DWC form walkthrough

The DWC-1 Notice of Potential Eligibility, explained

By the CalCompGuide editorial team · Last updated November 2026 · How we write and check guides

What each section means

Medical care

The claims administrator pays for reasonable and necessary treatment, directly, so you shouldn't see a bill. There are visit limits on chiropractic, physical therapy and occupational therapy. Within one working day after you file, up to $10,000 in treatment must be authorized while the claim is pending. If treatment isn't authorized, the notice tells you to use your own health insurance, which can seek reimbursement later. See choosing a doctor.

Primary treating physician, MPNs and HCOs

Explains who chooses your doctor: your predesignated physician, an MPN or HCO doctor, or the claims administrator for the first 30 days, and when you can switch.

Disputes about medical care and QME/AME

Explains that disagreements with your doctor's findings can go to a qualified or agreed medical evaluator. See QME and AME.

Temporary disability (lost wages)

Two-thirds of your average weekly pay within state limits, tax-free; not paid for the first three days unless you're hospitalized overnight or off more than 14 days. See the TD calculator.

Stay at work or return to work

Encourages you and your employer to talk about modified work.

Permanent disability

Additional payments if you don't completely recover, depending on the injury, impairment, age, occupation and wages. See PD explained.

Supplemental job displacement benefit

A voucher for retraining if you have permanent disability and no regular, modified or alternative work is offered. For injuries since 2013 it's $6,000.

Death benefits

Payments to a spouse, children or other dependents if the injury causes death.

Discrimination, fraud and contacts

It's illegal to punish you for filing a claim (LC §132a). False statements to get or deny benefits are a felony. The notice lists the DWC's information line, 1-800-736-7401.

Keep it with your records

Put the notice in your claim folder with your dated DWC-1 copy and every letter from the claims administrator.

We link to the official form on dir.ca.gov rather than hosting a copy, so you always get the current version.