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Thursday, April 25, 2024 -
WCC PDF Forms
| Form Name | Form Number |
|---|---|
| Employee's Request For Informal Permanent Disability Rating | DEU 200 |
| Employer's Report Of Occupational Injury Or Illness | DLSR 5020 |
| Faculty Disclosure of Commercial Interest | QME Form 119 |
| Fee Disclosure Statement | DWC 3 |
| Finding and Order (Replacement QME Represented) | |
| Finding and Order (Replacement QME Unrepresented) | |
| Finding and Order RE: Second QME Panel (Unrepresented Case) | |
| Finding and Order RE:Second QME Panel (represented case) | |
| For More Information | Fact Sheet #4 |
| Frequently Asked Questions Regarding the Self Insurer's Annual Report | |
| General Information and Instructions, Effective for Dates of Service on or after January 1, 2004 | 9789.11(a)(1) |
| General Information and Instructions, Effective for Dates of Service on or after July 1, 2004 | 9789.11(a)(1) |
| Getting Appropriate Medical Care for Your Injury (October 2006) | |
| Glossary of workers' compensation terms for injured workers (07-2005) | Fact Sheet B |
| Glossary of workers' compensation terms for injured workers - Spanish (09-2005) | Fact Sheet B |
| HCO Enrollment Form | WC-HCO1 |
| Help in Returning to Work | 10133.2 |
| How to correctly name your employer for the Uninsured Employers Fund (05-2007) | IA16A |
| How to correctly name your employer for the Uninsured Employers Fund - Spanish (07-2007) | IA 16A |
| How to File a Claim with the Uninsured Employers Fund - Form and Instruction Packet - SPANISH (05-2007) | I&A16(sp) |
| How to File a Claim with the Uninsured Employers Fund - Forms and Instructions (05-2007) | I&A 16 |
| How to file a complaint with the Audit Unit (06-2006) | DWC-AU-905 |
| How to Request A QME-If you do not have a lawyer | IMC 105 |
| Hurt on the Job? for Young Workers | Fact Sheet Young Workers |
| Hurt on the Job? for Young Workers (SP) | Fact Sheet Young Workers |
| Indemnity Notices Resumption, Change, Termination - Instructions | |
| Independent medical review application | |
| Information Guidelines for Submission of Settlement Documents | Set guide |
| Information Request Form | WCAB-7A |
| Information Response Form | WCAB-7B |
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