Fact sheets and guides for injured workers

When injured workers have problems with their claims, they may need to go to the local workers' compensation office for help. Each of the guides below provides information on how to fill out a form they may need to get the problem resolved. Most have samples attached. The forms may also be downloaded from the DWC forms page.

Injured worker fact sheets

English	Spanish	Chinese	Hmong	Korean	Tagalog	Vietnamese

Basic facts on workers' compensation for injured workers
Answers to your questions about utilization review (Fact sheet A)
Glossary of workers' compensation terms for injured workers (Fact sheet B)
Answers to your questions about temporary disability benefits (Fact sheet C)
Answers to your questions about permanent disability benefits (Fact sheet D)
Answers to your questions about qualified medical evaluators and agreed medical evaluators (Fact sheet E)
Answers to your questions about the state's Uninsured Employers Benefits Trust Fund (Fact sheet F)
Rights And Obligations In Asserting A Claim Before The Workers’ Compensation Appeals Board (Fact sheet G)

Injured Worker guides

Spanish

Guide 1	How to file a workers' compensation claim form REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Workers' compensation claim form - DWC 1
Guide 2	How to request a qualified medical evaluation REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Request For QME panel under Labor Code Section 4062.1 - QME form 105 Instructions
Guide 3	How to object to your summary rating REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Request for reconsideration of summary rating by the administrative director - DWC-AD form 103 The summary rating determination The QME or your doctor’s report Any other information that supports your request
Guide 4	How to file an application for adjudication of claim REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for application for adjudication of claim Application for adjudication of claim - DWC/WCAB form 1A Document separator sheet - for proof of service by mail Proof of service by mail Document separator sheet - for Labor Code Section 4906(h) Declaration pursuant to Labor Code Section 4906(h)
Guide 5	How to file a declaration of readiness to proceed REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for declaration of readiness to proceed Declaration of readiness to proceed - DWC-CA form 10250.1 Document separator sheet - for proof of service by mail Proof of service by mail
Guide 6	How to request an expedited hearing REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for declaration of readiness to proceed to expedited hearing (trial) Declaration of readiness to proceed (expedited trial) - DWC-WCAB form 10208.3 Document separator sheet - for proof of service by mail Proof of service by mail
Guide 7	How to file a petition for discrimination (Labor Code 132a) REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for petition for discrimination (Labor Code 132a) Petition for discrimination (Labor Code section 132a) Verification Document separator sheet - for proof of service by mail Proof of service by mail
Guide 8	How to file a serious and willful misconduct petition REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for serious and willful misconduct petition Petition for serious & willful misconduct Verification Document separator sheet - for proof of service by mail Proof of service by mail
Guide 9	How to file a petition for commutation REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for petition for commutation Petition for commutation of future payments - DWC/WCAB form 49 Verification Document separator sheet - for proof of service by mail Proof of service by mail
Guide 10	How to file a lien REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for Notice and Request for Allowance of Lien Notice and request for allowance of lien - DWC/WCAB form 6 Document separator sheet - for 10770.5 Verification Lien Verification 10770.5 Document separator sheet - for proof of service by mail Proof of service by mail
Guide 11	How to file a petition to reopen REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for petition for reopen Petition to reopen - DWC/WCAB form 42 Verification Document separator sheet - for proof of service by mail Proof of service by mail
Guide 12	How to file a petition for reconsideration REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for petition for reconsideration Petition for reconsideration - DWC/WCAB form 45 Document separator sheet - for proof of service by mail Proof of service by mail
Guide 13	How to file an appeal of the administrative director REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for Appeal of the administrative director Appeal of the administrative director Document separator sheet - for proof of service by mail Proof of service by mail
Guide 14	How to file a complaint with the Audit Unit REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Audit referral form - DWC-AU form 906
Guide 15	How to dismiss your attorney REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document separator sheet - for notice of dismissal of attorney Notice of dismissal of attorney - DWC/WCAB form 37 Document separator sheet - for proof of service by mail Proof of service by mail
Guide 16	How to file a claim with the Uninsured Employers Benefits Trust Fund REQUIRED CHECKLIST FOR FILING THIS FORM Refer to the text in this guide to see which forms are needed
Guide 16A	How to correctly name your employer for the Uninsured Employers Benefit Trust Fund
Guide 16B	How to serve your employer in an Uninsured Employers Benefit Trust Fund case
Guide 17	How to complete a document cover sheet REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet - DWC-CA form 10232.1
Guide 18	How to complete a document separator sheet REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document separator sheet - DWC-CA form 10232.2
Guide 19	How to file a petition appealing administrative director's independent medical review determination REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document Separate Sheet - for Petition Appeal IMR Determination Petition Appealing Administrative Director’s Independent Medical Review Determination Verification Copy of Administrative Director’s Independent Medical Review Determination Document Separator Sheet - for Proof of Service by Mail Proof of Service by Mail
Guide 20	How to file a petition for change of venue REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document Separate Sheet - for petition for change of venue Petition for Change of Venue Verification Document Separator Sheet - for Proof of Service by Mail Proof of Service by Mail
Guide 21	How to file a petition for penalties REQUIRED CHECKLIST FOR FILING THIS FORM (Please file the forms in the order indicated) Document cover sheet Document Separate Sheet - for petition for penalties Petition for Penalties Verification Document Separator Sheet - for Proof of Service by Mail Proof of Service by Mail
Guide 22	How to Obtain a Subpoena Form Subpoena (To compel a witness to appear at trial) Subpoena Duces Tecum (To compel the production of documents and to appear for a deposition)

November 2024

Office Name	Topic	Phone Numbers
Cal/OSHA	Workplace Safety and Health	833-579-0927
Labor Commissioner's Office	Wages, breaks, retaliation and labor laws	833-526-4636
Division of Workers' Compensation	Benefits for work-related injuries and illnesses	1-800-736-7401
Office of the Director	Any other topic related to the Department of Industrial Relations	844-522-6734

Fact sheets and guides for injured workers

Injured worker fact sheets

Injured Worker guides

Division of Workers' Compensation (DWC)

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