California Workers' Compensation Clearance Document
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FAQ
Following the Workers' Comp Claim Process Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.
Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.
DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers' compensation benefits and the Medical Provider Network (MPN) in California.
A clearance letter is a document that contains information about your clean criminal record. These letters are sometimes needed when applying for a visa, other travel purposes, or when adopting a child.
Public Records Act requests for DWC-maintained documents that are not directly related to a specific workers' compensation case may be obtained by contacting DWC's Statewide Public Records Coordinator by mail at P.O. Box 420603, San Francisco, CA 94142, by phone at (866) 681-1459, by fax at (510) 286-0671, or by e-mail
A clearance letter indicates if a contractor has their own coverage or would need to be covered as your worker. If the contractor has their own coverage, the letter clears you of responsibility by notifying you if the contractor has paid their WCB premiums.
Most courteously, I would like to inform you that my name is (name) and I have been working in (department) of your reputed company as (designation) since (duration). I would most humbly inform you that this letter is to request you to issue a clearance certificate in my name.
Division of Workers' Compensation (DWC)
A Clearance Certificate, also called a Transfer Certificate, serves as a record of your health insurance cover. The certificate confirms the following details: Type of cover (e.g. hospital, general treatment, combined. Level of cover.
Period of Validity. The C O C is valid for five years.
