Workers' Compensation Free Forms

We have numerous free forms available for download in various fields.  

Keep in mind that we do not guarantee the applicability of any of the forms to your case.  We also do not guarantee that the forms are updated and current.  Use these forms at your own risk.  We strongly recommend researching the forms and their applicability on your own, or call us at (310) 571-8777 to discuss your legal issues.

Workers' Compensation Claim form (DWC 1)
Application for Adjudication of Claim
Application for Adjudication of Claim - Death Case
​Application for Benefits for Serious and Willful Misconduct of Employer
Application for Benefits for Serious and Willful Misconduct of Employer - Verification
Application for Discretionary Payments from the Uninsured Employers' Fund
Application for Discrimination Benefits Pursuant to LC 132A
​Application for Discrimination Benefits Pursuant to LC 132A - Verification
Application for Independent Medical Review
Application for Subsequent Injuries Fund Benefits
Body Part Codes List
Complaint About Administrative Law Judge
Compromise and Release
Compromise and Release - Dependency Claim
Compromise and Release - Third Party
Declaration of Readiness to Proceed
Declaration of Readiness to Proceed - Expedited Trial
Document Cover Sheet
Document Separator Sheet
Document Titles List
Employees Permanent Disability Questionnaire
Medical Mileage Expense Form
Notice of Dismissal of Attorney
Notice of Personal Chiropractor or Personal Acupuncturist
Notice of Pre-Designation of Personal Physician
Notice to Employees Poster
Petition for Reconsideration
Pre-Trial Conference Statement
Proof of Service
Request for Public Records
Stipulation with Request for Award - DOI Post 1-1-2013
Stipulation with Request for Award - Death Case
Substitution of Attorney
Utilization Review Complaint Form