What You Need to Know About Workers’ Compensation Claim Forms

First Report of Injury: The DWC-1 Form

A workers’ compensation claim formally begins with the completion of a Report of Injury, or the DWC-1 form. Your employer should make the DWC-1 available to you within 24 hours after you report your injury. The form may also be available from the human resources department, your supervisor, or your designated workers’ comp advocate.

When Your Employer Refuses To Cooperate

If you’ve been injured on the job, your employer must cooperate in processing your workers’ compensation claim form or he can be subject to fines and penalties. If you believe your employer is hindering your claim, you can file a complaint with your state’s workers’ compensation administration.

Example: Forcing an Employer to Cooperate

Henry was working for a small plumbing company when he stumbled and fell over another employee’s tools. He broke his arm in the fall. After returning from the hospital, Henry asked his employer, the owner of the company, for a DWC-1 injury report form. The owner told Henry he would get it to him the next day.

After several days, the owner hadn’t given Henry the form. Henry became frustrated and contacted his state’s workers’ compensation administration for help. Within seven days a representative contacted Henry’s employer and instructed him to cooperate or suffer substantial fines and penalties. The next day the owner gave Henry the form and continued to cooperate with processing his claim.

When an Employer Fails To Carry Workers’ Compensation Insurance

In most states, an employer’s failure to carry workers’ compensation coverage is a criminal offense. For example, in the State of California it’s a misdemeanor, punishable by a fine of up to $10,000 and/or imprisonment in county jail for up to one year.

If your employer is not insured and you’re injured on the job, your employer is still responsible for all your medical bills and related expenses. In some states, the workers’ compensation board can shut down your employer’s business until he obtains coverage.

In the absence of workers’ comp insurance, you are entitled to file a separate lawsuit against your employer. You are allowed by law to demand reimbursement for your medical and therapy bills, out-of-pocket expenses, costs for transportation to and from treatment, an amount for your pain and suffering, and the cost of your attorney’s fees.

Example: Broken Leg with No Insurance Coverage

Maggie worked for a small, family-owned pizzeria. The restaurant was normally manned by the owner, his wife, and their son. Maggie was a student and worked part time after school and on weekends. One afternoon, Maggie slipped and fell on some water which spilled while serving a meal to a customer. She suffered a broken leg.

Maggie’s father told her to ask the owner for a workers’ compensation claim form (DWC-1). When she asked the owner for the form, he told her he didn’t carry workers’ comp. He told her to use her own insurance. Maggie filed a complaint with the workers’ compensation board. While they conducted an investigation, Maggie used her family’s medical insurance for the treatment she required.

Several months later, the board notified Maggie that her employer failed to carry workers’ compensation insurance and had been fined. To recover her medical bills and related expenses, Maggie sued her employer. The court awarded Maggie the cost of her medical bills, out-of-pocket expenses, and a substantial amount for her pain and suffering.

Retaliation for Filing a Workers’ Comp Claim

It is illegal for an employer to retaliate against an employee for filing a workers’ compensation claim. Retaliation against an employee could include:

  • Termination
  • Demotion
  • Disciplinary actions
  • Isolation from other employees
  • Interfering with the claim process
  • Making threatening statements or actions

If you believe you’ve suffered retaliation from your employer, you can file a lawsuit. Victims of retaliation may be entitled to damages for past and future wage loss, loss of pension benefits, and emotional distress. If you can prove your employer’s actions constituted malice, or willful and wanton conduct, you may also be entitled to punitive damages.

In addition to your other legal alternatives, you can file a claim against your employer with the U.S. Equal Employment Opportunity Commission (EEOC). You can file a complaint against your employer with the EEOC here.

You’ll need an attorney to pursue a retaliation case against your employer. These cases often involve highly contentious court battles. You won’t be able to handle it on your own.

Completing Your DWC-1 Form

The process of completing the DWC-1 is similar in all states. The information you enter is vital to the success of your workers’ compensation injury claim. Information to provide on your DWC-1 form includes:

    • Your full name, address, telephone number, and e-mail address
    • The name, address, and telephone number of your employer; also your employer’s web site and e-mail address
    • The date you informed your employer of your injury
    • The date you received the claim form
    • Your Social Security Number
  • Your signature

Thoroughly read the entire DWC-1 form so you understand the requirements. Ask for help from your employer, supervisor, or other reliable source if you don’t understand any part of the form. Once you’ve completed and submitted the form, it will be difficult for you to go back and change it.

Underneath your signature is an area for your employer to complete. As soon as you complete your portion, return it to your employer or the person designated to handle workers’ comp claims. Your employer should provide you with a copy of the completed form. Depending upon which state you live in, your employer has one to two days to file the form with his insurance company.

The Role of Attorneys

An employer usually has no reason to hinder an employee filing a claim form. You can contact your state’s workers’ compensation administration and ask them to help if your employer fails to cooperate.

If your employer doesn’t carry workers’ compensation insurance, or has retaliated against you because you filed a claim, you’ll need an experienced workers’ comp attorney.

Attorneys can file lawsuits, take depositions, subpoena your employer’s company records, and do a lot more in pursuit of your claim. Most workers’ comp attorneys don’t charge for initial consultations. If the attorney accepts your case, you won’t pay any fees until, and unless, he wins.

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Visitor Questions on Workers Comp Claim Forms