Workers' Compensation Claim Form (DWC-1)Download Form
If you are hurt at work, it is imperative that you report your work-related injury or illness, regardless of the nature or severity, to your supervisor immediately. Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.
Fill out the employee section of the DWC 1 claim form accurately, and return the form to your supervisor as soon as possible, making sure to include all the parts of your body you feel may be hurt or effected by your workplace injury or illness.
Keep a copy of the completed form as your receipt and ask your employer to return the form to you with the employer section completed. By law, your employer has 24 hours to return the completed form to you.
It is important to keep in mind that by filling a DWC claim form, you are merely filing a claim for benefits—temporary disability, permanent disability and medical treatment. You are not suing your employer. Workers' compensation is a no-fault system in which benefits are paid for injuries on the job regardless of fault.
You can obtain a copy of the California DWC 1 claim form here.