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Dwc-1 claim form
#1
Ca



Where can you get a copy of this claim form if your employer filed one for you?
 
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#2
The carrier should have one in their file. Your employer might have kept a copy.
You can always file a second one.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
(09-07-2018, 07:47 AM)1171 Wrote: The carrier should have one in their file. Your employer might have kept a copy.
You can always file a second one.
 
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#4
Would it have any effect on the claim by filing a second one?
 
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#5
(09-07-2018, 11:07 AM)Lostandconfused Wrote: Would it have any effect on the claim by filing a second one?

It would if there were significant differences.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#6
(09-07-2018, 12:44 PM)1171 Wrote: [quote='Lostandconfused' pid='168000' dateline='1536332849']
Would it have any effect on the claim by filing a second one?

It would if there were significant differences.
[/quote



I don’t think there’s any difference other than the carrier ask about the injury. The first adjuster asked but after it was transfer a different adjuster. He denied the claim but I don’t recall speaking to him.


I understand the employer can file one but are they obligated to inform me?
 
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#7
As you can see from the instructions:
https://www.dir.ca.gov/dwc/DWCForm1.pdf
You complete the top and keep a copy.
The employer completes the bottom and gives you a copy.
The date and time of injury, the description and the part of the body should be the same as the first.
On a separate sheet You might want to include a brief statement as to why you are filing a second one on the same claim so they don,t open another claim.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#8
(09-07-2018, 06:45 PM)1171 Wrote: As you can see from the instructions:
https://www.dir.ca.gov/dwc/DWCForm1.pdf
You complete the top and keep a copy.
The employer completes the bottom and gives you a copy.
The date and time of injury, the description and the part of the body should be the same as the first.
On a separate sheet You might want to include a brief statement as to why you are filing a second one on the same claim so they don,t open another claim.

Thank you
 
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#9
Sure thing. Hope it helps.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#10
(09-07-2018, 07:18 PM)1171 Wrote: Sure thing. Hope it helps.

It did because I don’t recall signing one and I was terminated 2 weeks after so I don’t remember the employer mentioning anything about it.

I don’t know if it would help to ask the adjuster about it.
 
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