Filing a Claim
File a claim form (DWC-1) to protect your rights and start the workers’ compensation process. If your injury results in losing time from work or in medical treatment beyond first aid, your employer must give or mail you a claim form within one working day after learning about your injury or illness. If your employer doesn’t provide you the claim form and Keenan is the Claims Administrator, please contact us and we will provide you the form. Alternatively, you may download the form here or from the forms page of the DWC website. You also have the option of contacting the Information and Assistance Unit with the Division of Workers Compensation.
Fill Out a Claim Form
Complete only the “employee” section of the form. Be sure to sign and date the claim form and keep a copy for your records. Return the claim form to your employer in person or by mail. If you mail the claim form, use certified mail — return receipt requested — so you have a record of the date it was mailed and the date it was received. If you don’t return the completed form to your employer you may risk your right to benefits.
What's Next
Your employer should fill out the “employer” section and forward the completed claim form to their workers’ compensation claims administrator. You should receive a copy of the completed claim form from your employer. If you don’t, request a copy and keep it for your records.
Generally, claims administrators have 14 calendar days to mail you a letter telling you the status of your claim. If you don’t receive this letter, contact your employer's claims administrator to find out the status of your claim. Learn more from the Division of Workers’ Compensation in the guidebook, Chapter 2: After You Get Hurt on the Job.
Designed to address important safety related topics common in a K-12 environment.