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Workers' Compensation Board, copies to workers' compensation insurer, claimant and claimant's representative. Prior to award of workers' compensation benefits. Carriers and Board-approved Self-Insurers may contact the Board's Forms Department to obtain this form.
If you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to workers’ compensation benefits. Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below.
If you have trouble opening a form: (1) download/save the form onto your computer, (2) open Adobe Reader, (3) open the saved file. If you still have trouble with the form, please email the Board's Forms Department .
File a claim form to protect your rights and start the workers’ compensation process. Your employer must give or mail you a claim form within one working day after learning about your injury or illness.
14 wrz 2022 · Learn how to get workers’ comp benefits for an injury at work in California. Learn how to file a claim, what forms you must submit, & deadlines you must meet.
When injured workers have problems with their claims, they may need to go to the local workers' compensation office for help. Each of the guides below provides information on how to fill out a form they may need to get the problem resolved. Most have samples attached.
Here are the five steps for filing for workers’ comp benefits in California. Notify your employer about your occupational injury within 30 days of the accident. Seek medical treatment from an approved provider in your employer’s workers’ comp insurance network.
