Dwc 1 2025

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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 necessary steps for filing a claim, medical care coverage, temporary and permanent disability payments, and rights regarding treatment disputes. The document also emphasizes the importance of timely communication with employers and claims administrators, as well as the legal protections against retaliation for filing claims.

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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, city, state, and zip code.
Next, provide details about your injury. Include the date and time of the injury, along with a description of where it occurred and the affected body parts.
Enter your Social Security Number and indicate if you agree to receive notices about your claim via email. If so, provide your email address.
Sign the form to confirm that all information is accurate before submitting it to your employer.
Ensure you keep a copy marked as 'Employee’s Temporary Receipt' until you receive a signed copy from your employer.

Start filling out your DWC 1 form online for free today!

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (270 Votes)
2010	4.1 Satisfied (67 Votes)
2004	4 Satisfied (33 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What does DWC claim mean?

A: The workers compensation rate in California is calculated based on the injured workers average weekly wage and is usually two-thirds of the amount the worker was receiving prior to the injury that caused the accident.

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 not to say to a workers comp doctor?

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.

What is a DWC 1 form?

What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.

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.