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Release Number: 2020-44
May 20, 2020

DWC, WCAB Update Forms to Identify Injuries Related to COVID-19

The Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB) have updated certain forms to properly allow for identifying injuries related to COVID-19.

Parties are required to list body part codes when filing these forms. The forms listed below have been updated to include the new body part code which should be used in addition to those indicating specific body parts or functions resulting from the injury. If filing a claim for COVID-19, the body part code is “900.” The new code may be found in the drop down menu when listing body parts on the forms below. These forms may be found on the DWC website and are also available to e-filers for use beginning May 23, 2020.

Document Cover Sheet
Application for Adjudication of Claim
Compromise and Release
Stipulations with Request for Award (for injury on or after 1/1/2013)