Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 6. Claim Form: Availability, Filing, Acknowledgement of Receipt, Dismissal

New query
§10118. Form.

DWC Form 1, Employee's Claim For Workers' Compensation Benefits Adobe Acrobat PDF Format (.pdf format, 89K)

HISTORY

1. New section filed 1-18-90 (Register 90, No. 4). New section is exempt from review by OAL pursuant to Government Code section 11351.

2. Amendment making editorial correction to the Spanish version of form filed 6-12-91 (Register 91, No. 34). Exempt from review by OAL pursuant to Government Code section 11351.

3. Repealer and new section filed 4-13-93; operative 4-13-93. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 16).

4. Repealer and new section filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).

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The above information is provided free of charge by the Department of Industrial Relations from its web site at www.dir.ca.gov.