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DWC Form-121, Claim Administration Contact Information DWC Form-121, Claim Administration Contact In

DWC Form-121, Claim Administration Contact Information DWC Form-121, Claim Administration Contact In 2025

DWC Form-121, Claim Administration Contact Information DWC Form-121, Claim Administration Contact In Preview on Page 1

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4.8 out of 5

76 votes

The document DWC121 provides a form for insurance carriers to submit or update their claim administration contact information, including details about representatives, insurance carrier specifics, and various billing and authorization processes. It outlines the requirements for filing, updating information, and where to send the completed form, along with frequently asked questions regarding the process.

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2020	4.8 Satisfied (76 Votes)

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What is a DWC 1 claim 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.

Where to send DWC 1 form?

Submit the DWC-1 to your employer Your Supervisor/HR Representative is then required to complete the Employer section of the form and return a signed copy to you within one working day.

What is a DWC notice?

Division of Workers Compensation. Notice to Employees--Injuries Caused By Work. You may be entitled to workers compensation benefits if you are injured or become ill because of your job. Workers compensation covers most work-related physical or mental injuries and illnesses.

What does DWC claim mean?

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.