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Workers compensation claim form 2026
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- Click ‘Get Form’ to open the Workers’ Compensation Claim Form (DWC 1) in the editor.
- Begin by completing the 'Employee' section. Fill in your name, home address, date of injury, and a description of where the injury occurred.
- In the same section, describe the injury and specify which part of your body is affected. Ensure you include your Social Security Number.
- Sign the form in the designated area to confirm that all information provided is accurate.
- Once completed, keep a copy marked as 'Employee’s Temporary Receipt' and submit the rest to your employer for their completion.
- Your employer will fill out their section and provide you with a dated copy. They must also send one copy to the claims administrator within one working day.
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See more accident compensation versions
We've got more versions of the accident compensation form. Select the right accident compensation version from the list and start editing it straight away!
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4.8 Satisfied (244 Votes) |
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dwc 1 form 2022 pdf
Jan 1, 2016 To file a claim, complete the Employee section of the form, keep one copy and give the rest to your employer. Do this right away to avoidRead more
Benefits under workers compensation insurance are payable: 1. For bodily Title insurance forms. Promulgated forms. (Reg 13.14.8.10;. 13.14.18.8).Read more
The following pages of this packet include forms that are requiredfor your claim to be processed. Please read and fully complete each form. Some forms includeRead more