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

166
total templates

Documents

166

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

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

The purpose of this form is to gather all of the information about an employee's case in the state of California and deliver it to the WCAB.

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

Form I&A4 "Information & Assistance Unit Guide - How to File an Application for Adjudication of Claim" - California

Rate (4.7 / 5) 17 votes
Size: 5 MB
18 pages

Form I&A6 "Information & Assistance Unit Guide - How to Request an Expedited Hearing" - California

Rate (4.4 / 5) 23 votes
Size: 4 MB
12 pages

Form I&A5 "Information & Assistance Unit Guide - How to File a Declaration of Readiness to Proceed" - California

Rate (4.7 / 5) 29 votes
Size: 3 MB
13 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

Form I&A1 "Information & Assistance Unit Guide - How to File a Workers' Compensation Claim Form" - California

Rate (4.4 / 5) 5 votes
Size: 1 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 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California

Rate (4.7 / 5) 18 votes
Size: 403 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 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

Form I&A19 "Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination" - California

Rate (4.5 / 5) 33 votes
Size: 4 MB
12 pages

Form I&A12 "Information & Assistance Unit Guide - How to File a Petition for Reconsideration" - California

Rate (4.3 / 5) 8 votes
Size: 3 MB
12 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 24 "Pre-trial Conference Statement" - California

Rate (4.6 / 5) 30 votes
Size: 4 MB
5 pages

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
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