Claims First Notice of Injury Form 2025

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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.
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.
The Employers First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimants employment and circumstances surrounding the injury or illness are also requested.
The Department of Labors LS-202 is used to report workplace injuries and illnesses. It must be submitted any time a workers injury or illness leads to the loss of one or more shifts of work.
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 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.
This form is used by an employee to claim compensation in an established case for traumatic injury or occupational disease.

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