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Formulario de reclamo de compensación de trabajadores (dwc 1) y notificación de posible elegibilidad if you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to workers’ compensation benefits. State of californiathe division of workers' compensation (dwc) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits This guide includes a direct dwc‑1 form download link, printable sample completed dwc‑1, step‑by‑step instructions on how to complete workers comp paperwork, and options for reporting workplace injury online.

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Give this form to the employee and have them complete the employee section and then return the form to you. Workers' compensation claim form (dwc 1) and notice of potential eligibility California residents who are injured at work can start the workers’ comp process by filing form dwc 1

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Learn where to get it and how to fill it out.

Access california department of industrial relations forms for workers' compensation and related purposes. When you report an injury, the employer is required to provide you with a dwc1 claim form for you to fill out After you turn it in, they are to return it to you within 1 day with the wc carrier information See an attorney as soon as possible to make sure your rights are being protected.