Workers’ Compensation Claim

You must report a workers’ compensation claim to your carrier yourself – Leavitt United cannot do it for you. If your employee had a work accident but does not need or want medical care, they should fill out a Declination of Medical Treatment form.

If your employee needs medical care, you MUST give them access to a doctor and the DWC-1 Form (Employee’s Claim for Workers’ Compensation Benefits) within a day of knowing about the injury.

NOTE: The DWC-1 form is only for California. Other States may have different forms.

DWC-1 Form (California)

Report a claim

Below is a list of Leavitt United’s workers’ compensation carriers and claims administrators. To report a claim, please select your carrier or administrator and follow the online reporting instructions.

Carrier reporting information