In California, Work Injuries are reported by via a Workers’ Compensation Claim Form. This Claim Form is also called a “DWC-1” form. This is a State of California Form which can be obtained either the State of California Department of Industrial Relations Website, www.dir.ca.gov, or at your local Workers’ Compensation Appeals Board. You can submit the Claim Form to your employer personally. It can also be provided to them via your representative, i.e. your lawyer or your union representative. If you choose to personally report your injury, you can first go to your supervisor or employer representative and tell them that you would like to report your work injury. Otherwise, if your company has a Human Resources Department, you can report the injury to them as well. Your employer is required to provide you a Claim Form within one working day after learning about your injury. Sometimes, your employer will witness the accident. In those circumstances, they should provide you the Claim Form.
The Workers’ Compensation Claim Form contains two sections. The first section is for the Employee and the second, for the Employer. The first part of the form is for the Employee to complete. It requests the employee’s name, the date it is being filled out, the employee’s home address, the date of injury, the time of the injury, the address and description of where the accident happened, the description of the injury and the body part affected, and the employee’s social security number . There is a new section as well that allows for the employee to authorize the emailing of notifications by the claims administrator. Finally, the Employee is requested to sign the Claim Form.
The second section of the Workers’ Compensation Claim Form is for the Employer to fill out. Your employer is supposed to identify itself by name, provide its address, provide the date that the employer first knew of the injury, provide the date that the claim form was provided to the employee, provide the date that the employer received the claim form, provide the name and address of the insurance carrier or adjusting agency, provide the insurance policy number. Finally, the Employer’s Representative is to sign the Claim Form, provide his or her Title. They are also required to provide a telephone number.
What happens once the Claim Form has been completed?
Once a Claim Form has been filled out and submitted to the Employer, your Employer is obligated to date the form and provide copies to your insurer or claims administrator and to the employee, dependent or representative who filed the claim within one working day of receipt of the form from the employee.
Does filing a Claim Form mean I have a valid claim?
The receipt and completion of a Claim Form by your Employer is simply a notification of a claimed injury. The signing of this form by your Employer is not an admission of liability.
After I filed the Claim, can I get treatment?
Within one working day after you file a claim form, your employer or claims administrator must authorize the provision of all treatment, up to ten thousand dollars, consistent with the applicable treatment guidelines, for your alleged injury until the claim is accepted or rejected.
After I file the Claim Form, can I receive benefits?
The filing of a claim does not mean that your claim is accepted. The Claims Administrator is under no obligation to provide any benefits to you other than medical care during a 90 day delay period. This means benefits such as total temporary disability benefits or permanent disability benefits will not be provided until the case is accepted.
Claims can be delayed for 90 days. Labor Code Section 5402(b) provides that a 90 day period for Claims Administrators to accept or deny a claim. If they deny your claim, they are allowed to stop the provision of your medical treatment.
With more than 23 years of expertise in defending workers’ rights, the Law Offices of Edward J. Singer, A Professional Law Corporation, is here to assist. If you have any questions concerning your rights, please do not hesitate to contact our offices. Please contact us today concerning any workers’ compensation questions or issues.