"Compromise and Release (Dependency Claim) for Workers' Compensation" is a official California Workers Compensation form.
California Compromise And Release Form
State:
California
Control #:
CA-WCAB-16-WC
Format:
PDF
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Description
How to fill out California Compromise And Release Form?
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FAQ
Filling out a DWC-1 form is actually pretty straightforward....On the form, you will need to only fill out the Employee section, which asks for basic information:Name, date, and address.Date and location of injury.Brief description of injury.List of injured body parts.Social Security Number.
In addition, if the applicant (employee) has been injured by a third party, both the workers' compensation claim and the third party claim may be settled by means of what is called a "Third Party Compromise and Release." The filing of a Compromise and Release may be deemed the filing of an application.
In California, the parties have a right to negotiate a Compromise and Release to resolve their claim. These settlements are often effective for both parties. In fact, most workers' compensation claims are now settled through C&Rs. It is important to note that these agreements must be approved by a judge.
1.4 Is the compromise and release settlement taxable? Workers' compensation benefits are not taxable. This includes payments an injured worker receives in a Compromise and Release workers' compensation settlement.
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.
More info
CT. Continuing Trauma Injury (Gradual onset of injury, not specific incident). CTS. DWC-CA form 10214 (e) (PAGE 1) (REV.Typically, when you agree to settle your case with a Compromise and Release, you are agreeing to a full and final settlement.