Prepare and File Documents

Complete the applicable forms and our team of experienced lawyers will

prepare and file the documents on your behalf!

DWC-1 Claim Form

Readiness to Proceed Form

Adjudication Application Form

First Name

Last Name

Email

Date of Birth (MM/DD/YYYY)

Job Title/Position

Date of Injury (SP, CT)

Address of Injury

Body Parts Injured (select all that apply):

AbdomenAnkleArmBackBrainChestCirculatory SystemCOVID-19Digestive SystemEarExcretory SystemEyeFaceFingersFootHandHerniaHipsJawKneeLeg(s)Lower ExtremitiesLower LegMouthMusculoskeletal SystemNeckNervous SystemNoseReproductive SystemRespiratory SystemScalpShoulder(s)SkinSkullTeethThighToesTrunkUpper ExtremitiesWristOther/Unclassified

How were you injured?

Insurance Carrier Name

Insurance Carrier Address

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DIY Work Comp

Simplifying the California Worker's Compensation System

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