Dwc 1 2026

The document outlines the Workers' Compensation Claim Form (DWC 1) and provides information on how to file a claim for workers' compensation benefits in California. It details the process for employees who are injured or become ill due to their job, including instructions for completing the claim form, medical care coverage, rights regarding treatment and disputes, and potential benefits such as temporary disability payments and death benefits. The document emphasizes the importance of timely filing and communication with employers and claims administrators.

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Click ‘Get Form’ to open the DWC 1 in the editor.
Begin by completing the 'Employee' section. Fill in your name, today's date, home address, and social security number.
Next, provide details about your injury. Include the date and time of the injury, as well as a description of where it occurred and the body parts affected.
If you wish to receive notices electronically, check the appropriate box and enter your email address.
Sign the form at the bottom of the 'Employee' section. Keep a copy marked 'Employee’s Temporary Receipt' for your records.
Submit the completed form to your employer immediately to avoid delays in processing your claim.
Ensure that your employer completes their section of the form within one working day and provides you with a dated copy.

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