Delaware Workers' Compensation Acknowledgment Form

State:
Multi-State
Control #:
US-537EM
Format:
Word; 
Rich Text
Instant download

Description

This is an acknowledgement form regarding workers' compensation. The form states that the employee has read and understands the workers' compensation guidelines.

How to fill out Workers' Compensation Acknowledgment Form?

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FAQ

Your employer is required to give you the DWC1 form within one business day of your injury notification. You are then expected to complete the DWC1 form within one business day after you receive it. Sections one through nine of the DWC1 form should be completed by the injured employee.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

Workers' compensation provides medical expenses, lost wages, and rehabilitation costs to employees who are injured or become ill in the course and scope of their job. It also pays death benefits to families of employees who are killed on the job.

In Delaware, temporary total disability is 662154% of the employee's gross weekly wages at the time of the injury, up to a maximum set by the state. Effective July 1, 2020, the weekly maximum in Delaware is $747.66.

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

Filling out a DWC-1 form is actually pretty straightforward....On the form, you will need to only fill out the Employee section, which asks for basic information:Name, date, and address.Date and location of injury.Brief description of injury.List of injured body parts.Social Security Number.

These benefits are usually paid every two weeks at the following rates for as long as you are unable to return to your regular job. The calculation works like this: 75% of your net earnings loss for up to 26 weeks after your injury occurs. After 26 weeks the TERB increases to 85% of your net earnings loss.

DWC-1 Workers Compensation Claim Form. This is the form you will complete and send to EMPLOYERS to initiate the claim process for your employee. This form must be completed and provided to EMPLOYERS within one working day from you becoming aware of a work-related injury or occupational disease.

Workers' compensation benefits are broadIf an employee is completely out of work, the benefit is 662154% of the employee's gross weekly wages. If an employee is receiving reduced wages, the benefit is 2154 of the difference between the employee's pre-injury wage and post-injury wage.

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Delaware Workers' Compensation Acknowledgment Form