Legal Resources

Worker’s Compensation Claim Form

Worker’s Compensation Claim Form

Pre-Designation

Predesignation of Personal Physician

Reimbursement

Out of pocket Reimbursement Form

Physician’s Return to Work

Physician’s Return to Work Form

California Department of Industrial Relations

California Department of Industrial Relations Division of Workers’ Compensation

Division of Workers’ Compensation (DWC)

Injured Worker Fact Sheets from the Department of Industrial Relations:

DWC Fact Sheet C: Answers to Your Questions About Temporary Disability Benefits
DWC Fact Sheet D: Answers to Your Questions About Permanent Disability Benefits
DWC Fact Sheet E: Answers to Your Questions About Qualified Medical Evaluators and Agreed Medical Evaluators

Essential Information

CA Department of Industrial Relations Guidebook for Injured Workers

CA Department of Industrial Relations Guidebook for Injured Workers

CA Department of Industrial Relations QME Competency Examination Study Guide

CA Department of Industrial Relations QME Competency Examination Study Guide

Permanent Disability Rating Schedule (2005)

Permanent Disability Rating Schedule (2005)

Request for Panel Qualified Medical Examiner- Unrepresented

Request for Panel Qualified Medical Examiner- Unrepresented

Sample Request for Authorization Form

Sample Request for Authorization Form

Sample PR-2 Form

Sample PR-2 Form

Permanent Disability Indemnity Chart

Permanent Disability Indemnity Chart