Dwc ca form 10214 2025

Show details

4.7 out of 5

63 votes

The document is a form from the State of California's Division of Workers' Compensation, specifically for stipulations with a request for an award related to workers' compensation claims. It includes sections for detailing the applicant's information, employer details, insurance carrier information, claims administrator data, and specifics about injuries sustained by the employee. The form also outlines stipulations regarding temporary and permanent disability, indemnity payments, medical expenses, attorney fees, and other relevant legal considerations.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to quickly redact Dwc ca form 10214 online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is a perfect editor for modifying your forms online. Adhere to this simple instruction to redact Dwc ca form 10214 in PDF format online free of charge:

Register and sign in. Register for a free account, set a strong password, and proceed with email verification to start working on your forms.
Upload a document. Click on New Document and select the file importing option: upload Dwc ca form 10214 from your device, the cloud, or a secure link.
Make changes to the template. Take advantage of the top and left panel tools to redact Dwc ca form 10214. Add and customize text, images, and fillable areas, whiteout unneeded details, highlight the important ones, and provide comments on your updates.
Get your documentation done. Send the sample to other parties via email, generate a link for faster document sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail included.

Discover all the advantages of our editor right now!

See more dwc ca form 10214 versions

We've got more versions of the dwc ca form 10214 form. Select the right dwc ca form 10214 version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (90 Votes)
2014	4.7 Satisfied (63 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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 not to say to a workers comp doctor?

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.

How to fill out a DWC 1 form?

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.

What does DWC stand for in workers comp?

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.

Who completes the DWC 1 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.

What are the exceptions to the going and coming rule in California?

As, mentioned above, exceptions to the going and coming rule include special mission activity undertaken at the request or invitation of the employer. Another exception is the premises line rule which determines the physical boundary for coverage based on the location of an employee where an injury occurs.

Is a DWC 1 required in California?

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.

What is the 5 year rule for workers comp in California?

The so-called 5 year rule that pertains to workers comp claims in California is very important. Basically, it says that: No workers compensation decision or benefits can be changed or canceled after five years from the date of the injury unless a party involved files a petition within that five-year period.

Can you waive workers compensation rights in California?

A: No, you cannot waive workers compensation claim rights in California in most cases. It is generally illegal to ask employees to sign a waiver to not receive workers compensation benefits. The only exception to this is if a board member, executive owner, or executive officer wishes to waive their benefits.

Dwc ca form 10214 2025

Here's how it works