Hi there, I'm Michael Rob, with height and rotten ortley here in San Diego, California. Today, we're going to talk about employee claim forms in the workers' compensation area. The form you have in front of you is the workers' compensation claim form, also known as the DWC one. Most of it is self-explanatory. Within one working day of your injury, provided that your employer has notice of your injury, they are required by law to provide you with a form like the one you see in front of you here. Now, it's your obligation to fill out items one through eight. Most of these are self-explanatory, but we're going to walk through them anyway. The first one is the name, and then the today's date that you filled out the form. Your address, your city and state, and zip code, and the date of injury. As for the date of injury, if you were hurt today, August 1st, then that's the date that you would put, along with the approximate time. Now, if you're unclear on whether or not you were injured today or you've been injured within the last few days, and based upon the repetitive nature of your job, it could even be a few weeks ago, or within the past year, you'll put the letters "C" as in Charlie, and "T" as in Tom, in front of today's date. Today's date being the last date that you worked before giving notice of your injury to your employer. I do want to point out at this juncture that this form is also available in Spanish. So you're not required to fill it out in English, you can fill it out in Spanish, and the directions are in Spanish as well. Moving on to item 5, the address and description of where...
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Dwc employee claim Form: What You Should Know
This form may be faxed to. Request an “Claim for Workers' Compensation for a Work-Related Injury” form from the supervisor (it's also known as a DWC 1 form). In this case, your employer must also provide your supervisor with both the “Employee” & “Claim for Workers' Compensation Benefits” forms. Your employer must provide both these forms to you by the deadline in your contract.
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Video instructions and help with filling out and completing Dwc employee claim form
