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01. Edit your dwc document cover sheet online
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Send dwcca via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out the dwc document with our platform
- Click ‘Get Form’ to open the dwc document in the editor.
- Begin by indicating if this is a new case. Select 'Yes' or 'No' for companion cases as applicable.
- Enter your Social Security Number (SSN) and the date of injury in the specified format (MM/DD/YYYY).
- For each specific injury, fill in the case number, start date, and end date if applicable. Use the start date as the specific date of injury for specific injuries.
- List affected body parts in the designated fields. You can refer to the body part code list provided within the document for accurate entries.
- Select one box from the options provided for where to file your claim (e.g., ADJ, DEU, etc.).
- Review all entered information for accuracy before saving or exporting your completed form.
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