about whether you case has been accepted or denied.
If your case has been accepted, click here to find out what's next.
If your case has been denied, click here to find out about your options.
Once you report your injury, your employer must give or mail you a "DWC-1" 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, which also has an Information and Assistance Unit that can help you fill out the form.
It is a very short and simple form that requires you to fill out your name and contact information, your employer's information, along with a brief description of your injury (e.g., slip and fall injury led to broken right ankle and fractured ribs, hurt back and legs from lifting, carpal/cubital tunnel from typing) and body parts affected. The people in the system understand that you are not a doctor, and all you need to do is the best you can in describing your injury. However, please be aware that copies of this form will get distributed to your employer, insurance carrier, workers' compensation appeals board, and your attorney.
How to fill out the claim form: Complete only the “employee” section of the form and hand it in to your employer right away. Be sure to sign and date the claim form. Be sure to keep a copy for your records. You can 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, you can keep your employer accountable by requesting a copy of the completed form to keep it for your records.
If your employer fails to submit the claim form to the insurance company in a timely manner, you can attempt to figure out who your employer's insurer is to report your claim or contact an attorney to handle that process for you.
Generally, once your employer's insurer receives a copy of the claim form, the insurance company has 14 days to mail you a letter with an explanation of your benefits and status of your claim. If you don’t receive this letter, call the insurance company to find out the status of your claim.
Within 90 days, the insurance company is required to send you a notice about whether you case has been accepted or denied.
If your case has been accepted, click here to find out what's next.
If your case has been denied, click here to find out about your options.