Form DWC 1 Explained: What It Is & How To Fill It Out

If you suffered a work-related injury, there are several steps you have to take before you can receive the medical bills and lost wage payments you’re entitled to. The process starts with an application form from the Division of Workers’ Compensation (DWC). Filling it out correctly is critical since it sets the stage for every other part of the workers’ comp claims process.

What is Form DWC 1?

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.

Where do I get Form DWC 1?

After a work injury, you should receive Form DWC 1 from your employer. They’re legally required to provide you with the form either in person or by mail within one work day after you report your injury.

That means that if you report your injury on a Tuesday, your employer should provide or send the form by the end of the day on Wednesday. But if you report it on a Friday, your employer has until Monday to give you a copy. (This all assumes a Monday-to-Friday work schedule.)

Who needs to file Form DWC 1?

You need to complete the employee portion and then your employer needs to file DWC 1 with their insurance company. Both steps need to happen to file a workers’ comp claim and you won’t start the claims process until your employer files it with the insurer.

After your employer sends the form to the insurer, they should also send you a copy of the completed form for your records. Keep it somewhere safe in case you run into issues later and need to prove when your claim was filed.

Related article: What Injuries Qualify for Workers’ Comp?

How to fill out Form DWC 1

Form DWC 1 has two parts: the employee section and the employer section. You’re only responsible for the employee section, which includes nine lines.

1. Name and date: Use your full legal name and the date you’re completing the form.

2. Home address: This is your street address only. You’ll add the rest of your address in line 3.

3. Home city, state, and zip: Add the city, state, and zip code of your home, even if you live outside of California.

4. Date and time of injury: Fill this out as accurately as you can. The date of your injury is important because California workers’ comp only offers full benefits after a three-day waiting period. For cumulative-strain injuries that developed over time, give the date you first knew that your condition was work-related. If you don’t know the exact time of your injury, give the closest estimate you can.

5. Address and description of where the injury happened: Part of qualifying for workers’ comp means proving that your injury was work-related. On this line, state where you were injured, including the address and any more specific location you have within that location. Be as specific as you can. For example, instead of saying the injury happened at the company warehouse, say it happened on the ramp outside of loading bay 1 of warehouse A.

6. Injury description: At this stage, you’ll describe your specific injury. List the body part that was injured, including each body part impacted by the injury. If you injured your fingers and your wrist, for example, include both on the form. You’ll also describe the type of injury. This could be a fracture, dislocation, burn, etc. Be accurate and specific as this can ultimately impact the amount of workers’ comp benefits you receive. 

7. Social Security number: Write down your Social Security number (SSN) if you have one. You don’t need to have an SSN to get workers’ comp and if you don’t include your SSN, you can still file DWC 1.

8. Email consent: If you check the box, you agree to receive communication about your claim by email only. There is also a line to write your email address. If you prefer to receive communication by physical mail, do not check the box and do not enter your email. Keep in mind that even if you check this box, some claims administrators don’t provide an email option and still mail physical communications. There is a separate box and email line for applicants who primarily speak Spanish.

9. Signature: The employee section isn’t complete until you sign it. By signing, you’re also verifying the accuracy of the information you wrote on the form.

Once you’ve completed your part of the form, also check the box at the bottom that says “Temporary Receipt.” This box shows that the employee portion was completed but the full form hasn't been completed or filed with insurance yet.

How to submit Form DWC 1

After filling out the employee portion, make a copy for your personal records so you have proof of when you filled it out. Return the form to your employer immediately. If you can’t return it in person, you can also mail it. If you send the form through the mail, choose certified mail so you can track when you sent it and when it was delivered. Having the delivery receipts is essential — otherwise you may struggle to get benefits if your employer claims that you didn’t return the form to them on time.

What happens after you file Form DWC 1?

After you give Form DWC 1 back to your employer, they should complete their section within one day and then give a completed copy to you and to the insurance company. Keep this completed copy for your records and make sure the information your employer entered is all correct. (We cover how to make sense of the employer section later in this article.)

The insurance company will review your workers’ comp claim once it receives the completed form and has 14 days to mail you a letter explaining whether it’s approving or denying your claim. If you don’t receive a letter within two weeks of returning the form to your employer, contact the insurer for an update. California generally considers claims as approved if the insurance company doesn’t deny the claim within 90 days.¹

To help your claim stay on track, here are four things you can do after you return the form to your employer:

• Request a copy. Your employer should provide you with a copy of the completed form once they’re finished with it. If they don’t, request one for your personal records.

• Get medical care. You don’t need to wait until your claim is officially approved for emergency or necessary medical treatment. California state law requires employers to cover up to $10,000 of necessary medical care even before anyone files a claim.

• Look for updates from the insurance company. It can take a few days for your employer and the insurance company to process your claim — potentially more if the form needs to go through the mail.

• Appeal a denial, if necessary. If you receive a letter denying your claim, you can challenge the decision. You’ll need to file an appeal with one of the state’s DWC offices, which also function as courts. We suggest talking to a California workers’ comp lawyer to help get your claim approved.

Understanding the Employer Section of Form DWC 1

This section is your employer’s responsibility, but understanding the information it contains could help you better understand what’s happening with your workers’ compensation claim. Correcting any mistakes could also help you avoid issues later on. After you return the form to your employer, they’ll complete the following:

10. Name

11. Address

12. Date employer first knew of injury: This should be the date you reported your injury. If this date is incorrect there could be issues with when you get benefits or how much you get.

13. Date claim form was provided: This is the date your employer either provided or mailed the DWC 1 form to you. It should be within one business day of the date your employer wrote on line 3 in the employer section.

14. Date employer received claim form: This is the date you returned the claim form to your employer. Again, make sure this date is correct. If you returned the form through the mail, make sure this date is the same as the date on your delivery receipt.

15. Insurance company name and address

16. Workers’ comp insurance policy number

17. Employer signature: Your employer must sign the form in this field. This could be the owner if you work for a small business, or someone from HR if you work for a larger company.

18. Title: Whoever signed the form will add their title here.

19. Contact phone number

How long do you have to file a workers’ comp claim in California?

In California, you have to report your injury within 30 days of the date of your injury or within 30 days of when you realized your injury or illness was work-related (such as a doctor's appointment). After that, you must file your workers’ compensation claim within one year.

However, as the saying goes, just because you can wait doesn’t mean you should. You should notify your employer of your injury and file DWC 1 as soon as possible to avoid missing out on your benefits.

Get help with your workers’ comp claim

Filling out Form DWC 1 is likely one of the simplest steps of the workers’ compensation claim process, but doing it correctly is essential for the success of your claim.

If you need help filing a claim or if you run into questions later in the process, you can get professional help by talking to a workers’ compensation lawyer. A lawyer can assist at every point in the process by answering your questions, completing other forms, helping you get proper medical care, handling calls with the insurance, negotiating a settlement for you, and fighting for your rights if any issues arise.

An Atticus workers’ comp lawyer is also affordable for all workers. Our lawyers all offer a free consultation and if you want to work with them, you won’t pay anything until after they help you get a settlement or win benefits. Fill out this free workers’ comp quiz and someone from our team will reach out to learn more about your situation and answer any questions you have.

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Related resources:

California Workers' Comp: Everything You Need to Know

By Victoria Muñoz

Your Guide to California Workers’ Comp Settlements

By Victoria Muñoz