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WC-1 - Department of Labor and Industrial Relations

WC-1 - Department of Labor and Industrial Relations 2025

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The document outlines the legal requirements for reporting work-related injuries that result in employee absence or require medical treatment. Employers must report such injuries within 7 working days, with penalties for late reporting. It includes a detailed form for documenting the injury, employee information, and treatment details.

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Click ‘Get Form’ to open the WC-1 in the editor.
Begin with the Identification Section. Fill in the employee's name, social security number, date of birth, sex, and marital status. Ensure all fields are completed accurately to avoid delays.
Next, provide additional address information and contact details for the employee. This includes their occupation, years employed, and date hired.
In the Detail of Injury / Illness section, specify the time and place of injury. Describe how the accident occurred in detail to ensure clarity.
Complete the Time Lost Information section by indicating if meals or lodging were provided and whether the employee was paid for the day of injury.
Finally, fill out treatment details including physician information and insurance carrier data before signing and dating the form.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (100 Votes)
2003	4.4 Satisfied (157 Votes)
2001	3.8 Satisfied (25 Votes)

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Is a DWC 1 required in California?

Employer Responsibilities Once a small business owner is notified of a potentially work-related injury or illness, they should provide the employee the DWC 1 claim form. The employer should fill out their part of the form and send the completed form to the insurance company.

Who is responsible for employee compensation?

All California employers must provide workers compensation benefits to their employees under California Labor Code Section 3700. If a business employs one or more employees, it must satisfy the requirement of the law.

What happens when you file a complaint with the US Department of Labor?

A BOFE representative will review the report to determine whether to investigate the employer. If BOFE starts an investigation, it may inspect the worksite, issue citations for violations, work with the employer to correct the problem, and collect any unpaid wages owed to workers.

Do you get 100% pay on workers comp?

In that case, you may qualify for time-loss compensation due to the fact that youre temporarily unable to return to work. Typically, the workers comp system in most states offers 66% of your wages. Depending on the state, you may receive your salary benefits weekly, bi-weekly, or once a month.

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.

Who completes the DWC1 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.

WC-1 - Department of Labor and Industrial Relations 2025

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