Get Workers' Compensation Claim Form (dwc 1) & Notice Of ... - Hanover

Filling out the Workers' Compensation Claim Form (DWC 1) is a crucial step if you have been injured or become ill due to your job. This guide will provide you with easy-to-follow instructions to ensure your claim is submitted accurately and efficiently.

Follow the steps to complete your claim form effectively.

1. Click ‘Get Form’ button to obtain the Workers' Compensation Claim Form (DWC 1) and open it in a suitable editor for completion.
2. In the 'Employee' section, provide your personal information, including your name, home address, city, state, zip code, and social security number. Thoroughly describe your injury, the part of your body affected, and the address where the injury occurred. Specify the date and time of the injury.
3. If you prefer to receive notices about your claim via email, check the appropriate box and enter your email address. Otherwise, you will receive notifications by regular mail.
4. Sign the form to confirm the accuracy of the information you have provided. Keep a copy for your records as the 'Employee’s Temporary Receipt' until you receive a signed and dated copy from your employer.
5. Submit the form to your employer immediately. Within one working day, your employer must complete the 'Employer' section, date it, and provide copies to you and the claims administrator.
6. After reviewing the form, your employer will need to retain one copy and send the completed form to the claims administrator. Monitor your claim's progress and keep records of all interactions.
7. Finally, once your claim is underway, ensure you follow up on medical care approvals and any correspondence regarding your claim. You may also consider saving, downloading, printing, or sharing the form if necessary.

Complete your Workers' Compensation Claim Form online today to initiate your claim process.