California Workers' Compensation Forms: A Practical Guide
The California workers' compensation system requires a series of official forms at key moments in your case. Knowing which form applies to each situation — and filing it correctly and on time — can be the difference between protecting your rights or losing them.
This page describes the most important forms in the California workers' comp system, when they are used, and where to find them.
All official forms from the California Department of Industrial Relations are available at: dir.ca.gov/dwc/forms.html
Essential Workers' Compensation Forms
DWC-1 — Employee's Claim for Workers' Compensation Benefits
What is it? The DWC-1 is the official form with which you formally notify your employer that you suffered a work injury and are claiming workers' compensation benefits.
When is it used? Immediately after suffering an injury or upon learning that an illness is related to your work. Your employer is required by law to provide it within one business day of receiving your verbal injury report.
What you should know: - Complete the employee section with your injury information. - Always keep a signed, date-stamped copy with your employer's acknowledgment. - The form is available in English and Spanish (DWC-1 S). - Once filed, the insurer has 14 days to accept or deny your claim, and 90 days to investigate it.
Available at: dir.ca.gov/dwc/forms.html
DWC-1 S — DWC-1 in Spanish
What is it? The Spanish-language version of the claim form. It carries the exact same legal weight as the English version.
What you should know: If your employer provides only the English version and you do not understand it, you have the right to request the Spanish version. Never sign a document you do not understand.
DWC-7 — Notice of Workers' Compensation Carrier
What is it? A form your employer is required to post in the workplace, notifying employees who the workers' comp insurer is and how to contact them in the event of injury.
When is it used? You do not complete this form — your employer must display it visibly. If it is missing from your workplace, that may be a sign your employer is operating without insurance.
What to do if it is missing: Note your employer's name and address and contact an attorney. Coverage may be available through the state's Uninsured Employers Benefits Trust Fund (UEBTF).
Application for Adjudication of Claim
What is it? This form formally opens your case before the Workers' Compensation Appeals Board (WCAB). It is the legal action that allows your case to be heard by a workers' compensation judge.
When is it used? - When your claim was denied and you want to appeal. - When there is a dispute over the amount of your benefits. - When the insurer is not paying or is delaying payments. - Generally must be filed within one year from the date of injury.
What you should know: This is a formal legal document. While you can file it yourself, it is highly recommended to do so with attorney assistance. Zapata Legal Group can file it on your behalf at no upfront cost.
Request for Authorization (RFA) — Treatment Authorization Form
What is it? A form your treating physician completes to request authorization for a specific treatment (surgery, therapy, medication, imaging study, etc.) from the insurer.
When is it used? Whenever your physician wants to request a treatment requiring prior approval from the insurer. The insurer has 5 business days (or 72 hours for urgent cases) to respond to an RFA.
What to do if your RFA is denied? If the insurer denies treatment through the Utilization Review (UR) process, you may request an Independent Medical Review (IMR) within 30 days. Contact your attorney immediately.
Predesignation of Personal Physician
What is it? A form that allows you to designate your own personal physician before a work injury occurs, so that physician will treat you if you are injured at work, rather than the insurer's network physician.
When is it used? Completed before the injury. To predesignate, you need: - Your own health insurance (not through your employer) - A personal physician who has agreed to treat you for work injuries
What you should know: If you did not predesignate a physician before the injury, you will generally receive treatment through your employer's insurer's Medical Provider Network (MPN) for the first 30 days, after which you may switch providers within that network.
Other Important Forms
| Form | Name | Use |
|---|---|---|
| DWC-AD 10133.53 | Notice of Offer of Modified/Alternative Work | Employer offers modified work |
| DWC-AD 10118 | Supplemental Job Displacement Benefit Voucher | $6,000 training voucher |
| DWC-AD 10214 | Compromise and Release | Final settlement closing the case |
| DWC-AD 10231.1 | Stipulations with Request for Award | PD agreement with open future medical care |
Need Help With Your Forms?
Workers' comp forms appear simple, but errors in completion — or missing deadlines — can have serious consequences for your case. Zapata Legal Group can guide you through this process at no upfront cost.
Consultation is free and we charge no fees unless you win.
Contact us: Intake@ZapataLegalGroup.com
Phone: (800) 555-0142
View all workers' comp benefits → Was your claim denied? Learn how to appeal →
Frequently Asked Questions
Is my employer required to give me the DWC-1 form?
Yes. California Labor Code 5401 requires employers to provide the DWC-1 form within one business day of receiving an injury report. If your employer refuses or delays, you can file a complaint with the Division of Workers' Compensation (DWC).
Can I file the DWC-1 myself if my employer does not give it to me?
Yes. You can download the form directly from the Department of Industrial Relations at dir.ca.gov/dwc/forms.html, complete it, and deliver it to your employer in writing, keeping a copy with delivery confirmation.
In what language can I submit my forms?
Official forms are available in English and Spanish. You may submit them in either language. Your attorney can assist you in any language.
What if I do not know how to complete the Application for Adjudication?
We strongly recommend not filing this document without legal guidance. Contact Zapata Legal Group for a free consultation. We can file it on your behalf and ensure your case is properly opened before the WCAB.