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MM/DD/YYYY) (End Date: MM/DD/YYYY) (If Specific Injury, use the start date as the specific date of injury) Body Part 1: Body Part 3: Body Part 2: Body Part 4: Other Body Parts: Specific Injury Case Number 14 Cumulative Injury (Start Date: MM/DD/YYYY) (End Date: MM/DD/YYYY) (If Specific Injury, use the start date as the specific date of injury) Body Part 1: Body Part 3: Body Part 2: Body Part 4: Other Body Parts: DWC-CA form 10232.1 Rev. 10/2008- Page 5 of 8 Specific Injury Ca.

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Division of Workers' Compensation (DWC)

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

Your employer should fill out the “employer” section and forward the completed claim form to the insurance company. You should receive a copy of the completed claim form from your employer. If you don't, request a copy and keep it for your records.

California Workers' Compensation Insurance Forms CA 130 Workers' Compensation Application. ... California Employer Fact Sheet for Employers. ... California Application for Exclusion of Officers and Stockholders. ... CA Affidavit of Exemption for Workers' Compensation Insurance. ... CA First Report of Injury Form.

A sheet that separates batches (before they are scanned), documents, or sub-documents. Separators usually contain barcodes, which are extracted and used during processing.

The CA-1 form is used if the employee has sustained a Traumatic Injury on the job. Traumatic Injury - A wound or other condition of the body caused by external force, including stress or strain.

A request to inspect and/or obtain copies of disclosable public records maintained by the Office of the Commissioners of the WCAB may be made by e-mail. E-mail requests should be sent to WCABReconPRA@dir.ca.gov.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232