Overview
Wrapbook provides workers’ compensation coverage for eligible employees and loan-out workers who are onboarded and paid through Wrapbook on projects with approved workers’ compensation coverage.
🚨 If there is a true emergency, call 911 and seek immediate medical care first.
Do not delay treatment to complete paperwork. After the emergency has been addressed, follow the instructions below.
To report a new workplace injury, first make sure the injured worker is fully onboarded in Wrapbook. Wrapbook must be able to confirm the worker’s information before the claim can be submitted to the claims administrator.
✍️ How to complete forms available on this page
The forms below are organized by scenario. Start with the section that matches the worker’s situation, then open only the forms listed there. Some forms may apply to more than one scenario, so follow the instructions in the relevant scenario section.
No medical treatment: Open the Injured Worker Statement and Declination of Medical Treatment forms
Medical treatment: Open the Injured Worker Statement, then the Supervisor Statement and Witness Statement, if applicable
California: Also review the California forms when the injury occurred in California
Documents to provide or reference: These documents are informational and separate from the forms you need to complete. Click the document links to download a copy to your computer.
Tools to help you complete the forms
Click the arrow next to a form name to open the PDF in the embedded viewer
You can enter the requested information directly in the form
If the form is difficult to read, use the viewer’s + zoom control to increase it to 100% or another comfortable size
Signatures must be handwritten using the viewer’s freehand-signing tool, or print the form, sign it with a pen, and save a scanned or photographed PDF copy to your computer
Select Download to save the completed and signed PDF to your computer
The form must be signed before you submit it. If the worker needs medical treatment, upload the completed and signed PDFs in the Attachments section of the Workers’ Compensation claim submission. If the worker does not need medical treatment, follow the no-treatment submission instructions below.
🩹 If the worker does not need medical treatment
Use this scenario when the worker does not require or seek medical treatment. Do not submit an incident-only claim through the Workers’ Compensation claim submission form when the worker declines treatment.
If the worker does not need or seek medical treatment, complete and sign the applicable forms, then email the signed PDFs to workerscompclaims@wrapbook.com within 24 hours.
Forms to complete
Complete and sign the forms below. The instructions above explain how to open, fill out, sign, and save each PDF. For this scenario, follow the no-treatment submission instructions below after the forms are signed.
Injured Worker Statement
Complete the form with the worker’s account of the workplace injury and have the worker sign it.
Declination of Medical Treatment
Complete and sign the form when the worker declines medical treatment.
California forms
If the injury occurred in California, provide the applicable California forms to the worker and complete the receipt process described in If the claim is in California below.
No-treatment submission
After the applicable forms are complete and signed, send them to workerscompclaims@wrapbook.com within 24 hours, subject to final Workers’ Comp confirmation of the approved routing process. Retain copies for your records.
If the worker later seeks medical treatment, contact the Workers’ Comp team so the appropriate claim process can begin.
🏥 If the worker needs or receives medical treatment
Use this scenario when the worker needs or receives medical treatment. Seek medical care first when needed, then submit the claim
Complete and sign the applicable forms, including the DWC-1, DWC-7, MPN Notice, and receipt when required for a California injury. Submit the completed and signed PDFs within 24 hours through Wrapbook’s Workers’ Compensation claim submission form. Upload the forms in Attachments, along with medical records, photos, witness statements, and other supporting documents.
Forms to complete
Complete and sign the Injured Worker Statement above. Then complete the forms below that apply to the injury.
Supervisor Statement
Complete the form with the supervisor’s account of the workplace injury.
Witness Statement
Complete this form when someone witnessed the workplace injury or has relevant information about what happened.
Medical-treatment submission
Complete and sign the applicable forms, then open the Wrapbook’s Workers’ Compensation claim submission page and upload the forms in the Attachments section. You can also upload medical records, photos, witness statements, and other supporting documents.
Documents to provide or reference
If a worker receives medical care, provide the applicable documents below to the worker. Unlike the other forms in this section, these documents are for reference only. They don’t need to be completed or submitted to Wrapbook.
Medical Provider Billing Information
Provide the information to the urgent care center, doctor, or other medical provider so they have the appropriate workers’ compensation billing information
Use this for prescription medication when applicable
EK Health MPN Portal Instructions
Use this to find participating medical providers when applicable
Use mySedgwick after the claim has been filed to access claim information. It is not required for the initial claim submission.
📍 If the claim is in California
If the worker needs or receives medical treatment, use the medical-treatment forms and submit the completed documents within 24 hours. For California injuries, also complete the DWC-1, DWC-7, MPN Notice, and receipt before submitting the claim.
DWC-1 Claim Form
Provide the current form to the worker and have the worker complete and sign the employee section as instructed on the form.
This form is for the worker to complete, you do not need to fill out the form below
You can use the viewer below to download/print the form so it can be shared with the worker
DWC-7 Notice to Employees
Provide the current notice to the worker.
MPN Notification
Provide the current Medical Provider Network notification to the worker.
Receipt of DWC-1, DWC-7, and MPN
Have the worker review and sign the receipt after receiving the applicable California forms.
💬 When to contact the Workers’ Comp team
Contact the Workers’ Comp team at workerscompclaims@wrapbook.com for:
Questions or issues about an existing claim
Claim status questions
Medical billing or provider issues
Non-standard or edge-case situations
Help after you have already tried to submit a new claim through the form
Do not submit a duplicate new-claim form for an existing claim or claim-status question.
❓ Frequently Asked Questions
What should I do if the worker is seriously injured?
Call 911 and seek immediate medical care. Do not delay treatment to complete paperwork. After the emergency has been addressed, follow the appropriate claim-submission scenario described above.
Does the worker need to be onboarded before I submit a claim?
Yes. The injured worker must be fully onboarded in Wrapbook so Wrapbook can confirm the worker’s information before submitting the claim to the claims administrator.
Which forms should I complete if the worker did not receive medical treatment?
Complete the Injured Worker Statement and Declination of Medical Treatment forms. If the injury occurred in California, provide the applicable California forms and complete the receipt process. Follow the no-treatment submission instructions in the section above instead of submitting an incident-only claim.
Which forms should I complete if the worker received medical treatment?
Complete the Injured Worker Statement, Supervisor Statement, and Witness Statement, if applicable. For California claims, provide the additional state forms described above. Upload the completed and signed forms through the Workers’ Compensation claim submission.
What if I have already submitted a claim or need an update?
Email Wrapbook’s Workers’ Comp Team at workerscompclaims@wrapbook.com for questions about an existing claim, claim status, medical billing or provider issues, or other non-standard situations.
What if I need help with the submission form?
If you have already tried the submission form and need assistance, email Wrapbook’s Workers’ Comp Team at workerscompclaims@wrapbook.com and explain what happened. Include the production, project, injured worker, and any submission details that may help the team locate or complete the intake.