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State Fund supports California's entrepreneurial spirit and plays a stabilizing role . Workers' Compensation Claim Form DWC 1 - e3301 »</a></li><li><a workers' compensation benefits. Use the attached form to file a workers' compensation claim with your employer. You should read all of the information below. File a claim form to protect your rights and start the workers' compensation process. Your employer must give or mail you a claim form within one working day Workers Compensation Claim Form & Notice of Potential Eligibility. DWC 1, Rev. Supervisor (Northern California Audit Team), 916-574-0300 lasio@dir.ca.gov NEW California Workers' Compensation Claim Forms and Posting Notice. Click HERE for PDF version. SAN DIEGO, CA, January 7, 2015 - Effective January 1st, 1 Ene 2016 Workers' Compensation Claim Form (DWC 1) & Notice of Potential Eligibility working day after you file the claim form, your employer must Workers' Compensation; Forms Complaint form: Workers' Compensation Judge How to submit an amended application for adjudication of claim, WCAB 1. The Employer's Report of Occupational Injury or Illness (Form 5020). A completed Claim Form (DWC-1) must be filed with the employer by the injured Filing a workers' compensation claim in California requires submitting several forms within a time limit. If an employee suffers a work-related injury or illness, he or she may be entitled to workers' compensation benefits.
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