Injured at Work in California? What to Do After a Job Injury

First steps after a California work injury

1. Address immediate safety concerns. For a medical emergency, call 911 or obtain emergency assistance. Move away from a continuing workplace hazard when it can be done safely.
2. Notify the employer promptly. Tell a supervisor, manager or other designated employer representative that an injury, illness or condition is believed to be related to work.
3. Request and complete the Workers’ Compensation Claim Form, DWC 1. Complete the employee section, sign and date it, return it to the employer and keep a copy showing when it was provided.
4. Determine whether a workers’ compensation ADR Program applies. Covered employees may have collectively bargained procedures, providers, forms and dispute-resolution resources.
5. Preserve claim information. Retain forms, claim numbers, notices, work-status reports and relevant communications.

An employer’s internal accident or incident report and the DWC 1 claim form serve different purposes. Completing one should not automatically be assumed to complete the other.

How to report a work injury and start a California workers’ compensation claim

Notify the employer

Report the injury or condition as soon as reasonably possible. Identify when and where the incident occurred, or explain that the condition is believed to have developed through work activities or exposures over time.

California law contains written-notice requirements and exceptions. Prompt reporting helps create a clearer record and reduces the possibility of avoidable questions about when the employer first received notice. See California Labor Code section 5400.

Request the DWC 1 claim form

For an injury resulting in lost time beyond the work shift or medical treatment beyond first aid, California Labor Code section 5401 generally requires the employer to provide or mail a claim form and notice of potential eligibility within one working day after receiving notice or knowledge of the injury.

The official Workers’ Compensation Claim Form, DWC 1 is also available from the California Division of Workers’ Compensation.

Complete the employee section accurately

• Complete only the portion identified for the employee.
• Describe the injury or condition factually.
• Identify the body parts or conditions being reported as completely as reasonably possible.
• Do not attempt to supply a medical diagnosis that has not been made.
• Sign and date the form.
• Return the form to the employer and retain a copy.
• If the form is mailed, preserve proof of mailing and delivery.

Internal incident reports are not necessarily claim forms

An employer may ask an employee to complete a company accident report, safety report or incident statement. That document may be useful, but it is not necessarily the DWC 1 workers’ compensation claim form. Employees and employers should identify clearly which documents have been completed and retain copies.

Specific injuries, cumulative trauma and occupational illness

A work injury is not always associated with one dramatic accident. The way an injury or illness is reported may depend on how it is believed to have occurred.

Specific injury

A specific injury is generally associated with one incident or exposure occurring at an identifiable time, such as a fall, collision, lifting incident or equipment accident.

Cumulative trauma injury

A cumulative trauma injury is alleged to have developed through repetitive physically or mentally traumatic activities or workplace exposures extending over a period of time. The claimed period may involve repeated lifting, gripping, overhead work, vibration, noise, keyboard activity or other recurring demands or exposures.

Learn more on the Cumulative Trauma Injury in California Workers’ Compensation page.

Occupational illness or exposure

A reported occupational illness may involve workplace exposure to dust, fumes, chemicals, infectious materials, noise or another asserted occupational condition. Reporting the claim does not by itself establish a diagnosis, work causation or eligibility for benefits.

Employees should report what they know factually: the work performed, the incident or exposure, the general time period and the condition or body parts being reported.

Find out whether the claim is covered by a workers’ compensation ADR Program

Some union-represented California employees are covered by collectively bargained workers’ compensation Alternative Dispute Resolution Programs. These Programs may operate under California Labor Code sections 3201.5 or 3201.7, depending on the industry and agreement.

A covered claim remains a workers’ compensation claim, but the governing collective bargaining agreement, ADR Agreement and Program Rules may establish procedures that differ from those ordinarily used in the state WCAB system.

Depending on the applicable Program, those procedures may address:

• Where and how an injury is reported
• The claims administrator responsible for the claim
• Authorized medical providers or provider networks
• Medical-evaluation procedures
• Ombudsman assistance
• Informal claim-resolution procedures
• Mediation or arbitration
• Forms and filing procedures

A covered employee should not assume that an ordinary WCAB dispute form, QME procedure or state-system filing is the correct next step without reviewing the governing Program materials.

What happens after the DWC 1 claim form is returned?

The employer completes its section

The employer completes the employer section, provides the employee with a dated copy and forwards the claim information to the workers’ compensation insurer or claims administrator.

A claim file is established

The employee should receive information identifying the claim number, claims administrator and contact information. Preserve this information because it will ordinarily be used in later communications.

The claims administrator communicates the claim status

California DWC generally describes a 14-day period for the claims administrator to send a notice stating whether the claim is accepted, delayed for additional investigation or denied.

Accepted

The claims administrator has accepted responsibility for the claim or for identified parts of the claim and will administer applicable benefits and services.

Delayed

The claims administrator is obtaining additional information before making a final decision. The delay notice should identify the information being investigated and the expected decision period.

Denied

The claims administrator has stated that it does not accept responsibility for the claim or an identified part of it. A denial notice ordinarily explains the stated reasons and available response procedures.

DWC guidance also explains that appropriate medical treatment may be authorized, subject to applicable rules and limits, while a claim decision is pending. Review the written claim notices and contact the claims administrator regarding authorization questions.

The official DWC Claims Process Flowchart provides a visual overview of the ordinary California claims process.

Who may be involved in a workers’ compensation claim?

Medical-care and medical-process information

California workers’ compensation law generally requires the employer to provide medical treatment that is reasonably required to cure or relieve the effects of a compensable work injury. The provider-selection and authorization process depends on the arrangement applicable to the claim.

The process may involve:

• A Medical Provider Network, commonly called an MPN
• A Health Care Organization
• A valid predesignation of a personal physician or medical group
• Another state-system provider arrangement
• A medical-provider system established by a collective bargaining or ADR Agreement

The employer, claims administrator or ADR Program should provide information about the authorized process. Useful administrative questions may include:

• Who is the assigned claims administrator or adjuster?
• What is the claim number?
• Which provider network or ADR medical system applies?
• Has an appointment or referral been authorized?
• Where should work-status reports be sent?
• How should authorized medical mileage be documented?

Workers’ compensation benefits that may be available

The California Division of Workers’ Compensation identifies five basic categories of potential workers’ compensation benefits:

• Medical care: Authorized care for the effects of a work-related injury or illness.
• Temporary disability benefits: Wage-replacement payments that may apply when an injury temporarily prevents the employee from performing the usual work.
• Permanent disability benefits: Payments that may apply when an injury results in lasting impairment.
• Supplemental job displacement benefits: A potential retraining or skill-enhancement voucher in qualifying cases.
• Death benefits: Benefits that may be payable to qualifying dependents when a work injury or illness results in death.

The availability, duration and amount of any benefit depend on the facts of the claim and applicable law. See Workers’ Comp Benefits for a broader overview.

Work status, restrictions and return-to-work communication

Work status is ordinarily documented through medical reports. The employer considers whether regular, modified or alternative work is available, while the claims administrator uses the reports to administer the claim.

Information that may need to be communicated includes:

• The employee’s usual job duties
• The physical or other demands of the position
• Work restrictions stated in the medical report
• The duration of stated restrictions
• Modified or alternative duties the employer may have available
• Changes in work status stated in later reports

Employees, employers, medical providers and claims administrators should use the written reports and applicable claim process rather than relying on assumptions about an employee’s work capacity.

What to do when a claim is delayed, denied or disputed

Do not ignore a claim-status letter, benefit notice, medical decision or request for information. Read the document and identify:

• The decision that was made
• The person or organization that made it
• The stated reason for the decision
• The date of the notice
• Any response procedure or deadline described in the notice
• The contact information for questions

A worker may contact the claims administrator to clarify missing information or attempt to resolve an administrative problem. A union representative may help identify applicable collectively bargained resources.

Claims covered by an ADR Program

Contact the Office of the Ombudsman when the issue concerns Program coverage, delayed communication, the medical-provider or evaluation process, missing benefits information or the appropriate dispute-resolution stage. The Program may use informal resolution, mediation or arbitration instead of an ordinary WCAB procedure.

Claims handled in the ordinary California state system

The California DWC Information and Assistance Unit provides information to injured workers and other participants about California workers’ compensation rights, benefits, forms and procedures.

A person who wants legal advice concerning a deadline, denial, settlement or other individual issue may consult an attorney licensed to practice in the applicable jurisdiction. This webpage does not determine whether representation is necessary.

Workers’ compensation records worth keeping

A complete and organized claim record makes it easier for all participants to identify what has occurred. Records may include:

• The completed DWC 1 and dated employer copy
• Employer accident or incident reports
• The claim number
• The claims administrator’s name and contact information
• Acceptance, delay, denial and benefit notices
• Medical appointment information
• Medical work-status and restriction reports
• Wage statements or earnings information requested for the claim
• Medical-mileage records and receipts
• Letters, emails and portal messages
• Names of people contacted and dates of conversations
• Union, collective bargaining and ADR Program materials
• Copies of forms submitted through the Program or state system

Record facts as accurately as possible. When an exact date or detail is not known, identify it as approximate rather than presenting an estimate as certain.

Frequently asked questions after a California work injury

Official California workers’ compensation resources

• California DWC: I Was Injured at Work — the state’s principal injured-worker information page.
• Workers’ Compensation Claim Form, DWC 1 — the official employee claim form and notice of potential eligibility.
• Workers’ Compensation in California: A Guidebook for Injured Workers — the DWC’s detailed guide to the California system.
• DWC Information and Assistance Unit — state information, workshops, forms and assistance.
• DWC Claims Process Flowchart — a visual outline of the ordinary state claims process.
• DWC Fact Sheets and Guides for Injured Workers — guides concerning benefits, medical disputes, forms and terminology.