How to file a workers’ comp claim online in California

Sixteen steps, from getting the form to the first 90 days of your claim. Every screenshot is a still from the source video and links to the exact second it was taken.

1. 1

   Know what filing a claim actually does

   Filing a California workers’ compensation claim is one act: telling your employer, in writing, that you were injured at work and that you want the benefits the workers’ comp system pays for. The written form is the DWC-1. It is an insurance claim against your employer’s workers’ compensation carrier — the attorney in the source video is careful about this — and it is not a lawsuit against your employer or the insurance company. The carrier will contact your employer to confirm you worked there and to check what you had already reported, so the story on the form and the story you told your supervisor should match.

2. 2

   Get the DWC-1 form within one working day — or download it yourself

   Tell your supervisor as soon as you can. California rules require your employer to give or mail you a DWC-1 claim form within one working day of learning about the injury, and the DWC says to report the injury within 30 days, warning that a late report can cost you benefits. If no form appears, download it from the DWC forms page at dir.ca.gov/dwc/forms.html, which also publishes the form in Chinese, Korean, Tagalog and Vietnamese; the standard DWC-1 itself carries the English and Spanish text on the same sheet. Download the fillable PDF to your desktop rather than typing in a browser preview, and use the PRINT and CLEAR buttons in the form header when you are finished.

   

3. 3

   Line 1: write your full legal name

   Line 1 wants your full legal name — the name you use at work and the one that shows on your paycheck. Everything that follows on the claim, from the adjuster’s letters to the case number, is indexed under this name, so a nickname or an abbreviated first name is worth avoiding here.

   

4. 4

   Line 1: put today’s date, not the injury date

   The date sitting to the right of your name is the date you are filling out the form. It does not have to be the day you were injured — the injury has its own line, number 4, further down the page. Read the calendar before you sign so the two dates are not confused.

   

5. 5

   Lines 2 and 3: the home address where notices should arrive

   Line 2 takes your home address and line 3 splits the city, state and ZIP code onto one row. This is the address the claims administrator and the DWC use for further information and correspondence about the claim, so give the address where mail will actually reach you.

   

6. 6

   Line 4: the date of injury, the line most claims get wrong

   Two kinds of injury date exist and they are written differently. A specific trauma — a fall from a ladder or roof, a car accident, a burn, a pop in your back from heavy lifting — gets the single calendar date it happened. A cumulative trauma, meaning a repetitive-motion injury such as carpal tunnel from years of typing, gets the whole period you worked for that employer: the approximate start date through the last date you physically worked before filling out the form. The source video writes 8/1/2015 – 8/5/2020 for the first type of entry and 8/2015 – 8/5/2020 for a worker who does not remember the exact start day; month and year are fine, and the end date is normally your last physical day of work for that employer.

   

7. 7

   Line 4: the time of injury only belongs to a specific trauma

   The small a.m. and p.m. boxes beside the date belong to a specific-trauma claim. If the injury happened at a particular moment, write the time you know. If it developed over months or years, leave the time blank: there is no single hour for a repetitive-motion injury, and an invented time is worse than an empty box.

   

8. 8

   Line 5: the address and description of where the injury happened

   Normally this is your employer’s address, the place you go every day. If you were working somewhere else — the video’s example is being rear-ended while driving to a client’s house — put as much detail as you can. If you genuinely do not know, leave it blank: the source attorney’s advice is that a blank beats a wrong address, because the insurer’s first investigation runs on this line.

   

9. 9

   Line 6: describe the injury and every body part affected

   The attorney calls this the most important section on the form. Write a full list of your injuries rather than only the one that hurts worst today, and include anything that bothers you and that you believe work caused at least in part. “At least in part” covers an older injury that employment aggravated or made permanently worse — that is a new claim for it. Use plain words: left wrist with numbness in two fingers, low back with pain down the leg, hearing loss, skin rash, anxiety and trouble sleeping. An injury you never wrote down is an injury you have to argue about later.

   

10. 10

    Making a claim is not the same as being taken off work

    These two things get confused, so the source video stops on it. Filing the DWC-1 and listing body parts is a claim for benefits; work restrictions are a medical decision. The claim itself does not take you off work — what takes you off work, or changes what you do, is a restriction a doctor writes. That is why the video tells workers to talk with their treating doctor about what they can still do, and to keep any restriction within what the job actually requires.

11. 11

    Line 7: the Social Security number is your call

    Your employer already holds your Social Security number in its payroll records, and line 7 asks you to repeat it. The attorney in the source video tells unrepresented workers to leave this line blank if they are uncomfortable filling it in, and describes disclosure at this stage as voluntary. Whatever you decide, keep the rest of the form honest: the form itself carries a warning that a knowingly false or fraudulent statement made to obtain or deny benefits is a felony.

    

12. 12

    Line 8: the email-notice checkbox

    Line 8 asks whether you agree to receive notices about your claim by email only. The video’s recommendation is to leave the box unchecked and not to supply an email address, so the claims administrator has to mail paper notices to the home address you entered on line 2. The form itself spells out both sides: you receive benefit notices by regular mail if you do not choose an electronic option, and if you later change your mind you have to tell your employer in writing.

    

13. 13

    Line 9: sign it and keep a copy

    Line 9 is the employee signature. Sign and date the form yourself before it leaves your hands — the DWC asks for a signed, dated claim form, and an unsigned one will not open your case. The video’s instruction is to make a copy first; the DWC adds that you can mark your copy as the employee’s temporary receipt until the signed and dated copy comes back from your employer.

    

14. 14

    Lines 10 to 18: stop, this part is the employer’s

    Everything from line 10 down is the employer’s section: employer name and address, the date the employer first knew about the injury, the dates the form was provided and received, the name and address of the insurer or adjusting agency, the policy number, and the employer representative’s signature. Do not fill in any of it. Your employer completes those lines and forwards the form to the workers’ compensation insurance company, and you should receive a copy of the completed form back — ask for it if it never arrives, and keep it with the rest of your claim paperwork.

    

15. 15

    Deliver the form and keep proof of the date

    Give the completed form to your employer right away. The DWC’s instruction is to return it in person or by mail, and if you mail it, to use certified mail with return receipt requested so you have a record of the day it went out and the day it arrived. If handing it over in person is awkward — a small employer, or a supervisor you are already in conflict with — the source attorney says emailing or faxing the form is a reasonable alternative as long as you confirm the employer actually received it. What you should not do is sit on it: the DWC warns that failing to return the completed form can put your right to benefits at risk.

16. 16

    What should happen next — and when to pick up the phone

    Once the employer has your form, medical treatment must be authorized within one day, and the DWC puts a number on it: while the claim is being accepted or rejected you may receive up to $10,000 in treatment. The insurance company generally has 14 days to mail you a letter telling you the status of your claim, and a claim your employer does not deny within 90 days of receiving the completed form is presumed to be work-related. If no letter arrives and no treatment is authorized, call the claims administrator named on your paperwork, or the DWC Information Services Center at 1-800-736-7401 — the number printed on the form itself.

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