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Workers’ Compensation Claim Form (DWC 1 Form)

A DWC1 form is the workers’ compensation claim form and the first step in the workers’ compensation process. Submitting a DWC1 form is the official declaration stating you have been injured at work. Many people believe a doctor’s visit creates a claim for their workers’ compensation case, but this is not true. After notifying your employer you have been injured, they should provide you with the DWC1 form. Visit Sacramento Workers’ Compensation Attorneys, P.C. if you need help filling out a DWC1 form.

How do I fill out a claim form? 

It is essential you fill out the DWC1 claim form to the best of your ability. If you have issues filing a DWC1 claim, a Sacramento workers’ compensation attorney can help. Your employer is required to give you the DWC1 form within one business day of your injury notification. You are then expected to complete the DWC1 form within one business day after you receive it. 

Sections one through nine of the DWC1 form should be completed by the injured employee. Sections one through three ask for basic information including your name, address, and the date you are filling out the form. Many people get confused in section four. This section asks for the date and time of the injury. This section can be frustrating because the injury may have been building over time, so you may not know when your injury first occurred. In this case, you can write cumulative and put a range of dates under the date of injury. For the time of injury, you should write “not applicable” only for a cumulative injury.

Section five of the DWC1 form asks for an address and description of where the injury occurred and what happened. If a single traumatic event caused your injury, this section is relatively straight forward. You should write the address of where the injury occurred and a brief description of the accident. If your injury was not caused by a single event, this can be more confusing. 

In section six, you write a description of your injury and the body parts affected. This section should not be overly complicated, but it is essential to include all the affected body parts, not just the body part that hurts the most. For example, if a forklift hit you and you broke your wrist, it is very common for someone to write “broken wrist” on the DWC1 form because that’s what hurts the most. In reality, you may also have a bruised left side, hit your head, and have back pain. All of these injuries can be caused by the forklift accident and are covered by workers’ compensation. You can find a list of body part codes online that you can use to describe the body parts affected by the accident. This section can be changed as your claim continues and as your injury progresses. 

Section seven is for your social security number. This section of the DWC1 form can be a problem if you don’t have a social security number under your name. If you do have a personal social security number, don’t forget to write it down in this section. If you use someone else’s social security number for employment, you should not use that number. Instead, leave that section of the DWC1 form blank. 

Section eight of the DWC1 form is an option to receive notices about your claim via email only. We recommend that you do not check this box. Email-only claims become an issue because people don’t always check their email in a timely manner or they respond too quickly with something that could affect their case. As time goes by, it may be more applicable to receive email only claims notices, but in the beginning stages, we recommend against it. 

Lastly, in section nine, you sign the form. 

What can you do? 

After signing, you will return the form to your employer who will complete the second half of the form, sections ten through eighteen. Many times, your employer will complete their portion of the form before they give it to you. However, if they do not give you the form at all, this could be a cause for concern. You can click here to download the DWC1 form or contact a Sacramento Workers’ Compensation Attorney who will help you fill out the form. 

Return the form to your employer either in person or by certified mail, as soon as possible. Don’t forget to keep a copy of the form for your records. Filing a claim as quickly as possible is extremely important as a timely submission can affect the benefits you may receive. Once your employer fills out their section of the form, he/she submits it to the insurance company who has 14 days to send you a letter detailing the status of the claim. Contact Sacramento Workers’ Compensation Attorneys, P.C. today if you need help filling out a DWC1 form.