Reference · DWC & WCAB forms

California workers’ comp forms, explained

The 14 forms a California comp case actually runs on, organized by where they fit in the case — what each one does, who files it, and the trap the form itself doesn’t mention. Every link goes to DWC’s official PDF.

Opening the claimMedical treatmentMedical-legal (QME panels)Getting a hearingSettlementEAMS filing mechanicsExpenses & special funds

Opening the claim

Two different openings that get confused: the DWC-1 opens the benefits claim with the employer; the Application opens a case at the WCAB.

DWC-1Workers’ Compensation Claim Form

Legally opens the benefits claim. Filing it starts the 90-day decision clock (§5402) and up to $10,000 of treatment while the administrator decides.

Who & when · The injured worker completes the employee section and returns it to the employer; the employer must provide it within one working day of notice (§5401).

This is not a lawsuit and does not open a WCAB case — that takes the Application below.

WCAB-1Application for Adjudication of Claim

Opens a case at the Workers’ Compensation Appeals Board — the forum where disputes get decided — and generates the ADJ case number.

Who & when · Usually the worker or their attorney, when something needs deciding; subject to the one-year §5405 statute.

Filed with EAMS body-part codes and venued by ZIP. DWC’s EAMS filename for this PDF is confusingly "DWC1.pdf" — it is not the DWC-1 claim form.

Medical treatment

Treatment requests flow through utilization review; this form is how a request officially enters that pipeline.

DWC Form RFARequest for Authorization for Medical Treatment

The treating physician’s formal request for a specific treatment. Submitting it starts the §4610 utilization-review clocks.

Who & when · The treating physician (with the report supporting the request attached); sent to the claims administrator.

If UR denies, the worker’s remedy is Independent Medical Review — on the IMR form the denial letter comes with, within the deadline printed on it.

Getting a hearing

Nothing gets on a judge’s calendar by itself — this is the form that asks for the hearing.

DWC-CA 10250.1Declaration of Readiness to Proceed (DOR)

Tells the board a dispute is ready for a judge and asks for a hearing — usually a mandatory settlement conference, or an expedited hearing on the fast-track issues.

Who & when · Either party, once they’re genuinely ready to proceed on the issue listed.

Filing a DOR for an MSC starts the path to §5502 discovery closure — file it before the record is complete and the trap closes on you.

Settlement

The two settlement structures use two different form sets — and close different things.

DWC-CA 10214-cCompromise and Release (C&R)

The buyout: one lump sum closes PD, usually future medical, and the reopening right. Requires WCAB adequacy approval — often as a same-day walk-through.

Who & when · Both parties jointly, after the numbers are agreed.

DWC-CA 10214-aStipulations with Request for Award

The agreed award: parties stipulate the PD percentage, an award issues, payments run out over the §4658 weeks, future medical usually stays open, and §5410 reopening survives.

Who & when · Both parties jointly; the award still passes through a judge.

EAMS filing mechanics

The two sheets every paper filing rides on — get them wrong and the filing bounces.

DWC-CA 10232.1Document Cover Sheet

The routing sheet on top of every filed document set: case number, parties, and the body-part codes EAMS recognizes.

Who & when · Whoever files — attorney, adjuster, or lien claimant.

DWC-CA 10232.2Document Separator Sheet

Divides a multi-document filing so EAMS’s OCR files each document under the right title.

Who & when · Same filer, between each document in the set.

Expenses & special funds

The money forms outside the rating itself.

Mileage formMedical Mileage Expense Form

Claims reimbursement for travel to treatment and medical-legal exams, at the DWC’s per-mile rate for the year of travel.

Who & when · The injured worker, submitted to the claims administrator with dates and mileage.

UEF 50Application for Discretionary Payments — Uninsured Employers’ Fund

Asks the UEBTF for payments when the employer was illegally uninsured and can’t pay the award.

Who & when · The injured worker (typically with counsel) after establishing the employer had no coverage.

Forms FAQ

What is a DOR in California workers' comp?
The Declaration of Readiness to Proceed (DWC-CA 10250.1) — the form that asks the WCAB to set a hearing, usually a mandatory settlement conference or an expedited hearing. Nothing gets on a judge's calendar without one, and filing it for an MSC starts the path to §5502 discovery closure.
What's the difference between the DWC-1 and the Application for Adjudication?
The DWC-1 opens the benefits claim with the employer and starts the 90-day decision clock (§5402). The Application for Adjudication opens a case at the WCAB — the forum where disputes get decided — and is subject to the one-year §5405 statute. They are different forms filed at different times for different purposes.
Which form requests a QME panel?
QME Form 105 for unrepresented workers (§4062.1) and QME Form 106 for represented cases (§4062.2). Replacement panels use Form 31.5 and additional-specialty panels use Form 31.7.
What forms are used to settle a workers' comp case?
A Compromise and Release uses DWC-CA 10214-c — one lump sum that usually closes PD, future medical, and reopening rights. Stipulations with Request for Award use DWC-CA 10214-a — the agreed PD percentage pays out over the §4658 weeks, future medical usually stays open, and §5410 reopening survives. Both require judge approval.
Do I need a cover sheet to file documents with the WCAB?
Yes — every paper filing rides on a Document Cover Sheet (DWC-CA 10232.1), which carries the case number and the EAMS body-part codes, with a Document Separator Sheet (10232.2) between each document so EAMS's OCR files them correctly.
The forms move the case. The rating decides what it’s worth.
WPI in — the full 2005 PDRS pipeline and the DEU-format string out. Free, no login.
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Related: EAMS body-part codes · where to file — offices by ZIP · the statutory clocks · glossary

Every PDF link verified against DWC on July 30, 2026. DWC revises forms in place — the current versions always live on DWC’s forms page. Procedural summaries for orientation, not legal advice; deadlines have exceptions this page doesn’t evaluate.