Labor Code §5401 – The DWC-1 Claim Form

Labor Code §5401 is the law behind the DWC-1 claim form. Your employer must give or mail you a claim form within one working day after learning of a work injury that causes lost time beyond your shift or needs more than first aid. Once you complete the form and file it with your employer, several important clocks start.

The date you file the claim form matters more than most workers realize. It starts your employer’s 90-day window to accept or deny the claim (Labor Code §5402). Within one working day after it, your employer must authorize up to $10,000 in treatment. It also pauses the one-year deadline to file a case (Labor Code §5405). A claim form that sits in your glove box does none of that.

This explainer focuses on the statute: what §5401 requires, who it covers, when a claim form legally counts as “filed,” the disputes that come up, and what to do. For a box-by-box walkthrough of the form itself, see our DWC-1 form guide.

What Labor Code §5401 says

Section 5401 has four subdivisions:

• §5401(a), the employer’s duty to provide the form. Within one working day of receiving notice or knowledge of an injury (under §5400 or §5402), the employer must provide a claim form and a notice of potential eligibility for benefits, personally or by first-class mail. The duty applies when the injury causes lost time beyond the employee’s work shift at the time of injury or requires medical treatment beyond first aid. If the worker died, the form goes to the dependents.
• §5401(b), the notice. The notice and claim form should be a single document where practicable, easy to understand and available in English and Spanish. It must explain, among other things, how to start a claim, the types of benefits, how to get medical care while the claim is pending, the right to choose and change the treating doctor, and protections against discrimination under Labor Code §132a. It must also tell you that you can disagree with decisions about your claim and can consult an attorney.
• §5401(c), filing the form. You (or a dependent or agent) file the completed form with the employer. It is “deemed filed when it is personally delivered to the employer or received by the employer by first-class or certified mail.” The employer must give a dated copy to its insurer and to you.
• §5401(d), why filing matters. The form must be filed before you are entitled to the 10% late-payment increase under §4650(d) and before you request a medical-legal evaluation under §§4060–4062. Filing it also tolls the deadlines in §§5405 and 5406, for injuries on or after January 1, 1994, until the employer denies the claim or it becomes presumed compensable.

Key fact

Who §5401 covers: lost time or more than first aid

The one-working-day duty applies to injuries that cause lost time beyond the shift or need more than first aid. The statute defines “first aid” narrowly:

• First aid is any one-time treatment, plus any follow-up visit to observe minor scratches, cuts, burns, splinters or other minor injuries that ordinarily don’t need medical care.
• It counts as first aid even if a doctor or nurse provides it.
• A “minor industrial injury” does not include serious exposure to a hazardous substance (as defined in Labor Code §6302(i)).

Anything more, such as stitches, a prescription, physical therapy or follow-up care, generally triggers the duty to provide the form. If your employer didn’t give you one, you can get the DWC-1 from the Division of Workers’ Compensation’s forms page, from DWC district offices or from EDD offices.

The form asks for your name and address, Social Security number, the time and address where the injury happened, and the nature of the injury and the body parts affected. Fill out only the employee section.

Watch: injured at work in California

Our attorneys explain what your employer must do after a work injury, and what to do in the first 24 hours to protect your claim.

Deadlines and timeline: when the claim is “filed”

Event	Deadline or effect	Statute
Employer learns of a qualifying injury	Must provide the claim form and notice within 1 working day	LC §5401(a)
You deliver the form in person, or the employer receives it by mail	Claim form “deemed filed”	LC §5401(c)
Filing (for tolling, delivery or mailing counts)	One-year deadlines in §§5405 and 5406 are tolled	LC §5401(d)
1 working day after filing	Employer authorizes treatment, up to $10,000 until accepted or rejected	LC §5402(c)
90 days after filing	Claim presumed compensable if not denied	LC §5402(b)

One detail is easy to miss. For the general filing rule in §5401(c), a mailed form counts when the employer receives it. For tolling under §5401(d), a form counts as filed when it is mailed by first-class or certified mail. That is one reason the DWC recommends certified mail with a return receipt.

💡 Example (hypothetical): Ana, a line cook, cuts her hand on Tuesday, April 14, 2026, and is sent to a clinic for stitches. Stitches go beyond first aid, so her employer must give or mail her a claim form by Wednesday, April 15. She mails the completed form by certified mail on Friday, April 17, and her employer receives it on Monday, April 20. For tolling the one-year deadline, her form counted as filed when she mailed it. Under the general rule in §5401(c), it was filed April 20, the date the employer received it, so the 90-day clock under §5402 generally runs from that date.

Common disputes under §5401

“We never got your claim form.”

Without proof of delivery, it’s your word against the employer’s. Keep a signed or date-stamped copy, a certified-mail receipt or an email confirmation.

The employer never provided a form

Some employers treat injuries as “first aid only” when they aren’t, or simply don’t hand out the form. That doesn’t stop you from filing. It may also be relevant if the employer later argues that you missed a deadline.

Was it really just first aid?

If you needed more than one-time treatment and a follow-up check, the injury is probably beyond first aid under the statute’s definition.

Late payments before the claim form

The 10% self-imposed increase for late disability payments under §4650(d) doesn’t apply until you have filed a claim form. It also doesn’t apply to payments due within 14 days after the form was submitted. Filing early protects that right.

Fear of retaliation

The notice must explain your protection against discrimination under Labor Code §132a. If you were punished for reporting an injury or filing a claim, see our guide to workers’ comp retaliation under §132a.

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What to do after a work injury

1. Report the injury to your supervisor right away. Written notice within 30 days is the rule (Labor Code §5400), but sooner is better.
2. Ask for the claim form. If you don’t get it within one working day, download the DWC-1 yourself.
3. Complete only the employee section. Sign and date it. Keep a copy.
4. Deliver it in person or by certified mail. Get a dated copy back from your employer, as §5401(c) requires.
5. Calendar your dates. Treatment should be authorized within one working day. The 90-day decision date runs from filing (see Labor Code §5402).
6. Watch for the claims administrator’s letter. The DWC says the insurer generally has 14 days to send a letter about the status of your claim.
7. Get help if the claim is delayed or denied. A denial can lead to a medical-legal evaluation. See Labor Code §4060.

By the numbers$10,000

Related Labor Code sections

• §5400: 30-day written notice of injury to the employer.
• §5402: employer knowledge counts as notice; the 90-day presumption; up to $10,000 in treatment.
• §5405: one-year deadline, tolled by filing the claim form. See Labor Code §5405.
• §4650: first TD payment within 14 days, and the 10% late-payment increase. See Labor Code §4650.
• §132a: protection against discrimination for filing a claim.

Once your claim is underway, our workers’ comp calculator can estimate your weekly benefits.

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Frequently asked questions

How soon must my employer give me a DWC-1 claim form?

Within one working day after it receives notice or learns of an injury that causes lost time beyond your shift or needs more than first aid (Labor Code §5401(a)).

When is my claim form considered filed?

When you personally deliver it to your employer, or when your employer receives it by first-class or certified mail. For tolling the filing deadlines, a mailed form counts as filed when it is mailed.

Do I file the DWC-1 with the state?

No. The claim form is filed with your employer, which forwards it to its insurer. A case before a workers’ comp judge starts with a separate document, the Application for Adjudication of Claim.

What if my employer refuses to sign or forward the form?

Your filing date is the date you delivered it, or the date the employer received it by mail. Keep your proof. If the employer won’t cooperate, talk to an attorney or a DWC Information and Assistance officer.

Is there a deadline for me to file the claim form?

You should give written notice within 30 days and file as soon as possible. The main deadline to start a case is one year under Labor Code §5405, and filing the claim form pauses that deadline.

Can I be fired for filing a claim form?

Labor Code §132a prohibits discrimination against workers for filing a workers’ comp claim. The notice that comes with the claim form must explain those protections.

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