A California workers’ comp claim can run on two filings that do different jobs. The DWC-1 claim form is filed with the employer (the DWC-1 guide covers it). The Application for Adjudication of Claim is filed with the Workers’ Compensation Appeals Board, and it opens a case there — the route to having the board resolve a dispute. Labor Code §5500 draws the line: outside a carve-out for claim forms filed on injuries from 1990 through 1993, “the filing of an application for adjudication and not the filing of a claim form shall establish the jurisdiction of the appeals board and shall commence proceedings before the appeals board for the collection of benefits.”
What filing it does
The EAMS regulations define the application as “the initial pleading that asserts a right to relief under the provisions of Labor Code section 5300” (8 CCR §10205(e)), and with the defendant’s answer it’s one of the only two pleadings the Labor Code requires (§5500). The form’s own instructions put its effect plainly: “Filing of this application begins formal proceedings against the defendant(s) named in your application.” The person applying is the applicant, and the adverse party the defendant (§5503).
With exceptions set out in two other rules, proceedings begin and the board’s jurisdiction is invoked by filing an Application for Adjudication of Claim, a case-opening Compromise and Release, a case-opening Stipulations with Request for Award, or a Request for Findings of Fact under rule 10460 (8 CCR §10450(a)). Until one of those is filed, the board “may not conduct hearings, issue orders or authorize the commencement of formal, compelled discovery, including the use of subpoenas to obtain records or sworn testimony” (§10450(b)). A case number assigned earlier by another DWC unit, such as the Disability Evaluation Unit or an Information and Assistance office, doesn’t change that: it doesn’t establish the board’s jurisdiction, doesn’t authorize compelled discovery, and doesn’t toll the statute of limitations, except as §5454 provides for submissions to the Information and Assistance Unit (§10450(c)).
When it’s due
Because it commences proceedings, the application is what has to beat the one-year limit. Proceedings to collect medical treatment or disability payments must be commenced within one year from the date of injury, the expiration of any period covered by a disability payment, or the last date medical benefits were furnished (Labor Code §5405) — and because the year runs from any of them, the latest sets the deadline. Filing the DWC-1 with the employer tolls that year, for injuries on or after January 1, 1994, “until the claim is denied by the employer or the injury becomes presumptively compensable” (§5401(d)), and submitting a matter to a DWC Information and Assistance officer tolls any applicable limit while the officer considers it and for 60 days after the officer’s recommendation (§5454). Other rules can change the answer: the limits don’t run against a minor or an incompetent until a guardian or conservator of the estate, or a trustee, is appointed (§5408); proceedings on the ground that the original injury has caused new and further disability can be instituted within five years after the date of injury (§5410); the limitation is an affirmative defense, waived if it isn’t raised before the case is submitted for decision (§5409); and death and serious-and-willful claims have limits of their own (§5406, §5407). The statute of limitations guide covers all of them. The DWC’s guide for workers on filing the application adds that the form can be filed when the board may be needed to resolve a dispute later and the time to file could run out.
The time of day matters too. A document received before 5:00 p.m. on a court day is filed that day; one received after 5:00 p.m. on a court day is filed as of the next court day (8 CCR §10615(b)). For a filing subject to a statute of limitations, the rules also blunt the paperwork traps: an application can’t be rejected solely because it went to the wrong board office, was submitted without the proper form or on one that’s incomplete or inaccurate, or lacked the required cover sheet or separator sheets or had incomplete ones (8 CCR §10617(a)). It can be rejected if it doesn’t carry enough information to open an adjudication file. Then the filer is served a Notice of Document Discrepancy and has 15 days from its service to correct and resubmit — or longer on a showing of good cause — and the corrected application is deemed filed as of the date it was first submitted (§10617(b)).
Who files it, and where
Under §5501, the application “may be filed with the appeals board by any party in interest, his attorney, or other representative authorized in writing,” and a representative who isn’t an attorney licensed by the State Bar of California must notify the board of that in writing. The form has boxes for an applicant other than the injured worker: a lien claimant, the employer, or the insurance carrier. A death claim has its own version of the form, the death-case application (DIA 2).
Where it’s filed sets the venue — the district office where the case’s proceedings will be conducted and its district-office orders, decisions, and awards issued (8 CCR §10205(mm)) — and the filer designates it and states the basis (8 CCR §10480). Section 5501.5(a) allows three counties: (1) where the injured employee, or the dependent of a deceased employee, resides on the date of filing; (2) where the injury allegedly occurred — or, in cumulative trauma and industrial disease claims, where the last alleged injurious exposure occurred; or (3) where the employee’s attorney maintains a principal place of business, if the employee is represented by an attorney. In a county with more than one board office, the application can go to any of them that meets those criteria, and subdivision (b) adds that “the written consent of the employee, or dependent of a deceased employee, to the selected venue site shall be filed with the application.” With no board office in the county, it goes to the office nearest the residence, the place of injury or last exposure, or the attorney’s principal place of business, “unless the employer objects under subdivision (c)” (§5501.5(d)). The WCAB office finder matches a California ZIP code to its district office.
The attorney’s-office choice is the one an employer can override by objection. Under the board’s rule implementing §5501.5(c), any employer or insurance carrier listed on an initial application may object to it within 30 days after receiving notice of the case number and venue, stating under penalty of perjury the date the notice arrived; a timely objection moves venue to one of the first two choices, §5501.5(a)(1) or (a)(2) (8 CCR §10488). Otherwise venue changes by petition: an applicant or defendant may ask, a change “shall be granted for good cause,” and the reasons must be specifically set out — along with the witnesses’ names, addresses, and the substance of their testimony when the change is sought for their convenience (§5501.6). The petition is filed at the office that has venue, objections are due within 10 days of its filing, and within 30 days the presiding judge (at a permanently staffed satellite office, its judge) grants or denies it or serves notice of a status conference (8 CCR §10490).
What the form asks
The DWC lists the form as WCAB 1; the current version prints as DWC/WCAB Form 1A (5/2020). Filed on paper, it’s one of the DWC’s OCR forms — “a paper form designed to be scanned so that its information is automatically extracted and stored in EAMS” (§10205(z)) — so text added to it goes in capital letters, and the injured body parts and the venue office go in as the DWC’s codes (8 CCR §10205.12(a)(6), (8), (9)). The venue line takes the three-letter office code from the document cover sheet.
The required sections come first: the venue choice and its basis, the injured worker, and the employer — insured, self-insured, legally uninsured, or uninsured — followed by the insurance carrier and claims administrator, if known and applicable. Then nine numbered claims: (1) the worker’s date of birth and occupation, and either a specific injury and its date or a cumulative injury with its start and end dates (the form allows only one), where it happened, and up to four body parts plus others; (2) how the injury occurred; (3) actual earnings at the time of injury, including the value of tips, meals, lodging, or other advantages regularly received, and hours worked per week; (4) the last day off work and the periods of disability; (5) whether compensation was paid, with the total, the weekly rates, and the date of the last payment; (6) any unemployment insurance or state disability benefits since the injury; (7) medical treatment — whether the employer or carrier furnished all of it, the date of last treatment, and who else provided or paid, including Medi-Cal; (8) other cases the worker has filed for industrial injuries; and (9) what the application is filed over: “a disagreement regarding liability for” temporary or permanent disability, medical treatment, reimbursement for medical expense, compensation at the proper rate, rehabilitation, supplemental job displacement or return to work, or something else. The signature page asks whether the applicant is represented: an unrepresented applicant signs it; otherwise the attorney or non-attorney representative completes and signs it. Disclosing a Social Security number is optional (8 CCR §10455(e)).
Each separate injury gets its own application, and only one per injury; duplicates are “subject to summary dismissal” (§10455(a)). An amended application uses the same form with its “Amended Application” box checked (§10455(c)), and its venue choice must match the original unless an order changing venue has issued (the form’s instructions). For a minor or an incompetent applicant, the application must be accompanied by a Petition for Appointment of Guardian ad Litem and Trustee (§10455(d)). And for a cumulative injury or occupational disease that may have arisen out of more than one employment, the application “shall state the names and addresses of all employers liable” under the statute’s liability rule, with the places and approximate periods of employment; an omitted employer can be joined later (§5500.5(b)).
Filing and serving it
Documents are filed in EAMS or with the district office having venue (8 CCR §10615(a)). A sworn statement has to come with the application: under Labor Code §4906(h), the employee, the insurer, the employer, and the attorneys for each party sign under penalty of perjury and file, “with the complete application or answer,” a statement that they have not violated §139.3 and have not offered, delivered, received, or accepted any rebate, refund, commission, discount, or other consideration as compensation or inducement for any referred examination or evaluation. The DWC’s version is the Declaration Pursuant to Labor Code Section 4906(h). Failing to file it means the board refuses to file that party’s application or answer. If someone who must sign is unavailable, can’t be located, or won’t sign, a declaration under penalty of perjury giving the reasons in specific detail and describing good-faith efforts to comply may be filed instead, and if the presiding judge finds good cause, the judge may accept the filing (8 CCR §10470).
For unrepresented workers, the DWC’s guide lists the paper filing in order: document cover sheet; separator sheet and application; separator sheet and proof of service (which it recommends); separator sheet and the §4906(h) declaration — not folded or stapled. The cover and separator sheet guide covers the two scanning forms and their format rules.
Service happens twice. At filing, the filer serves a copy of the application and any accompanying documents on all other parties (§10455(b)) — on each party’s attorney or agent of record, or on the party directly if it’s unrepresented (8 CCR §10625(a)). The board then assigns an adjudication case number and venue, shown on a conformed copy (§10455(f)). If the filer is unrepresented, the board serves that conformed copy on all parties and lien claimants; if the filer is represented, the board serves it on the filer, who must then “forthwith” serve it on everyone else (§10455(f)(1)–(2); Labor Code §5501).
The answer, and what comes next
A defendant’s response is the answer, on the board’s form, the Answer to Application for Adjudication of Claim. Labor Code §5505 describes its job — setting out the particulars in which the application is “inaccurate or incomplete,” and “the facts upon which he intends to rely” — and speaks of an answer within 10 days after service of the application. The board’s current rule requires any answer to be filed and served no later than the shorter of 10 days after service of a Declaration of Readiness to Proceed or 90 days after service of the application (8 CCR §10465). “A general denial is not an answer within this rule” (§10465(a)); the answer goes with a proof of service (§10465(b)); and evidence on matters and affirmative defenses it doesn’t plead is allowed only on terms the board or judge imposes (§10465(c)). A defendant that doesn’t answer isn’t defaulted: if it fails to appear or answer, “no default shall be taken against him,” and the board proceeds to the hearing on terms it deems proper (§5506).
Filing the application doesn’t put anything on calendar. The form’s instructions say so in capitals — “FILING AND SERVICE OF A DECLARATION OF READINESS IS A PREREQUISITE TO THE SETTING OF A CASE FOR HEARING” — and the statute sets the mandatory settlement conference “not less than 10 days, and not more than 30 days, after the filing of a declaration of readiness to proceed” (§5502(d)(1)). The DOR and pretrial statement guide picks up from there. The instructions also note that an applicant may ask a DWC Information and Assistance officer for help filling out the form, and that any attorney’s fee “will be set by the Workers’ Compensation Appeals Board at the time the case is decided and is ordinarily payable out of your award.” Descriptive summary of Labor Code §§5500–5506 and the WCAB and EAMS rules on applications; check the current form on the DWC site before filing; not legal advice.