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Workers' Compensation Attorney Scot D. Shoemaker

Workers' compensation news, insights, and information for San Francisco Bay Area residents.

What Forms are Needed to File a Workers’ Compensation Claim?

what forms are needed to file a workers compensation claim californiaThere are specific forms that must be filed if you wish to file a workers’ compensation claim in California. While you may file on your own, you also have the option of having a qualified workers’ compensation lawyer file on your behalf at no cost to you. There are many attorneys in the San Francisco Bay Area who can help you. They get paid once there is an award. If there isn’t an award, then you pay nothing. Attorney Scot Shoemaker, in San Francisco, California, has over 2 decades of experience fighting for hard-working Northern California employees. He is among a select few attorneys recognized as a workers’ compensation certified specialist from the State Bar of California. To speak with Attorney Shoemaker about your specific claim, call (415) 463-5310 today.

 

DWC-1 Claim Form

The form DWC-1, Workers’ Compensation Claim Form and Notice of Potential Eligibility, is the workers’ compensation claim form. It asks for a description of your injury, along with your name, address and the time, date, and location of your work-related injury. Instructions for filling out the claim form can be found on the form itself. Be sure to be very specific about your injury. You submit this form to your employer, and your employer is required to submit the form to the employers workers’ compensation insurance company.

Application for Adjudication of Claim Form

In order to complete your official filing of your workers’ comp claim, you are required to file this the form WCAB Form 1, Application for Adjudication of Claim, with the Workers’ Compensation Appeals Board (WCAB). You will need to know the name of your employer’s insurance company in order to fill out this form. You can file this form personally at the WCAB district office, or by serving it to the WCAB (sending it by mail with a proof or service form).

Declaration Pursuant to Labor Code 4906(g)

The Declaration Pursuant to Labor Code 4906(g) must be submitted when you submit an Application for Adjudication of Claim, above. In this DWC form, you swear that you haven’t asked a hospital, medical facility, or a doctor to submit any fraudulent information to the DWC.

Document Separator Sheets

Place a Document Separator Sheet, available at the DWC website, after each form in your package.

Document Cover Sheet

Include one Document Cover Sheet, available at the DWC website, for the package of forms that you’re filing.

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  • Certified Specialist From the State Bar of California +

    Scot Shoemaker is one of a select few attorneys recognized as a workers' compensation certified specialist from the State Bar Read More
  • 100% Focused on Workers' Compensation Legal Matters +

    Our law firm is totally focused on legal matters related to workers' compensation. You will get our full attention, and Read More
  • Over 20 Years Experience +

    Attorney Scot Shoemaker has over 20 years experience helping Northern California residents like you with workers' compensation legal matters. Read More
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