Fillable form instructions = Fillable Adobe Acrobat form - en espaсol = Adobe Acrobat for = Word form
Forms are listed by relevant subject, then in alphabetical order.
When identifying a claims administrator or representative on EAMS OCR forms, you must use the claims administrator or representative's uniform assigned name - UAN. Click on this link to search for a UAN.
If you are a claims administrator or representative and can't find your office in the UAN database, please submit your name, location, mailing address, telephone, e-mail, fax, or preferred method of service on letterhead with an authorized signature by e-mail to firstname.lastname@example.org or fax to - 888 822-9309. - Please note this is for claims administrators and representatives only.
ZIP code locator tool will help you locate the DWC district office serving your ZIP code.
If you are an injured worker, you should be aware that, once an "Application for Adjudication of Claim" is filed, case file information, including case documents, may be disclosed under the
California Public Records Act. Even in this circumstance, an injured worker's address and Social Security number are not revealed to the requestor by the DWC. The division uses this information solely to administer its duties in workers' compensation claims. Note that some case file information can be found by using the public information search tool. such as an injured worker's name, case number, case status, court location, employer name, a description of events in the case, and associated dates. It may list the parts of the body that were injured, but it does not include medical records or any case documents. The information provided in this search tool relates solely to cases in DWC's adjudication unit and is intended to help move cases through the court system efficiently. Any person requesting access to this information is required to identify themselves, state the reason for making the request, and instructed not to disclose the information to any person who is not entitled to it under Labor Code section 138.7 .
Forms in this section:Source: www.dir.ca.gov