dwc-1 Form 2024

dwc-1 Form: What You Should Know

Workers' Compensation Claim Form (DWC 1) & Notice of This form must be completed, signed by you, your employer, and a witness. If the witness is not with you, ask your supervisor to complete the witness affidavit. To complete the form, choose the appropriate information and then sign one of the available signatures. The date is printed on the top line. Keep a copy of the form. When to file: If you have suffered a physical injury and there is no medical certification for the work-related condition causing the injury, file your claim using the “Health” section. If you have a physical condition that the medical office diagnosed as a disability, but the medical office did not submit a Certificate of Disability on file, then you must file your claim using the “Workers' Compensation” section. You can obtain a Certificate of Disability from your worker's or supervisor's doctor. DWC-CA 10511-a is the form you can use to obtain this form. Workers Compensation Claim Form (DWC 1) & Notice of Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility After a claim is filed, a Workers' Compensation investigator must sign off the claim form and mail it to the state DWC office. You will receive a final “Pending” or “Denied” (which means the form is pending; the attorney will not know whether the case will move forward or not) notice after four or six weeks, depending on how long it's been since the accident or work site. You will receive an award notice from your employer if an award is granted. The amount of an award is determined by the amount of the claim plus any other payments the worker received from his or her insurer during the claim process. If you filed your claim while employed as a full-time worker and the claim was determined in favor of the injured worker, a payment is made to you. If you filed the claim before you were a full-time worker (i.e., before becoming legally disabled) and the work-related disability was determined “less than and properly related to any past work-related employment,” then the worker collects the full compensation amount plus a 2,000 “reduction” in monthly compensation from the employer as a lump sum.

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