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- California Department of Industrial Relations - Division of Workers' Compensation
Documents
166
![DWC/WCAB Form 1A "Application for Adjudication of Claim" - California](https://data.templateroller.com/pdf_docs_html/2080/20804/2080414/dwc-wcab-form-1a-application-for-adjudication-of-claim-california.png "DWC/WCAB Form 1A "Application for Adjudication of Claim" - California")
DWC/WCAB Form 1A "Application for Adjudication of Claim" - California
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](https://data.templateroller.com/pdf_docs_html/1999/19995/1999551/dwc-form-rfa-request-for-authorization-california.png "DWC Form RFA "Request for Authorization" - California")
DWC Form RFA "Request for Authorization" - California
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](https://data.templateroller.com/pdf_docs_html/2073/20732/2073201/form-i-a9-how-to-file-a-petition-for-commutation-california.png "Form I&A9 "How to File a Petition for Commutation" - California")
![Form I&A7 "How to File a Petition for Discrimination (Labor Code Section 132a)" - California](https://data.templateroller.com/pdf_docs_html/2073/20731/2073198/form-i-a7-how-to-file-a-petition-for-discrimination-labor-code-section-132a-california.png "Form I&A7 "How to File a Petition for Discrimination (Labor Code Section 132a)" - California")
![Form I&A4 "Information & Assistance Unit Guide - How to File an Application for Adjudication of Claim" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325497/form-i-a4-information-assistance-unit-guide-how-to-file-an-application-for-adjudication-of-claim-california.png "Form I&A4 "Information & Assistance Unit Guide - How to File an Application for Adjudication of Claim" - California")
![Form I&A6 "Information & Assistance Unit Guide - How to Request an Expedited Hearing" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325493/form-i-a6-information-assistance-unit-guide-how-to-request-an-expedited-hearing-california.png "Form I&A6 "Information & Assistance Unit Guide - How to Request an Expedited Hearing" - California")
![Form I&A5 "Information & Assistance Unit Guide - How to File a Declaration of Readiness to Proceed" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325489/form-i-a5-information-assistance-unit-guide-how-to-file-a-declaration-of-readiness-to-proceed-california.png "Form I&A5 "Information & Assistance Unit Guide - How to File a Declaration of Readiness to Proceed" - California")
![Formulario DWC3 "Declaracion Sobre Cobro De Honorarios" - California (Spanish)](https://data.templateroller.com/pdf_docs_html/2073/20731/2073197/formulario-dwc3-declaracion-sobre-cobro-de-honorarios-california-spanish.png "Formulario DWC3 "Declaracion Sobre Cobro De Honorarios" - California (Spanish)")
![DWC Form 3 "Fee Disclosure Statement" - California](https://data.templateroller.com/pdf_docs_html/2059/20593/2059371/dwc-form-3-fee-disclosure-statement-california.png "DWC Form 3 "Fee Disclosure Statement" - California")
![DWC Form PR-4 "Primary Treating Physician's Permanent and Stationary Report" - California](https://data.templateroller.com/pdf_docs_html/2059/20592/2059279/dwc-form-pr-4-primary-treating-physician-s-permanent-and-stationary-report-california.png "DWC Form PR-4 "Primary Treating Physician's Permanent and Stationary Report" - California")
![Form DWC1 "Workers' Compensation Claim Form" - California (English/Korean)](https://data.templateroller.com/pdf_docs_html/2073/20731/2073181/form-dwc1-workers-compensation-claim-form-california-english-korean.png "Form DWC1 "Workers' Compensation Claim Form" - California (English/Korean)")
![DWC Form 7 "Notice to Employees - Injuries Caused by Work" - California (English/Spanish)](https://data.templateroller.com/pdf_docs_html/121/1215/121572/dwc-form-7-notice-to-employees-injuries-caused-by-work-california-english-spanish.png "DWC Form 7 "Notice to Employees - Injuries Caused by Work" - California (English/Spanish)")
![Form DWC1 "Workers' Compensation Claim Form" - California (English/Spanish)](https://data.templateroller.com/pdf_docs_html/2059/20592/2059272/form-dwc1-workers-compensation-claim-form-california-english-spanish.png "Form DWC1 "Workers' Compensation Claim Form" - California (English/Spanish)")
![Form DWC1 "Workers' Compensation Claim Form" - California (English/Chinese)](https://data.templateroller.com/pdf_docs_html/2073/20731/2073180/form-dwc1-workers-compensation-claim-form-california-english-chinese.png "Form DWC1 "Workers' Compensation Claim Form" - California (English/Chinese)")
![DWC Form PR-2 "Primary Treating Physician's Progress Report" - California](https://data.templateroller.com/pdf_docs_html/2049/20498/2049847/dwc-form-pr-2-primary-treating-physician-s-progress-report-california.png "DWC Form PR-2 "Primary Treating Physician's Progress Report" - California")
![DWC Form PR-3 "Primary Treating Physician's Permanent and Stationary Report" - California](https://data.templateroller.com/pdf_docs_html/2059/20592/2059280/dwc-form-pr-3-primary-treating-physician-s-permanent-and-stationary-report-california.png "DWC Form PR-3 "Primary Treating Physician's Permanent and Stationary Report" - California")
![Form I&A1 "Information & Assistance Unit Guide - How to File a Workers' Compensation Claim Form" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325485/form-i-a1-information-assistance-unit-guide-how-to-file-a-workers-compensation-claim-form-california.png "Form I&A1 "Information & Assistance Unit Guide - How to File a Workers' Compensation Claim Form" - California")
![DWC Form IBR-1 "Request for Independent Bill Review" - California](https://data.templateroller.com/pdf_docs_html/2059/20591/2059100/dwc-form-ibr-1-request-for-independent-bill-review-california.png "DWC Form IBR-1 "Request for Independent Bill Review" - California")
![DWC Form SBR-1 "Provider's Request for Second Bill Review" - California](https://data.templateroller.com/pdf_docs_html/202/2027/202741/dwc-form-sbr-1-provider-s-request-for-second-bill-review-california.png "DWC Form SBR-1 "Provider's Request for Second Bill Review" - California")
![WCAB Form 2 "Addendum to Application for Adjudication of Claim to Identify Legal Entity Employing Injured Worker" - California](https://data.templateroller.com/pdf_docs_html/2059/20590/2059085/wcab-form-2-addendum-to-application-for-adjudication-of-claim-to-identify-legal-entity-employing-injured-worker-california.png "WCAB Form 2 "Addendum to Application for Adjudication of Claim to Identify Legal Entity Employing Injured Worker" - California")
![DWC Form 5 "Request for Accommodation by Persons With Disabilities" - California](https://data.templateroller.com/pdf_docs_html/171/1715/171592/dwc-form-5-request-for-accommodation-by-persons-with-disabilities-california.png "DWC Form 5 "Request for Accommodation by Persons With Disabilities" - California")
![DWC/WCAB Form 6 "Notice and Request for Allowance of Lien" - California](https://data.templateroller.com/pdf_docs_html/2059/20591/2059118/dwc-wcab-form-6-notice-and-request-for-allowance-of-lien-california.png "DWC/WCAB Form 6 "Notice and Request for Allowance of Lien" - California")
![DWC Form AD-3 "Request for DWC Authorization Number" - California](https://data.templateroller.com/pdf_docs_html/2059/20590/2059097/dwc-form-ad-3-request-for-dwc-authorization-number-california.png "DWC Form AD-3 "Request for DWC Authorization Number" - California")
![DWC Form RGS-1 "Petition for Permission to Negotiate a Section 3201.7 Labor-Management Agreement" - California](https://data.templateroller.com/pdf_docs_html/2073/20732/2073205/dwc-form-rgs-1-petition-for-permission-to-negotiate-a-section-3201-7-labor-management-agreement-california.png "DWC Form RGS-1 "Petition for Permission to Negotiate a Section 3201.7 Labor-Management Agreement" - California")
![DWC/WCAB Form 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California](https://data.templateroller.com/pdf_docs_html/2059/20592/2059282/dwc-wcab-form-8-petition-for-appointment-of-guardian-ad-litem-and-trustee-california.png "DWC/WCAB Form 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California")
![DIA WCAB Form 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California](https://data.templateroller.com/pdf_docs_html/2120/21207/2120724/dia-wcab-form-8-petition-for-appointment-of-guardian-ad-litem-and-trustee-california.png "DIA WCAB Form 8 "Petition for Appointment of Guardian Ad Litem and Trustee" - California")
![DIA WCAB Form 2 (DIA2) "Application for Adjudication of Claim - Death Case" - California](https://data.templateroller.com/pdf_docs_html/2059/20590/2059086/dia-wcab-form-2-dia2-application-for-adjudication-of-claim-death-case-california.png "DIA WCAB Form 2 (DIA2) "Application for Adjudication of Claim - Death Case" - California")
![Form A "Lien Filing Fees Refund Request" - California](https://data.templateroller.com/pdf_docs_html/2059/20591/2059105/form-a-lien-filing-fees-refund-request-california.png "Form A "Lien Filing Fees Refund Request" - California")
![DWC WCAB Form 30 "Subpoena" - California](https://data.templateroller.com/pdf_docs_html/2073/20732/2073204/dwc-wcab-form-30-subpoena-california.png "DWC WCAB Form 30 "Subpoena" - California")
![Form I&A11 "How to File a Petition to Reopen" - California](https://data.templateroller.com/pdf_docs_html/2073/20732/2073202/form-i-a11-how-to-file-a-petition-to-reopen-california.png "Form I&A11 "How to File a Petition to Reopen" - California")
![Form DWC WCAB32 "Subpoena Duces Tecum" - California](https://data.templateroller.com/pdf_docs_html/2073/20732/2073203/form-dwc-wcab32-subpoena-duces-tecum-california.png "Form DWC WCAB32 "Subpoena Duces Tecum" - California")
![Form I&A19 "Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325494/form-i-a19-information-assistance-unit-guide-how-to-file-a-petition-appealing-administrative-director-s-independent-medical-review-determination-california.png "Form I&A19 "Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination" - California")
![Form I&A12 "Information & Assistance Unit Guide - How to File a Petition for Reconsideration" - California](https://data.templateroller.com/pdf_docs_html/2325/23254/2325492/form-i-a12-information-assistance-unit-guide-how-to-file-a-petition-for-reconsideration-california.png "Form I&A12 "Information & Assistance Unit Guide - How to File a Petition for Reconsideration" - California")
![DWC/WCAB Form 45 "Petition for Reconsideration" - California](https://data.templateroller.com/pdf_docs_html/103/1039/103934/dwc-wcab-form-45-petition-for-reconsideration-california.png "DWC/WCAB Form 45 "Petition for Reconsideration" - California")
![QME Form 37 "Request for Factual Correction of an Unrepresented Panel Qme Report" - California](https://data.templateroller.com/pdf_docs_html/2073/20732/2073215/qme-form-37-request-for-factual-correction-of-an-unrepresented-panel-qme-report-california.png "QME Form 37 "Request for Factual Correction of an Unrepresented Panel Qme Report" - California")
![WCAB Form 27 "Lien Conference Disposition" - California](https://data.templateroller.com/pdf_docs_html/2059/20591/2059107/wcab-form-27-lien-conference-disposition-california.png "WCAB Form 27 "Lien Conference Disposition" - California")
![WCAB Form 24 "Pre-trial Conference Statement" - California](https://data.templateroller.com/pdf_docs_html/2193/21932/2193224/wcab-form-24-pre-trial-conference-statement-california.png "WCAB Form 24 "Pre-trial Conference Statement" - California")
![WCAB Form 20 "Minutes of Hearing" - California](https://data.templateroller.com/pdf_docs_html/335/3358/335849/wcab-form-20-minutes-of-hearing-california.png "WCAB Form 20 "Minutes of Hearing" - California")
![DWC/WCAB Form 10 "Answer to Application for Adjudication of Claim" - California](https://data.templateroller.com/pdf_docs_html/2059/20592/2059293/dwc-wcab-form-10-answer-to-application-for-adjudication-of-claim-california.png "DWC/WCAB Form 10 "Answer to Application for Adjudication of Claim" - California")
![DWC/WCAB Form 46 "Petition to Terminate Liability for Temporary Disability Indemnity" - California](https://data.templateroller.com/pdf_docs_html/2059/20592/2059294/dwc-wcab-form-46-petition-to-terminate-liability-for-temporary-disability-indemnity-california.png "DWC/WCAB Form 46 "Petition to Terminate Liability for Temporary Disability Indemnity" - California")
