What is the primary purpose of the DWC-1 form?

• A. Death notification
• B. Employee claim submission
• C. Medical billing submission
• D. Wage payment request

Answer: (B)

The main purpose of the DWC-1 form is to serve as the employee’s claim for workers’ compensation benefits. It is the official document the employee uses to notify the workers’ compensation system about a work-related injury or illness and to request benefits. By completing it, the employee provides essential details—what happened, when, how it affects their ability to work, employer information, and chosen medical provider—which starts the claim process with the employer/insurer and the Division of Workers’ Compensation, including medical treatment authorization and potential disability benefits.

This form is not used for death notifications, medical billing submissions, or wage payment requests. Those are handled separately within the workers’ comp process.