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

What Is Form I&A7?

This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form I&A7 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.

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

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Information & Assistance Unit guide 7
How to file a petition for discrimination
(Labor Code section 132a)
This petition may be filed if your employer fired you or discriminated against you
for filing a workers' compensation claim. This is called a Labor Code 132a petition.
Please note this petition must be filed within one year of the discriminatory act or
date you were fired.
A 132a petition can only be filed if you have a pending Workers' Compensation
Appeals Board (WCAB) case. To open a WCAB case, you must file an application
for adjudication of claim (see I&A guide 4). When you are ready to have a WCAB
hearing, you must also file a declaration of readiness to proceed (see I&A guide
5).
Employer discrimination can be very difficult to prove. Because of the technical
nature of this petition, you may need legal advice.
A blank form you can use to write out your petition is attached. Also attached is a
sample that may be used as a guide.
Send the original to your local WCAB office and copies to all the parties.
Submit the following documents with your form filing in the order shown:
Document Cover Sheet
Document Separator Sheet
(for Petition for Discrimination Labor Code
132a)
Petition for Discrimination (Labor Code 132a)
Verification
Document Separator Sheet
(for Proof of Service By Mail)
Proof of Service By Mail
Keep copies of your filings for your records.
All documents filed with the WCAB must include a document cover sheet and
document separator sheet.
Please see I&A guides 17 and 18 to learn how to
complete these forms.
In addition all forms must be typed or handwritten in
block letters to insure legibility. Additional form instructions can be found on the
EAMS OCR handbook at
http://www.dir.ca.gov/dwc/eams/SampleFiles/EAMS_OCR%20handbook.pdf.
I&A 7
Rev. 06/18
Information & Assistance Unit guide 7
How to file a petition for discrimination
(Labor Code section 132a)
This petition may be filed if your employer fired you or discriminated against you
for filing a workers' compensation claim. This is called a Labor Code 132a petition.
Please note this petition must be filed within one year of the discriminatory act or
date you were fired.
A 132a petition can only be filed if you have a pending Workers' Compensation
Appeals Board (WCAB) case. To open a WCAB case, you must file an application
for adjudication of claim (see I&A guide 4). When you are ready to have a WCAB
hearing, you must also file a declaration of readiness to proceed (see I&A guide
5).
Employer discrimination can be very difficult to prove. Because of the technical
nature of this petition, you may need legal advice.
A blank form you can use to write out your petition is attached. Also attached is a
sample that may be used as a guide.
Send the original to your local WCAB office and copies to all the parties.
Submit the following documents with your form filing in the order shown:
Document Cover Sheet
Document Separator Sheet
(for Petition for Discrimination Labor Code
132a)
Petition for Discrimination (Labor Code 132a)
Verification
Document Separator Sheet
(for Proof of Service By Mail)
Proof of Service By Mail
Keep copies of your filings for your records.
All documents filed with the WCAB must include a document cover sheet and
document separator sheet.
Please see I&A guides 17 and 18 to learn how to
complete these forms.
In addition all forms must be typed or handwritten in
block letters to insure legibility. Additional form instructions can be found on the
EAMS OCR handbook at
http://www.dir.ca.gov/dwc/eams/SampleFiles/EAMS_OCR%20handbook.pdf.
I&A 7
Rev. 06/18
Information & Assistance Unit guide 7
If you need help, call an
Information and Assistance (I&A)
office, or attend a
workshop for injured
workers. The local I&A phone numbers are attached to this
guide. You can get information on a local workshop from the I&A office or on the
Web at www.dwc.ca.gov.
If you do not have the name and address of your insurance company to
complete a form, please link to
http://www.dir.ca.gov/DWC/EAMS/EAMS-
LC/EAMSClaimsAdmins.asp.
The information contained in this guide is general in nature and is not intended as a substitute for
legal advice. Changes in the law or the specific facts of your case may result in legal
interpretations different than those present here.
When sending documents to a district office, please make sure they are not folded or stapled.
Send them in a large manila envelope. Please see the EAMS OCR forms handbook for further
instructions.
I&A 7
Rev. 06/18
 
 
 
 
 
 
 
 
 
 
 
 
WORKERS’ COMPENSATION APPEALS BOARD DISTRICT OFFICES
ANAHEIM, 92806-2131
SACRAMENTO, 95834-2962
1065 N Link, Suite 170
160 Promenade Circle, Suite 300
Information & Assistance Unit (714) 414-1801
Information & Assistance Unit (916) 928-3158
BAKERSFIELD, 93301-1929
SALINAS, 93906-2204
th
1880 N Main Street, Suites 100 & 200
1800 30
Street, Suite 100
Information & Assistance (831) 443-3058
Information & Assistance Unit (661) 395-2514
EUREKA, 95501-0529 * Satellite office *
SAN BERNARDINO, 92401-1411
409 “K” Street, Room 201
464 W Fourth Street, Suite 239
Information & Assistance Unit (707) 441-5723
Information & Assistance Unit (909) 383-4522
FRESNO, 93721-2219
SAN DIEGO, 92108-4424
2550 Mariposa Street, Suite 4078
7575 Metropolitan Drive, Suite 202
Information & Assistance Unit (559) 445-5355
Information & Assistance Unit (619) 767-2082
LONG BEACH, 90802-4339
SAN FRANCISCO, 94102-7014
nd
300 Oceangate Street, Suite 200
455 Golden Gate Avenue, 2
Floor
Information & Assistance Unit (562) 590-5240
Information & Assistance Unit (415) 703-5020
LOS ANGELES, 90013-1105
SAN JOSE, 95113-1402
th
th
100 Paseo de San Antonio, Suite 241
320 W 4
Street, 9
Floor
Information & Assistance Unit (408) 277-1292
Information & Assistance Unit (213) 576-7389
MARINA DEL REY, 90292-6902
SAN LUIS OBISPO, 93401-8736
nd
rd
4740 Allene Way, Suite 100
4720 Lincoln Boulevard, 2
and 3
floors
Information & Assistance Unit (805) 596-4159
Information & Assistance Unit (310) 482-3820
OAKLAND, 94612-1499
SANTA ANA, 92707-7704
th
2 MacArthur Place, Suite 600
1515 Clay Street, 6
Floor
Information & Assistance Unit (714) 942-7576
Information & Assistance Unit (510) 622-2861
OXNARD, 93030-7912
SANTA BARBARA, 93101-7538 * Satellite office *
1901 N Rice Avenue, Suite 100
130 E Ortega Street
Information & Assistance Unit (805) 485-3528
Information & Assistance Unit (805) 568-1390
POMONA, 91768-1653
SANTA ROSA, 95404-4771
732 Corporate Center Drive
50 “D” Street, Suite 420
Information & Assistance Unit (909) 623-8568
Information & Assistance Unit (707) 576-2452
REDDING, 96002-0940
STOCKTON, 95202-2314
nd
31 E Channel Street, Suite 344
250 Hemsted Drive, 2
Fl, Ste. B
Information & Assistance Unit (209) 948-7980
Information & Assistance Unit (530) 225-2047
RIVERSIDE, 92501-3337
VAN NUYS, 91401-3370
3737 Main Street, Suite 300
6150 Van Nuys Boulevard, Suite 105
Information & Assistance Unit (951) 782-4347
Information & Assistance Unit (818) 901-5374
Rev. 11/19
STATE OF CALIFORNIA
SAMPLE
DWC DISTRICT OFFICE
DOCUMENT COVER SHEET
 
 
 
 
 
 
 
 
Is this a new case?
Companion Cases Exist
Yes
No
Walkthrough
Yes
No
More than 15 Companion Cases
YOUR SOCIAL
TODAY'S DATE
SECURITY NUMBER
SSN:
Date:(MM/DD/YYYY)
Specific Injury
EAMS CASE NUMBER
DATE OF INJURY
Case Number 1
Cumulative Injury
(Start Date: MM/DD/YYYY)
(End Date: MM/DD/YYYY)
(If Specific Injury, use the start date as the specific date of injury)
IF NEW CASE
LEAVE BLANK
USE CODE FROM
Body Part 1:
BODY PART CODE
Body Part 3:
LIST, SEE PAGE 8
Body Part 2:
Body Part 4:
WHEN MORE THAN 5 BODY PARTS USE BODY
Other Body Parts:
PART NUMBER 700 IN THIS FIELD
Please check unit to be filed on ( check only one box )
ADJ
DEU
SIF
UEF
SAU
INT
RSU
Companion Cases
Specific Injury
Case Number 2
Cumulative Injury
(Start Date: MM/DD/YYYY)
)
(End Date: MM/DD/YYYY
(If Specific Injury, use the start date as the specific date of injury)
Body Part 1:
Body Part 3:
Body Part 2:
Body Part 4:
Other Body Parts:
DWC-CA form 10232.1 Rev. 11/2017- Page 1 of 8
 
 
District office codes for place of venue
Legend
 
Abbreviation
Office
AHM
Anaheim
ANA
Santa Ana
BAK
Bakersfield
EUR
Eureka*
FRE
Fresno
LAO
Los Angeles
LBO
Long Beach
MDR
Marina del Rey
OAK
Oakland
OXN
Oxnard
POM
Pomona
RDG
Redding
RIV
Riverside
SAC
Sacramento
SAL
Salinas
SBA
Santa Barbara**
SBR
San Bernardino
SDO
San Diego
SFO
San Francisco
SJO
San Jose
San Luis Obispo
SLO
SRO
Santa Rosa
STK
Stockton
VNO
Van Nuys
* Eureka is a satellite office of Santa Rosa district office. ** Santa Barbara is a satellite office of the Oxnard district office.
Use this document to complete forms, but do not file this document with your forms.
 
DWC-CA form 10232.1 Rev. 11/2017- Page 7 of 8