“What is the DWC 1, and how do I file it?”

What the form is

Its full printed name is the Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility. It is a mandatory form, set out in 8 CCR § 10139, and it consists of an original and three copies.

The current version is dated January 1, 2016. Every page of the PDF that DWC links from its forms page carries that revision date, which is also the date the current § 10139 took effect. As of September 2026, that 2016 version is the DWC 1 that DWC links.

It comes in more than one language. The standard DWC 1 is a single bilingual document, with English and Spanish on each page. DWC’s forms page also links separate Chinese, Korean, Tagalog, and Vietnamese versions.

It is not the Application for AdjudicationApplication for Adjudication Opens your case at the Appeals Board. One year.. DWC says that giving the completed DWC 1 to your employer opens your workers’ compensation case. The Application for Adjudication (WCABWCAB Workers’ Compensation Appeals Board. The court system that decides these cases. 23 district offices statewide. 1) is a different form that opens a case at the Appeals Board, and it has its own deadline.

Every form, and what it starts Download the DWC 1 from DWC’s forms page

Who has to give it to you, and when

Your employer, within one working day. The law requires the employer to provide a claim form and a notice of potential eligibility for benefits, in person or by first-class mail, within one working day of receiving notice or knowledge of the injury. The duty applies to an injury that keeps you off work beyond the shift you were working when it happened, or that needs medical treatment beyond first aid.

Notice does not have to be formal. The law sets 30 days for written notice to the employer. But, knowledge of the injury by the employer or its managing agent, superintendent, foreman, or other person in authority, from any source, counts as notice. And, late or defective notice does not bar the claim unless the employer was in fact misled or prejudiced by it.

I didn’t report it right away

What each part asks, and who fills it in

The form has three parts. Only one is yours to complete.

Complete only the employee section, as DWC’s instructions say.

Name every body part, not just the worst one. A body part not mentioned early becomes a fight later.

Adding body parts to a claim

Be accurate. The form carries a warning that a knowingly false or fraudulent material statement made to obtain or deny benefits is a felony. Describe what happened as it happened.

Think before ticking the email box. If you agree to it, notices about your claim come by email only. Tick it only if you read that inbox reliably.

Your employer may add to its own part, but not to yours. The employer portion may carry a logo or other claim information, but that cannot impose additional duties on you or delay the claim.

Filing: what it is, and the date that counts

Filing means giving the completed form to your employer. That is how DWC’s Injured Worker Guidebook defines it. The form itself tells you to keep one copy and give the rest to your employer, and to do it right away.

The date that counts. A claim form is deemed filed when it is personally delivered to the employer, or when the employer receives it by first-class or certified mail. By mail, the filing date is the day the employer receives it, not the day you send it.

If you mail it, use certified mail, return receipt requested. DWC recommends this so that you have a record of the date it was mailed and the date it was received.

What your employer must do next. Within one working day of receiving your form, the employer must date it and give a dated copy to you and to its claims administratorClaims administrator / adjuster The person handling your claim for the insurer or self-insured employer.. The form adds that the employer completes the employer section and keeps a copy.

The clocks the filing date starts

The $10,000 covers the waiting period, not a denial. The duty runs while the claim is being decided, and a rejection ends it. If treatment is being held up, ask for it in writing and cite § 5402(c).

Mark 90 days from the filing date on a calendar. The period is 75 days for claims under the public safety presumptions in §§ 3212–3212.85 and 3212.9–3213.2.

• My claim is delayed
• Public safety presumptions
• The claim, start to finish

What to keep, and what to write down

• Make copies before you hand it over — The form is meant to be an original and three copies. If you printed it yourself, copy the completed pages first.
• Mark your copy as your temporary receipt — The form tells you to keep it until your employer gives you back a signed, dated copy.
• Write down the date and how you delivered it — By hand: the date and who took it. By mail: keep the certified mail receipt and the return receipt.
• Check the dated copy when it comes back — The employer section records the date the employer received your form. Compare it with your own record.
• Keep every letter that follows, with its envelope — The dates are how you prove the timeline.

What to do after a work injury Every deadline in one place

If your employer will not give you the form

Get it yourself. DWC says that if your employer does not give you a claim form, you can download it from the forms page or get one from an Information & Assistance officer. I&AI&A Information & Assistance officer. Free help with questions and forms at every district office. Underused. officers work out of DWC district offices, and DWC describes their services as free.

Where the offices are DWC Information and Assistance Unit

Then file it anyway. A form you download works the same way. Fill in your section, sign and date it, and give it to your employer, in person or by certified mail.

The claims administrator has its own duty. If it learns that your employer has not provided a claim form, the law requires it to give you one within three working days. If it cannot tell whether one was provided, the law gives it 30 days from when it learned of the claim.

Your employer does not decide whether you have a claim. Its role is to give you the form. DWC’s FAQ also states that discriminating against a worker for requesting workers’ compensation benefits is prohibited by Labor Code § 132a.

My employer says I can’t file Retaliation for filing