Reference · DWC & WCAB forms

California workers’ comp forms, explained

The 16 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 hearing — and what it producesSettlementEAMS 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 — and what it produces

The form that asks for the hearing, the joint statement that frames the trial, and the judge’s record of what happened.

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.

WCAB 24Pre-Trial Conference Statement (PTCS)

The joint statement completed when the MSC doesn’t settle the case: stipulations, disputed issues, witness lists, and exhibits. It frames the entire trial that follows.

Who & when · Both parties, together at the mandatory settlement conference, before the judge sets the case for trial.

Discovery closes at the MSC (§5502) and the trial generally runs on what the PTCS lists — an issue or exhibit left off is a fight to get back in. Treat the PTCS as the snapshot of the record you will try the case on.

WCAB 20Minutes of Hearing

The judge’s own record of a hearing — appearances, orders made, continuances, and, paired with the Summary of Evidence at trial, the testimony record.

Who & when · Nobody files this one: the judge generates it and the parties receive it after each hearing. Your job is to read it, immediately and carefully.

The minutes become the record. If they misstate a stipulation or an order, the moment to object is now — not when the misstatement surfaces in a decision months later.

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 August 13, 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.