Templates & Forms
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DWC Official Forms
31 forms
CA DWC ↗
Employee's Claim for Workers' Compensation Benefits
Initiates a workers' comp claim. Required for every new injury — triggers employer's 24-hour duty to provide and 90-day acceptance/denial window.
Declaration of Readiness to Proceed
Filed to request a WCAB hearing. Certifies all discovery is complete. Required before MSC, CCR, or trial scheduling.
Declaration of Readiness — Expedited Hearing
Requests expedited hearing for TD disputes, medical treatment, or return-to-work issues requiring priority scheduling.
Notice of Application for Adjudication
Opens a WCAB case number. Filed when a dispute requires formal adjudication. Usually defendant-side when applicant has not yet filed.
Answer to Application for Adjudication
Defense response admitting or denying each allegation, asserting affirmative defenses, and identifying issues in dispute.
Request for QME Panel (Represented)
Filed by represented parties to request a three-doctor QME panel from the MEDICAL-LEGAL specified specialty. 10-day selection deadline.
QME Panel Selection Form
Records parties' alternating strikes from the three-doctor QME panel and confirms the selected evaluator's name and specialty.
Objection to QME / PQME Report
Formally objects to a QME or panel QME report and requests a follow-up supplemental examination. Must be served within 20 days.
Request for Continuance
Requests postponement of a scheduled WCAB hearing with good-cause showing. Must be filed and served before the hearing date.
Compromise and Release (C&R)
Settles all aspects of a claim for a lump sum. Requires WCAB approval and a medical report confirming informed consent and understanding.
Stipulations with Request for Award
Structured settlement with periodic PD payments over time. Establishes PD percentage, future medical care, and vocational rehabilitation rights.
Work Status Report (PR-4)
Issued by treating physician to document work capacity, restrictions, and MMI status. Critical for TD disputes and return-to-work decisions.
Firm Templates
22 templates
Deposition Notice — Treating Physician
Standard deposition notice including subpoena duces tecum rider, medical record request checklist, and DWC deposition fee language.
Deposition Notice — Defense QME/PQME
Formatted for deposing a defense QME or panel QME. Includes standard exhibit list, fee schedule, and basis-of-opinion document requests.
AME Appointment Confirmation Letter
Confirms scheduled AME appointment with location, preparation instructions, and record-production requirements. Auto-filled from case data.
Used by /Walmart Weekly Summary
Client Status Report — Weekly Summary
Standard weekly status report for insurers and TPAs. Includes recent activity, upcoming hearings, deadlines, open issues, and AI-drafted next steps.
IMR Filing Cover Letter
Transmittal letter for Independent Medical Review requests following UR denial. Includes denial citation, treatment timeline, and MAXIMUS filing checklist.
Answer to Application — Firm Version
Firm's enhanced DWC AD 10006 with pre-drafted affirmative defenses, apportionment language, claims handler fields, and date-of-knowledge fields.