File a Claim

When you become injured at your job, you may be entitled to receive benefits to compensate you for medical treatment and the time spent not working during your recovery. In order to qualify to receive workers’ compensation benefits, you must report the injury to your Supervisor as soon as possible. You must then complete the necessary documentation required by the California State Division of Workers’ Compensation (DWC) to begin receiving your benefits.

How to file a Workers' Compensation Claim

1. Get immediate medical care if necessary

If the injury is one that requires emergency care, that is your first priority. If less serious, get first aid and then see your doctor if necessary. If possible, inform the hospital or doctor that the injury is from a work-related accident or incident. If the injury is one that requires emergency care, that is your first priority. If less serious, get first aid and then see your doctor if necessary. If possible, inform the hospital or doctor that the injury is from a work-related accident or incident.

2. Obtain a Claim Form

This form is referred to as the “DWC-1” form. Within a day after reporting your injury, your Supervisor/HR Representative should provide you with a copy of this form. If you do not receive one, you can download a copy from the DWC website.

DOWNLOAD DWC-1 FORM

If you are unable to get the form online, you can call the DWC Information and Assistance Unit at (800) 736-7401.

3. Complete the DWC-1 carefully

If you feel medical treatment is needed, you should complete and submit the DWC-1. Complete only the “Employee” section of the form.

This form is going to ask you for the following information:

Your Name
Your Address
Date and time of the injury
Address and description of the location where the injury occurred. It is good to be descriptive here
Injury you sustained and the body part affected. Again, be descriptive and complete.
Your Signature

4. Submit the DWC-1 to your employer

Make sure that you keep a copy of the form before submitting it. Your Supervisor/HR Representative is then required to complete the “Employer” section of the form and return a signed copy to you within one working day. If you do not receive the completed Employer’s copy, you should ask about getting it. You may turn in the copy by hand or by mail. If you are mailing the form, you should use certified mail, return receipt requested, so you have a copy of the date that you sent the form and the date it was received.

5. Obtain medical treatment from a designated provider

After requesting medical treatment, your Supervisor/HR Representative should direct you to an approved Initial Treatment Center from the County’s Medical Provider Network (MPN). To access the MPN, go to Get Medical Treatment.

Get Medical Treatment

6. Wait to hear from the County's Third Party Administrator (TPA)

After the Department completes the form that you have submitted, the form is sent to the designated TPA, where your claim will be assigned to an examiner. You should be contacted by your claims examiner within four business days. To find the status of your claim, go to Claim Status.

Claim Status