| Starting your Workers' Compensation Claim |
| It is very important that you notify your employer if you have been hurt on the job. |
To do this you need to file a claim form, the DWC-1 (archived). You can also find instructions WCAB site here. |
| Filling out the claim form is pretty simple. It should be done on the day you get hurt, if you have suffered a specific injury.
It should be done on the day you first seek medical treatment if you are filing a continuous trauma injury. |
Specific Injury: A work injury that occurs at one time or over a short time (like 1 day).
Example: You fall off a ladder at work and break your leg or you are lifting heavy boxes all day and by the end of the day your lower back hurts.
Continuous trauma injury: A work injury that occurs over a period of time due to repetitive work activities.
Example: Your wrists and hands begin to hurt after you have been doing computer data entry work over a period of six months. Finally, the pain is so great you need to be seen by a doctor.
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| The injury date is item #4 on the claim form. |
If you are filing for a specific injury, enter the date as follows: 1/1/02
If you are fling a continuous trauma injury, enter the date you are seeking medical treatment and 1 year previous as follows: 1/1/01-1/1/02 |
| Item #6 on the claim form asks for a description of the injury and the part of the body affected. Be sure to include every body part that is experiencing symptoms. |
For example: If you fall off a ladder breaking your right leg and landing on your back and hitting your head, describe as follows: Right leg, back and head from fall off ladder.
For example: If your injury is from repetitive work activities, describe as follows: Both hands, wrists and elbows from repetitive keyboarding. |
| Sign the form at item #8 and give it to your employer. Always keep a copy for your records. |
The employer has one day to complete the bottom portion of the form and return it to you. |
| Copyright 2004, All rights reserved, Charles R. Wear |
Claim Form
