WC-1 - Department of Labor and Industrial Relations 2025

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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.
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.
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.
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.
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.
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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.

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