Get Ca Dwc-au-906 2021-2025

The CA DWC-AU-906 is an important form used for submitting complaints related to workers' compensation issues. This guide provides step-by-step instructions to help you fill out the form accurately and efficiently.

Follow the steps to document your complaint effectively.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by entering the claims administrator or company name in the designated field.
3. Next, fill in the injured worker's name. Ensure you provide the full legal name as it appears in official documents.
4. Provide the claims administrator’s address, including street, city, state, and zip code. Remember to avoid using a P.O. Box.
5. Enter the claim number accurately in the specified field to ensure processing.
6. Input the date of injury and the date or period of violations, ensuring the format is consistent.
7. Name the employer involved in the complaint in the appropriate section.
8. In the 'Specific details of complaint' section, describe the nature of your complaint with clarity and detail. Include specifics such as late payments, denied claims, or other pertinent information.
9. Attach any supporting documentation that may bolster your complaint. This could include payment records or communication with the claims administrator.
10. Complete the complainant section by providing your name, title, address, city, state, and zip code.
11. Finally, include the date of submission and your email address for confirmation.
12. Once you have filled out all relevant fields, ensure to review for any errors before saving changes. You can download, print, or share the form as needed.

Start completing your CA DWC-AU-906 online to ensure your complaint is heard.