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Monday, October 02, 2023 -
WCC PDF Forms
| Form Name | Form Number |
|---|---|
| Arbitration Submittal Form | WCAB-32 |
| Arbitration Submittal Orders | WCAB-33 |
| Arbitrator Application (4/2007) | |
| Arbitrator Submittal Form | Form 10297 |
| Audit Referral Form (06-2006) | DWC-AU-906 |
| Audit Referral Form - Form and Instructions - SPANISH (05-2007) | I&A14(sp) |
| Audit Referral Form - with Instructions (05-2007) | I&A 14 |
| Benefit Notice Instruction Manual | |
| Billing and Statement of Charges for Medical-Legal Reports | IMC-76 |
| Case Initiation Document | RU 101 |
| Choosing Medical Care For Work Related Injuries and Illnesses | DW 1194 |
| Complaint About a Workers' Compensation Administrative Law Judge (01-2008) | Complaint Form |
| Cover Page for Medical Provider Network Application | DWC 97674 |
| Cover Page for Medical Provider Network Application (05/2007) | DWC form 9767.4 |
| Declaration of Readiness to Expedited Hearing - Form with Instructions - SPANISH (05-2007) | I&A6(sp) |
| Declaration of Readiness to Proceed - Form with Instructions - SPANISH (05-2007) | I&A5(sp) |
| Declaration of Readiness to Proceed - with Instructions (05-2007) | I&A 5 |
| Declaration of Readiness to Proceed to Expedited Hearing (Trial) - with Instructions (05-2007) | I&A 6 |
| Declaration Regarding Protection of Mental Health Record | QME Form 121 |
| Declination Of Vocational Rehabilitation Services (1-1-90 - 12-31-93) | RU 107 |
| Denial of Vocational Rehabilitation Benefits (RU-500Y) | RU-500Y |
| Description Of Employees Job Duties | RU 91 |
| Doctor's First Report Of Occupational Injury Or Illness | 5021 |
| DWC SB 899 Notice | DWC SB 899 Notice |
| EDEX client acknowledgment of legal constraints on access to information and use of information (06-2006) | |
| EDEX client list (06-2006) | |
| EDEX subscriber application (06-2006) | |
| Election for High Cost Outlier | DWC 15 |
| Employee's Claim For Workers' Compensation Benefits (07-2004) | DWC-1 |
| Employee's Permanent Disability Questionnaire | DEU100 |
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