Workers Compensation Claim Form (DWC 1) And Notice Of Potential Eligibility {DWC 1}

DWC 1 - WORKERS’ COMPENSATION CLAIM FORM AND NOTICE OF POTENTIAL ELIGIBILITY. This is a required California form used by employees to report a work-related injury or illness and formally start a workers’ compensation claim. Issued by the California Department of Industrial Relations, Division of Workers’ Compensation, this form explains potential benefits and outlines the steps employees and employers must take after an injury. The employee completes the claim section describing the injury, affected body parts, and date of occurrence, then submits it to the employer. The employer must complete their section and forward the form to the claims administrator. The notice portion provides important information about medical care, wage replacement, disability benefits, dispute resolution, and employee rights. www.FormsWorkflow.com