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The document is a Personal Physician Designation Form (DWC FORM 9783) that allows employees to designate their personal medical doctor or medical group for treatment of work-related injuries or illnesses, provided certain conditions are met. It outlines the requirements for predesignation, including having group health coverage, prior treatment by the physician, and written notice to the employer.

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Who completes the DWC 1 form?

Form DWC 1 is the official form that California businesses and employees use to file a workers compensation claim. The employee fills out a portion of the form, and the employer fills out the remainder. The employer then sends the completed form to their workers comp insurance company in order to file a claim.

What is the DWC in workers comp?

The 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.

Can I see my own doctor for a work-related injury in California?

Can I be treated by my regular doctor? If you predesignated your personal physician or medical group before you were injured, you can have your regular doctor treat you for your work-related injuries immediately after you are injured.

How to fill out a DWC 1 form?

What Does the Employee Fill Out? Name and date. This should be your full legal name and the current date when you are completing the form. Home address. Social Security number. Date and time of the injury. Description of how the injury happened. Address of where the injury happened. Injury description. Email consent.

What is a DWC form in Texas?

Form DWC-1 Employers First Report of Injury or Occupational Disease. The employer is required to submit this form with EMPLOYERS and the injured employee or the injured employees attorney within eight days after the employees absence from work or notice of the Injury or Occupational Disease.

Who fills out Froi?

First Report of Injury (or FROI) When an employee is injured on the job, the employer works with the injured worker in order to complete the form. Once the form has been completed, it is generally kept on site at the workplace.

What is DWC form 9783?

You may use this form to notify your employer if you wish to have your personal medical doctor or a doctor of osteopathic medicine treat you for a work-related injury or illness and the above requirements are met.

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