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California Workers' Compensation Claim Form
SKU: FED2170 |   E-mail this product to a friend
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Product Description



California Workers’ Compensation Claim Form

Worker’s Compensation is a federal institution that is governed at the state level. According to worker’s compensation laws, employers are required to provide employees with benefits in the event that they become injured or become ill as a result of their occupation. All employers in the state of California are required to provide Worker’s Compensation for their employees (even if they only have one employee) and waivers are not accepted.

Requirements for Employers
Employers are required to post information about the Worker’s Compensation program in the workplace in a visible place that is accessible to all employees. Employers are also required to provide employees with the Worker’s Compensation form so that they can file a claim.

Employees are covered for all of the above benefits. However, they have to notify the employer of the injury, illness, disability, or other condition in order to receive their benefits. This Worker’s Compensation form is designed to comply with Worker’s Compensation laws and allow employees to communicate the nature of their claims with the employer.

Worker’s Compensation Form
This Worker’s Compensation form contains all of the necessary fields for employees to provide information to their employers in order to file a Worker’s Compensation claim. Both the employee and the employer are required to complete portions of this form and submit it to the California Department of Industrial Relations Division of Workers’ Compensation (DWC).

This form is bilingual in Spanish and English.
 
 

Product Specifications:

  • This form is 8.5" x 11"
  • 50 Sheets/Package

 
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