The 1st thing that a California investigator needs…

Welcome to the first installment of the California Worker's Compensation Blog Series for claims investigators and worker's compensation claims professionals,

" The 9 Things An Investigator Needs From Their Claims Adjuster "

The first thing an investigator needs to obtain from their claims adjuster or the employer if not available from the claims adjuster is the injured claimant's worker's compensation claim form or (DWC - 1) & Notice of Potential Eligibility .

DWC-1 (Click Here to View and/or Save Form for Reference)

California Labor Code Section 5401(a) states as follows:

"Within one working day of receiving notice or knowledge of injury under Section 5400 or 5402, which injury results in lost time beyond the employee's work shift at the time of injury or which results in medical treatment beyond first aid, the employer shall provide, personally or by first-class mail, a claim form and a notice of potential eligibility for benefits under this division to the injured employee, or in the case of death, to his or her dependents."

Labor  Code Section 5402(a) states that "(a) Knowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400."

The California Worker's Compensation Claim Form (DWC-1) is the cornerstone form of the California Worker's Compensation System.  The filing of this form is meant to start the process into determining whether a claimant's claim for benefits will be accepted.  The provision of the claim form by the employer to a suspected injured worker and that injured worker's submission of that completed claim form to the employee begins the 90 day period in which the claims administrator has the opportunity to investigate the facts of the claim and make a determination whether to accept a claim or deny a claim in whole or in part.

The claim form (DWC-1) can provide the introductory information into the nature of the claim being made by the claimant or injured worker.  The claim form package including the notice of potential eligibility is divided basically into three sections.  The first section is the Notice of Potential Eligibility.  The notice of potential eligibility contains information in English & Spanish addressed to the injured worker regarding their rights and responsibilities under California Worker's Compensation law and describes benefits that the injured worker may be eligible for.  The second section is the employee’s section of the actual claim form, sections 1 through 8.  This section is only to be completed only by the employee or their authorized representative.  The third and final section is the employer’s section, sections 9-18.  The employer is to complete this section only after the employee has completed sections 1 through 8.  The employer is then to return a fully completed document copy to the injured worker and then also provide a copy to the employer's claims administrator.

It is imperative for the investigator and claims adjuster to verify the information contained in the Employee's Claim Form to make sure it is correct.  I recommend that an investigator and/or claims adjuster discuss the contents of the form with the persons who completed the form to verify the forms accuracy.  I also recommend that if a recorded statement is being taken of the claimant, that the claimant acknowledge on the recording what parts of the form that they completed and to acknowledge in the negative or affirmative that they read and understand the document inclusive of the Notice of Potential Eligibility Language.  Furthermore, I also make it a habit to have the claimant acknowledge the anti-Fraud statement which states as follows:

“Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony”.


This may elicit a guilty conscience for those claimant’s who may be misrepresenting their claims in whole or in part and may cause them to rethink the filing of their claim.


Join me next week for the next installment in this series to find out the 2nd thing you need prior to starting your investigation.


Until then,


Ryan D. Clock, The Precision Detective