Workers' Compensation Claim Form Guide

How to Properly Fill Out the California Workers' Compensation Form: A Step-by-Step Guide.

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Filing a workers’ compensation claim is essential if you’ve experienced an injury while on the job. Properly completing the claim form, known as the DWC 1 form, ensures you receive the benefits you’re entitled to and protects your rights as an injured worker.

This guide will walk you through the process of filling out the form accurately and efficiently.

Steps of filling out the form California Workers' Compensation Form:

1. Obtain the DWC 1 form:

  • Request the form from your employer, who must provide it within one working day of learning about your injury.
  • If your employer doesn’t give you the form, you can get it the form from the California Department of Industrial Relations website.

2. Complete the "Employee" section:

  • Fill out only the “Employee” portion of the form.
  • Please make sure to provide correct personal information, including your name, address, and contact details.
  • Ensure you date the form accurately. You should complete the “Employee” section of the DWC 1 form and submit it to your employer right away or immediately after the injury happened.
Employee Section How to Properly Fill Out the California Workers' Compensation Form

3. Describe your injury:

  • Clearly explain how, when, and where the injury occurred.
  • Include all affected body parts, even if the injury seems minor.
Injury Section How to Properly Fill Out the California Workers' Compensation Form

4. Sign and date the form:

  • Your signature is required to process the claim.

5. Make a copy:

  • Keep a copy of the completed form for your records.
  • Mark your copy as “Employee’s Temporary Receipt”.
Make a copy of the How to Properly Fill Out the California Workers' Compensation Form

6. Submit the form to your employer:

  • Return the completed form to your employer in person or by mail.
  • If mailing, use certified mail with return receipt requested to document when it was sent and received.

7. Receive the completed form:

  • Your employer should complete the “Employer” section and return a copy to you within one working day.
  • If you don’t receive it, request a copy from your employer.

8. Follow up:

  • The insurance company should send you a letter about your claim status within 14 days.
  • If you don’t receive this letter, contact the insurance company to inquire about your claim status.
By following these steps, you’ll ensure that your workers’ compensation claim is filed correctly in San Diego, California. Remember to act promptly, as delays in filing may affect your right to claim your benefits. If you need to check on the status of your claim, you can use the Electronic Adjudication Management System provided by the California Division of Workers’ Compensation. For additional assistance, or help with your workers’ compensation claim, contact Thomas DeBenedetto & Associates – Workers Compensation Attorneys. Our experienced team is here to assist you every step of the way. We speak both English and Spanish to better serve you.

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Thomas DeBenedetto, San Diego workers’ compensation attorney

Thomas DeBenedetto

Workers' Compensation Attorney

Thomas DeBenedetto has over 33 years of experience representing injured workers in California workers’ compensation claims. Based in San Diego, he focuses exclusively on workers’ compensation law and regularly publishes educational content to help injured employees understand their rights and benefits under California law.

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