How to fill out the Subrogation Workers Compensation Accident Form? A DWC1 form (Employee's Claim for Workers' Compensation Benefits) is to be given to the employee within 24 hours of the initial report.3.3. Workers' Compensation and Employer's Liability Coverage. The insurer shall agree to waive all rights of subrogation against the Town, its officials,. Subrogation is a Workers' Compensation insurance company's right to legally pursue a third party that caused an insurance loss to the employer. 1. Individuals who have experienced an accident must report their details. Attachments. A. Definitions. B. Service Levels of Agency Facilities. Orange County will receive sealed proposals (Bid 367-OC5399-R) in the office of Orange County Finance and. "At the current time ACCA is in the process of settling its case against Otis Elevator Company for the workers' compensation benefits paid on your behalf.