Menu
Call
Contact
Blog
  • Facebook
  • Twitter
  • LinkedIn
  • Youtube

Call for Free Consultation

Toll Free 866-769-0123

866-769-0123
Menu
Kaire & Heffernan
  • Facebook
  • Twitter
  • LinkedIn
  • Youtube
  • Firm Overview
    • Mark Kaire
    • David R. Heffernan
  • Practice Areas
    • Bicycle Accidents
    • Birth Injury
    • Construction Accident
    • Car Accidents
      • How Safe Is Your Miami Route?
    • Medical Malpractice
    • Motorcycle Accidents
    • Motel and Hotel Accidents
    • Negligent Security
    • Nursing Home Abuse
    • Pedestrian Accidents
    • Personal Injury
    • Premises Liability
    • Retinal Detachment
    • Spinal Cord Injury
    • Stroke Malpractice
    • Truck Accidents
    • Traumatic Brain Injury
    • Uber and Lyft Accidents
    • Workers Compensation
    • Wrongful Death
  • Results
  • Testimonials
  • Media
  • Safety Reports
    • Aventura Hospital
    • Baptist Hospital of Miami
    • Doctors Hospital
    • Kendall Regional Medical Center
    • Mount Sinai Medical Center
    • North Shore Medical Center
    • Palmetto General Hospital
    • South Miami Hospital
    • University of Miami Hospital
  • Video FAQ
  • Blog
  • Español
  • Contact Us
  • Menu Menu
  • American Board of Trail Advocates
  • Best Lawyers
  • 9.6David Roy Heffernan
  • David R. Heffernan
    Rated by Super Lawyers


    loading ...
  • Million Dollar Advocates Form
  • Multi-Million Dollar Advocates Form
  • Florida Legal Elite
  • Top 100 Trial Lawyers
  • Top 100 Personal Injury Attorneys
left arrow right arrow

Workers’ Compensation DWC Form #1

July 10, 2018/in Workers Compensation /by Mark Kaire

This form is used to initially report an injury or illness that occurred during the course and scope of employment to the Department of Financial Services Division of Workers’ Compensation. The document asks for all pertinent and relevant details for the individual who was injured. The form is to be completed in print or typed for ease of legibility. If, at any point, assistance is needed to complete, or any questions are had regarding the completing of this form, you should  contact your local EAO office or call the toll-free number provided on the form, 1-800-342-1741.

You don’t need to fill out the top portion of the file; only the department’s personnel fills out that section.

Employee Information

Along with the employee’s contact information, the form asks for the disclosure of the employee’s social security number. Giving the department the social security number allows them to process the employee through the regulated systems according to Florida state Laws when making a workers’ compensation claim.

Description of the Accident – Write a detailed description of the accident or illness. Outline from beginning to end what happened. To be sure that the entire accident is captured from beginning to end, describe your steps leading up the accident, what happened during the accident, and what happened immediately after the accident occurred.

Injury/Illness that Occurred – This information can be taken from the medical records diagnoses section. Usually, the physician will put a medical code alongside the name of the injury or illness.

Part of the Body Affected – Be sure to also be specific when stating which body part was affected. For example, instead of saying knee, state which knee was affected.

Employer Information

Be sure to list the information as clearly and specifically as you possibly can as you want to be sure that the department investigates the proper employer and can get to the right department within your employer’s company to not further delay your claim.

Complete by signing the form to certify that you have read and completed the form with information that is true and correct. The employer will also sign this document. Once both parties have signed, this document will be forward to the department with a wage statement (DWC-1a). The wage statement is a form that details your wages. This document is to be completed by the employer.

This form is essential to the claim. Without this form being properly executed and attached to DWC-1, the worker’s compensation claim be suspended until the error is rectified with the completed document.

 

Mark Kaire

Mark Kaire has been practicing law in Miami for nearly 15 years. He is dedicated to helping the injured people of Miami receive compensation. Mr. Kaire has been blogging on Miami’s legal issues for 4 years.

Share this entry
  • Share on WhatsApp

Do you have a case?

Get your question answered

Recent Posts

  • Miami Bicycle Accident Lawyer
  • Miami Nursing Home Negligence Lawyer
  • (no title)
  • Safety Tips During Holiday Shopping
  • Miami Surgical Malpractice Lawyer

Categories

  • Bike Accidents
  • Birth Injury
  • Car Accidents
  • Construction Accidents
  • Medical Malpractice
  • Negligent Security
  • News
  • Nursing Home Abuse
  • Personal Injury
  • Workers Compensation

How can we help?

Do you have a case?

Get your question answered
 

Kaire & Heffernan, LLC

999 Brickell Ave, PH 1102
Miami, FL 33131
Phone: 305-372-0123  
KaireHeffernan_map
  • Firm Overview
  • Practice Areas
  • Results
  • Testimonials
  • Video FAQ
  • Blog
  • Español
  • Contact Us
Copyright © 1999 - 2021. Kaire & Heffernan - All Rights Reserved. | Sitemap | Disclaimer
 
Workers’ Compensation Statute of Limitations Florida Workers’ Compensation Employees Earning Report DWC Form #19