DWC-1 Claim Form Guide
The DWC-1 is the official form that starts your California workers' compensation claim. Here is exactly how to fill it out, what your employer must do, and what happens next.
What Is the DWC-1 Form?
The DWC-1 Workers' Compensation Claim Form is the official document that initiates your workers' comp claim in California. Filed with your employer, it notifies their insurance company that you were injured on the job and triggers the claims process.
Without filing a DWC-1, your employer's insurance company has no obligation to investigate your claim, provide benefits, or authorize medical treatment beyond first aid. Filing this form is the single most important step in protecting your rights after a workplace injury.
Official Download
Download the DWC-1 form directly from the California DIR: DWC-1 Claim Form (PDF)
Who Fills Out the DWC-1?
The DWC-1 form has two distinct sections. Understanding who is responsible for each section prevents delays and confusion.
Employee Section (You)
The top portion of the form. You are responsible for filling out:
- Your full legal name and address
- Date and location of injury
- Description of what happened
- All body parts injured
- Your signature and date
Employer Section (Your Boss)
The bottom portion. Your employer fills out:
- Company name and address
- Insurance carrier information
- Policy number
- Date employer received notice
- Date form was provided to employee
Step-by-Step: Filling Out the Employee Section
Follow these steps carefully. What you write on this form becomes the foundation of your entire claim.
Get the DWC-1 Form
Request from your employer or download from DIR website.
KEY TIPS:
- Employer must provide within 1 working day
Fill Out Employee Section
Complete your name, address, date of injury, and injury description.
KEY TIPS:
- List ALL body parts affected
- Be specific about what happened
Describe the Injury
Write exactly what happened, where, and when.
KEY TIPS:
- Include witnesses if possible
Sign and Submit
Sign and date the form, submit to your employer.
KEY TIPS:
- Keep a copy for your records
Follow Up
Employer sends to insurance. Insurer has 90 days to accept or deny.
KEY TIPS:
- Track your submission date
Field-by-Field Breakdown
Here is what to write in each field of the employee section, with examples.
1. Employee Name
Your full legal name as it appears on your employment records. Do not use nicknames.
Example: "Maria Elena Rodriguez" (not "Maria R." or "Elena")
2. Home Address
Your current mailing address. This is where official correspondence about your claim will be sent.
Tip: If you expect to move, use an address where you can reliably receive mail. Update your address with the insurer if you relocate during the claim.
3. Date of Injury
The specific date you were hurt. For cumulative trauma injuries (like carpal tunnel from repetitive motion), use the date you first noticed symptoms or the date a doctor told you the condition was work-related.
Warning: Getting this date wrong can affect your statute of limitations. If you are unsure, consult an attorney before filing.
4. Description of Injury (How It Happened)
Describe what happened in clear, specific detail. Include the mechanism of injury, where you were, and what you were doing.
Too Vague:
"Hurt my back at work."
Specific and Clear:
"On 1/15/2026, while lifting a 50-lb box of inventory from the floor to a shelf in the warehouse at 123 Main St, I felt a sharp pain in my lower back and was unable to stand straight."
5. Body Parts Injured
List every body part that was affected. This is critical because body parts not listed on the DWC-1 may not be covered later in your claim.
Important: If you injured your back lifting something, you may also have injured your neck, shoulders, or hips. List everything that hurts, even mildly. You can always withdraw a body part later, but adding one after the fact is much harder.
Common DWC-1 Mistakes to Avoid
Insurance adjusters look for inconsistencies and gaps in your DWC-1. These are the mistakes we see most often in our practice.
Being Too Vague About the Injury
"I got hurt at work" gives the insurance company nothing to investigate and makes it easier to deny your claim. Be specific about the mechanism, location, and circumstances.
Wrong Date of Injury
Using the wrong date can trigger statute of limitations issues or create inconsistencies with medical records. For cumulative trauma, the date calculation is complex - get legal advice.
Failing to List All Body Parts
If you injure your back but also feel pain in your left leg and hip, list all three. Insurance companies will argue that unlisted body parts are not work-related, even if they clearly are.
Not Keeping a Copy
Always make a photocopy or take a photo of the completed form before handing it to your employer. Forms go missing more often than you would expect.
Waiting Too Long to File
Every day you delay gives the insurance company ammunition. Delays also make it harder for doctors to connect your injury to work. File as soon as possible after reporting your injury.
Employer Obligations After You Report an Injury
California law places strict requirements on employers when a worker reports an injury. Knowing these obligations helps you hold your employer accountable.
Provide DWC-1 Within 1 Working Day
Your employer must give you the DWC-1 claim form within one working day of learning about your injury. Labor Code §5400
Authorize Up to $10,000 in Medical Treatment
While the claim is being investigated, the insurer must authorize up to $10,000 in medical treatment. This is true even before the claim is formally accepted or denied. Labor Code §5402
Forward Claim to Insurance Carrier
After you submit the completed employee section, your employer must forward it to their workers' compensation insurance carrier. The employer cannot sit on it or delay.
No Retaliation
Your employer cannot fire, demote, or punish you for filing a workers' compensation claim. This is protected under Labor Code §132a.
What Happens After You File the DWC-1?
Once you submit the DWC-1 form, the insurance company takes over the investigation. Here is the timeline of what to expect.
Day 1: Claim Received
Insurance carrier receives the DWC-1 from your employer and assigns a claims adjuster to your case.
Within 14 Days: Initial Response
The insurer must begin paying temporary disability benefits within 14 days of the employer learning about the injury, or issue a letter explaining the delay. Labor Code §4650
Within 90 Days: Accept or Deny
The insurance company has 90 days from the date the DWC-1 is filed to accept or deny your claim. If they fail to issue a decision within 90 days, the claim is presumed accepted. Labor Code §5402
Claim Accepted or Denied
If accepted, benefits continue and medical treatment is authorized. If denied, you have the right to appeal to the Workers' Compensation Appeals Board (WCAB). A denial is not the end of your claim.
Key Deadlines at a Glance
| Deadline | What Must Happen |
|---|---|
| 1 Working Day | Employer provides DWC-1 form |
| 30 Days | Employee reports injury to employer |
| 14 Days | Insurer begins TD payments or issues delay letter |
| 90 Days | Insurer accepts or denies claim |
| 1 Year | Statute of limitations to file claim |
Sources: Labor Code §5400, Labor Code §5405, DIR How to File a Workers' Comp Claim
Claim Denied? Do Not Give Up.
Approximately 20-25% of California workers' comp claims are initially denied. A denial is a setback, not the end. You have the right to appeal to the WCAB, and many denials are overturned with proper legal representation.
Learn about claim denial next stepsRelated Resources
Frequently Asked Questions
Where can I download the DWC-1 form?
You can download the official DWC-1 Claim Form directly from the California DIR website at dir.ca.gov/dwc/DWCForm1.pdf. Your employer is also legally required to provide you with this form within one working day of learning about your injury.
What if my employer refuses to give me the DWC-1 form?
If your employer refuses or fails to provide the DWC-1 form within one working day, they are violating California Labor Code. You can download the form yourself from the DIR website, file it directly, and report your employer to the Division of Workers' Compensation. Your employer may face penalties for failing to comply.
Can I file the DWC-1 form myself or does my employer have to do it?
The DWC-1 form has two sections. You fill out the employee section (top half) with your personal information and injury details. Your employer fills out the employer section (bottom half) with company and insurance information. You submit the completed employee section to your employer, who then forwards the entire form to their insurance carrier.
What happens if I make a mistake on the DWC-1 form?
Minor errors can usually be corrected by filing an amended claim form. However, significant mistakes - like listing the wrong date of injury or failing to include all injured body parts - can create complications down the road. It's better to be thorough and accurate the first time. If you realize you left out an injured body part, notify your employer and the insurance company in writing as soon as possible.
How long after my injury do I have to file the DWC-1?
You should report your injury to your employer within 30 days (Labor Code §5400). However, you have up to one year from the date of injury to file your workers' compensation claim (Labor Code §5405). For cumulative trauma injuries (like repetitive stress), the one-year clock starts from the date you knew or should have known the injury was work-related. Despite the one-year deadline, filing sooner is always better.
Need Help Filing Your DWC-1?
Our attorneys can help you complete your claim form correctly and ensure nothing is missed. Free consultation, no fees unless we win your case.
How Much Is Your California Work Injury Case Worth?
Get a free, confidential case evaluation from our experienced attorneys. No obligation, no fees unless we win.
We respond within 15 minutes during business hours