DWC Forms - California Department of Industrial Relations
Workers' compensation claim form. Spanish - Chinese - Korean - Tagalog - Vietnamese; DWC 1: Supplemental job displacement non-transferable voucher * Injuries occurring on or after 1/1/13
If you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to workers’ compensation benefits. Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below.
Division of Workers' Compensation - California Department of …
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.
• Provide the employee with Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility form (e3301) within one working day of notice that a work-related injury or illness may have occurred; • Complete an Employer’s Report of …
California Workers Compensation Claim Forms & Resources
Accidents happen and when they do, Employers has your business covered. Find all of the California workers compensation forms & resources you need to file a claim.
Forms for Injured Workers - State Compensation Insurance Fund
These forms are mandatory for employers to provide to new employees, or post at the workplace. A collection of the most important forms for State Fund policyholders.
Workers’ Comp Employees Forms & Guides – Risk Management
Help workers with job injuries understand their basic legal rights, the steps to take to request workers’ compensation benefits, and where to seek further information and help if necessary. GO TO GUIDEBOOK
Workers' compensation information and forms for specific states
Includes Workers Compensation information kit and forms for specific states. Select your state to ensure your employees understand coverage and how to report a work place injury.
How to File a Worker's Comp Claim | State Claim Kits
Download a state-specific claims kit, or get individual documents from each state’s Forms & Resources page. Note that the list below represents states for which downloadable claim kits are currently available.
Workers' Compensation Board All Common Forms
Workers' Compensation Board: File with Form WTCVol-3. See form for complete instructions.