DWC form walkthrough
Application for Adjudication of Claim, explained
The Application for Adjudication of Claim opens a case at the Workers' Compensation Appeals Board (WCAB) so a judge can decide disputes. File it when your claim is denied or benefits aren't being provided, and generally within one year of the injury or the last benefit provided (LC §5405). Get the official form from the DIR website (PDF).
When you need it
- Your claim was denied, or not decided and benefits aren't being paid.
- You need a hearing on temporary disability, treatment or another dispute.
- You're approaching the one-year deadline with benefits disputed.
- A settlement needs a case to be approved in (the parties often file it then).
What the form asks
- Your name, address and the last digits of your Social Security number.
- The employer's legal name and address, and the insurer or claims administrator. If the employer is uninsured, the Uninsured Employers Benefits Trust Fund is named too.
- Date(s) of injury, specific or cumulative, and body parts.
- Your occupation and earnings, and benefits received.
- The issues in dispute (for example compensability, TD, medical treatment, PD).
How to file
Attorneys file electronically through the DWC's case system. If you don't have an attorney, you can file paper forms with a document cover sheet and separator sheet at the district office that serves you (find it by ZIP code), and you must serve copies on the other parties. The DWC's step-by-step I&A guide 4 walks through it, and I&A officers can help in person.
Choosing the venue (which WCAB office)
The form requires you to pick the basis for venue, from three choices in Labor Code §5501.5: the county where you live, the county where the injury happened, or the county of your attorney's main office. You then enter the three-letter code of that district office from the document cover sheet. The DWC's ZIP code finder shows which office serves an address; see all WCAB district offices.
After filing
You receive an ADJ case number. To get a hearing date, a party files a Declaration of Readiness to Proceed. See what happens at the WCAB and our list of WCAB district offices.
We link to the official form on dir.ca.gov rather than hosting a copy, so you always get the current version.
Sources
- Application for Adjudication of Claim (PDF)
- DWC I&A guide 4: How to file an Application for Adjudication of Claim (PDF)
- DWC I&A guide 5: How to file a Declaration of Readiness to Proceed (PDF)
- DWC: Electronic Adjudication Management System (case search and filing)
- DWC district office finder by ZIP code
- California Labor Code §5405 (one-year limit)
- DWC fact sheet: Rights and obligations in a claim before the WCAB (PDF)
Official sources checked November 2026. Laws and rates change; check the source for the latest version.
Common questions
What is the WCAB application form called?
It's the Application for Adjudication of Claim, the Workers' Compensation Appeals Board form that opens a case so a workers' comp judge can decide disputes. The official PDF is on the DIR website.
When do I have to file the Application for Adjudication?
Generally within one year of the date of injury, or within one year of the last benefit provided, under Labor Code §5405. Filing is most urgent when your claim is denied or benefits are disputed and that year is running.
Can I file the Application for Adjudication without an attorney?
Yes. Unrepresented workers can file paper forms, with a document cover sheet and separator sheet, at the district office that serves them, and must serve copies on the other parties. DWC Information & Assistance officers help for free at 1-800-736-7401.
What happens after I file?
You receive an ADJ case number. To get a hearing date, a party files a Declaration of Readiness to Proceed, and the case is set at the district office named on the application.