California Department of Industrial Relations - Division of Workers' Compensation Forms

122
total templates

Documents

122

DWC Form RFA "Request for Authorization" - California

Rate (4.5 / 5) 46 votes
Size: 108 KB
2 pages

This form is used as a legal document and filled out by a treating physician of an employee with a work-related injury or illness to request authorization of special medical treatment, services, and procedures.

Form I&A9 "How to File a Petition for Commutation" - California

Rate (4.3 / 5) 14 votes
Size: 1 MB
10 pages

Form I&A7 "How to File a Petition for Discrimination (Labor Code Section 132a)" - California

Rate (4.8 / 5) 20 votes
Size: 1 MB
11 pages

Formulario DWC3 "Declaracion Sobre Cobro De Honorarios" - California (Spanish)

Rate (4.7 / 5) 17 votes
Size: 1 MB
1 page

DWC Form 3 "Fee Disclosure Statement" - California

Rate (4.8 / 5) 57 votes
Size: 2 MB
1 page

DWC Form PR-4 "Primary Treating Physician's Permanent and Stationary Report" - California

Rate (4.5 / 5) 24 votes
Size: 2 MB
6 pages

Form DWC1 "Workers' Compensation Claim Form" - California (English/Korean)

Rate (4.6 / 5) 8 votes
Size: 336 KB
4 pages

DWC Form 7 "Notice to Employees - Injuries Caused by Work" - California (English/Spanish)

Rate (4.5 / 5) 82 votes
Size: 56 KB
2 pages

Form DWC1 "Workers' Compensation Claim Form" - California (English/Spanish)

Rate (4.7 / 5) 33 votes
Size: 101 KB
4 pages

Form DWC1 "Workers' Compensation Claim Form" - California (English/Chinese)

Rate (4.5 / 5) 6 votes
Size: 382 KB
4 pages

DWC Form PR-2 "Primary Treating Physician's Progress Report" - California

Rate (4.4 / 5) 10 votes
Size: 119 KB
2 pages

DWC Form PR-3 "Primary Treating Physician's Permanent and Stationary Report" - California

Rate (4.6 / 5) 5 votes
Size: 2 MB
6 pages

DWC Form IBR-1 "Request for Independent Bill Review" - California

Rate (4.5 / 5) 56 votes
Size: 246 KB
3 pages

DWC Form SBR-1 "Provider's Request for Second Bill Review" - California

Rate (4.3 / 5) 14 votes
Size: 1 MB
2 pages

WCAB Form 2 "Addendum to Application for Adjudication of Claim to Identify Legal Entity Employing Injured Worker" - California

Rate (4.7 / 5) 28 votes
Size: 1 MB
2 pages

DWC Form 5 "Request for Accommodation by Persons With Disabilities" - California

Rate (4.5 / 5) 13 votes
Size: 33 KB
1 page

DWC/WCAB Form 6 "Notice and Request for Allowance of Lien" - California

Rate (4.3 / 5) 12 votes
Size: 1 MB
3 pages

DWC Form AD-3 "Request for DWC Authorization Number" - California

Rate (4.3 / 5) 101 votes
Size: 104 KB
1 page

DWC Form RGS-1 "Petition for Permission to Negotiate a Section 3201.7 Labor-Management Agreement" - California

Rate (4.6 / 5) 15 votes
Size: 74 KB
2 pages

DWC/WCAB Form 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California

Rate (4.5 / 5) 12 votes
Size: 311 KB
1 page

DIA WCAB Form 2 (DIA2) "Application for Adjudication of Claim - Death Case" - California

Rate (4.8 / 5) 32 votes
Size: 74 KB
2 pages

Form A "Lien Filing Fees Refund Request" - California

Rate (4.6 / 5) 30 votes
Size: 174 KB
1 page

DWC/WCAB Form 1A "Application for Adjudication of Claim" - California

Rate (4.8 / 5) 18 votes
Size: 1 MB
6 pages

DWC WCAB Form 30 "Subpoena" - California

Rate (4.7 / 5) 75 votes
Size: 2 MB
2 pages

Form I&A11 "How to File a Petition to Reopen" - California

Rate (4.4 / 5) 23 votes
Size: 1 MB
11 pages

Form DWC WCAB32 "Subpoena Duces Tecum" - California

Rate (4.6 / 5) 10 votes
Size: 2 MB
2 pages

DWC/WCAB Form 45 "Petition for Reconsideration" - California

Rate (4.6 / 5) 24 votes
Size: 183 KB
2 pages

QME Form 37 "Request for Factual Correction of an Unrepresented Panel Qme Report" - California

Rate (4.3 / 5) 16 votes
Size: 1 MB
4 pages

WCAB Form 27 "Lien Conference Disposition" - California

Rate (4.8 / 5) 17 votes
Size: 2 MB
1 page

WCAB Form 20 "Minutes of Hearing" - California

Rate (4.7 / 5) 24 votes
Size: 3 MB
1 page

DWC/WCAB Form 10 "Answer to Application for Adjudication of Claim" - California

Rate (4.3 / 5) 9 votes
Size: 1 MB
3 pages

DWC/WCAB Form 46 "Petition to Terminate Liability for Temporary Disability Indemnity" - California

Rate (4.4 / 5) 10 votes
Size: 1 MB
2 pages

Form DWC / UEF50 "Application for Discretionary Payments From the Uninsured Employers' Fund" - California

Rate (4.7 / 5) 22 votes
Size: 1 MB
2 pages

DWC/WCAB Form 36 "Substitution of Attorneys" - California

Rate (4.7 / 5) 72 votes
Size: 390 KB
1 page

DWC/WCAB Form 42 "Petition to Reopen" - California

Rate (4.6 / 5) 23 votes
Size: 59 KB
1 page

DWC Form 37 "Notice of Dismissal of Attorney" - California

Rate (4.7 / 5) 20 votes
Size: 151 KB
1 page

DWC Form 49 "Petition for Commutation of Future Payments" - California

Rate (4.6 / 5) 22 votes
Size: 3 MB
1 page

Form PW26 "Statement of Employer Payments" - California

Rate (4.7 / 5) 53 votes
Size: 78 KB
1 page

Formulario DWC-AU-906 "Formulario De Queja De Auditoria" - California (Spanish)

Rate (4.5 / 5) 19 votes
Size: 178 KB
1 page

Form DWC-AU-906 "Audit Complaint Form" - California

Rate (4.6 / 5) 22 votes
Size: 96 KB
1 page