Prepare and File Documents

Complete the applicable forms and our team of experienced lawyers will

prepare and file the documents on your behalf!

Adjudication Application

Readiness to Proceed Form

DWC-1 Claim 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

Thanks for submitting!

We noticed you didn't add your insurance carrier information. This may cost you more.

DIY Work Comp

Simplifying the California Worker's Compensation System

Website Design by Patton Web Designs

bottom of page