DWC fact sheets and guides for injured worker

Division of Workers' Compensation - Fact sheets and guides for injured worker

Fact sheets

These fact sheets provide injured workers with answers to frequently asked questions about issues affecting their benefits.

Fact sheet A version version	Answers to your questions about utilization review
Fact sheet B version version	Glossary of workers' compensation terms for injured workers
Fact sheet C version version	Answers to your questions about temporary disability benefits
Fact sheet D version version	Answers to your questions about permanent disability benefits
Fact sheet E version version	Answers to your questions about qualified medical evaluators and agreed medical evaluators
Fact sheet F version version	Answers to your questions about the state's Uninsured Employers Fund

Hojas de información en español

Injured worker guides

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.

Guide	Guides
I&A 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
I&A 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 105
I&A 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 - DEU 103 QME or doctor’s report
I&A 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 1 Document separator sheet - for proof of service by mail Proof of service by mail Document separator sheet - for Labor Code Section 4906(g) Declaration pursuant to Labor Code Section 4906(g)
I&A 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 10250.1 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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-CA 10252.1 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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 132(a)) Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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 Document separator sheet - for proof of service by mail Proof of service by mail
I&A guide 10	How to file a lien Document cover sheet Document separator sheet - for lien Notice and request for allowance of lien - DWC/WCAB 6 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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 42 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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 45 Document separator sheet - for proof of service by mail Proof of service by mail
I&A 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
I&A 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 - AU-906
I&A 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 37 Document separator sheet - for proof of service by mail Proof of service by mail
I&A guide 16	How to file a claim with the Uninsured Employers Benefits Trust Fund Refer to the text in this guide to see which forms are needed
I&A guide 16A	How to correctly name your employer for the Uninsured Employers Fund
I&A guide 16B	How to serve your employer in an Uninsured Employers Fund case
I&A 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 10232.1
I&A 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 10232.2

Guides in Spanish coming soon

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May 2009

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