State Revises DWC-1 Claim Form and Notice of Potential Eligibility

The State Office of Administrative Law (OAL) has approved final revisions to the California Workers’ Compensation Claim Form (DWC-1) and Notice of Potential Eligibility (CCR §§ 10117.1 – 10118.1), incorporating changes from SB 899 as well as earlier workers’ compensation reforms.

The effective date for the new claim form is August 1, 2004, and the Division of Workers’ Compensation plans to release a limited supply of paper proofs to the Employment Development Department and Information and Assistance Unit Offices so single copies can be distributed to individual claimants. However, because state lawmakers have yet to pass the budget, DWC is unable to get the new form printed by the Office of State Printing – a process that will take 7-10 days once the budget is approved.

DWC also plans to post a copy of the new DWC-1 on its website, but the revised form will still need to be reproduced as a 5-part form, as the first page will be the new Notice of Potential Eligibility, followed by four copies of the claim form (one as an employee temporary receipt, and one each for the employer, claims administrator and the employee’s final copy signed and dated by the employer). Recently proposed audit regulations [CCR §10111.2 (b)(25)] would imposed a new $100 penalty for each failure to provide the correct claim form, so the Institute has requested that the state allow a reasonable grace period to provide adequate time for the form to be produced and distributed. The Division has indicated it expects to approve a 60-day grace period, which would make the effective date October 1, 2004.

To help meet the demand for the new form, the Institute has added the revised DWC-1 to our publications list along with the state-mandated employee pamphlets and posting notices, which were updated earlier this month with SB 899 changes. Last week the Institute began production on the 5-part form using NCR (carbon) paper, and we expect to have a supply available for shipment within three weeks. The forms will be shrink wrapped in sets of 100, which is the minimum order, with significant savings available on bulk orders. To order, click here for the DWC-1 form in our store.