Regulations
| 10133.14....Form RU-103 Request for Dispute Resolution and Form Filing Instructions. (Repealed) | |
| Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Section 139. 5, Labor Code;Godinez v. Buffets, Inc. (2004, Significant Panel Decision) ...more | |
| 10133.15....Form RB-105 Request for Conclusion of Rehabilitation Benefits and Form Filing Instructions. [Repealed] | |
| Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Sections 4637, 4643 and 4644, Labor Code. New section and new Form RB-105 and form filing ...more | |
| 10133.16....Form RU-105 Notice of Termination of Vocational Rehabilitation Services and Form Filing Instructions. [Repealed] | |
| Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Section 139. 5, Labor Code;Godinez v. Buffets, Inc. (2004, Significant Panel Decision) ...more | |
| 10133.18....Form RU-107 "Employee Statement of Declination of Vocational Rehabilitation Services" and Form Filing Instructions. [Repealed] | |
| Â Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Sections 4641 and 4644, Labor Code. Â HISTORY Â . New section and new Form ...more | |
| 10133.19....Form RU-107A "Statement of Declination of Vocational Rehabilitation Services" and Form Filing Instructions. [Repealed] | |
| Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Sections 4641 and 4644, Labor Code. HISTORY . New section, relocation and amendment of ...more | |
| 10133.2....Pamphlets. (Repealed) | |
| HISTORY Â . New section filed 2-21-95; operative 2-21-95. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 95, No. 8). . ...more | |
| 10133.20....Form RU-120 "Initial Evaluation Summary" and Form Filing Instructions. [Repealed] | |
| Note: Authority cited: Sections 133, 138. 4, 139. 5 and 5307. 3, Labor Code. Reference: Section 139. 5, Labor Code. HISTORY Â . New section, relocation and amendment ...more | |
| 10133.22....Form RU-122 "Settlement of Prospective Vocational Rehabilitation Services" and Form Filing Instructions. [Repealed] | |
| Note: Authority cited: Sections 133, 139. 5 and 5307. 3, Labor Code. Reference: Section 139. 5, Labor Code;Godinez v. Buffets, Inc. (2004, Significant Panel Decision) ...more | |
| 10133.3....Rehabilitation Unit File Retention. [Repealed] | |
| Note: Authority cited: Sections 133, 138. 4, 139. 5 and 5307. 3, Labor Code. Reference: Section 139. 5, Labor Code. . Â Â HISTORYÂ Â Â Â . ...more | |
| 10133.31....Supplemental Job Displacement Nontransferable Voucher for Injuries Occurring on or After January 1, 2013 | |
| Â (1) Upon receipt of the Physician's Return-to-Work & Voucher Report (Form DWC-AD 10133. 36), the claims administrator shall forward the form to the employer. Â ...more | |
| 10133.32....Form [DWC-AD 10133.32 âSupplemental Job Displacement Nontransferable Voucher For Injuries Occurring on or After 1/1/13.â] | |
| Supplemental Job Displacement Nontransferable Voucher For Injuries Occurring on or After 1/1/13Â Note: Authority cited: Sections 133, 4658. 1, 4658. 7 and 5307. 3, ...more | |
| 10133.34....Offer of Work for Injuries Occurring on or After January 1, 2013 | |
| (a) This section shall apply to all injuries occurring on or after January 1, 2013. Â (b) The injured employee shall be entitled to a supplemental job displacement ...more | |
| 10133.35....Form [DWC-AD 10133.35 âNotice of Offer of Regular, Modified, or Alternative Work For injuries Occurring on or After 1/1/13.â] | |
| This form may be produced without a logo and may be produced on the claim's administrator's letterhead. New section filed 12-20-2012 as an emergency; operative 1-1-2013 ...more | |
| 10133.4....Rehabilitation of Industrially Injured Inmates. (Repealed) | |
| Note: Authority cited: Sections 133, 138. 4, 139. 5 and 5307. 3, Labor Code. Reference: Sections 3351 and 3370, Labor Code; and Section 5069, Penal Code. Renumbering of ...more | |
| 10133.50....Definitions. [Repealed] | |
| Note: Authority cited: Sections 133, 4658. 5 and 5307. 3, Labor Code. Reference: Sections 124, 4658. 1, 4658. 5 and 4658. 6, Labor Code. HISTORY Â . New article 7. 5 ...more | |
| 10133.51....Notice of Potential Right to Supplemental Job Displacement Benefit. [Repealed] | |
| Repealer filed 12-20-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346. 1(d) (Register 2012, No. 51). A Certificate of Compliance must ...more | |
| 10133.52...."Notice of Potential Right to Supplemental Job Displacement Benefit Form." [Repealed] | |
| Repealer filed 12-20-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346. 1(d) (Register 2012, No. 51). A Certificate of Compliance must ...more | |
| 10133.54....Dispute Resolution | |
| (a) This section and section 10133. 55 shall only apply to injuries occurring on or after January 1, 2004. Â (b) When there is a dispute regarding the Supplemental Job ...more | |
| 10133.55....Form [DWC-AD 10133.55 "Request for Dispute Resolution Before the Administrative Director."] | |
| Request for Dispute Resolution Before the Administrative Director (Form DWC-AD 10133. 55) Note: Authority cited: Sections 133, 4658. 5 and 5307. 3, Labor Code. ...more | |
| 10133.56....Requirement to Issue Supplemental Job Displacement Nontransferable Training Voucher | |
| (a) This section and section 10133. 57 shall only apply to injuries occurring between January 1, 2004 and December 31, 2012, inclusive. Â (d) The voucher shall be ...more | |
| 10133.58....State Approved or Accredited Schools | |
| Note: Authority cited: Sections 133, 4658. 5 and 5307. 3, Labor Code. Amendment filed 11-17-2008; operative 11-17-2008 pursuant to Government Code section 11343. 4 ...more | |
| 10133.59....The Administrative Director's List of Vocational Return to Work Counselors | |
| Â (b) The Administrative Director shall maintain a list of Vocational & Return to Work Counselors (VRTWC) who perform the work of assisting injured employees. A VRTWC ...more | |
| 10133.60....Termination of Claims Administrator's Liability for the Supplemental Job Displacement Benefit | |
| the offer of regular, modified or alternative work is on a similar seasonal basis to the employee's previous employment; Â (2) the maximum funds of the voucher have ...more | |
| 10134....Attorney Fee Disclosure Statement Form | |
| DWC Form 3, Attorney Fee Disclosure Statement Form. DWC Form 3, Attorney Fee Disclosure Statement Form. Â (Spanish) Note: Authority cited: Sections 133 and 5307. 3, ...more | |
| 10135....Required Use of Form | |
| Every attorney or his/her agent who consults with an injured worker or dependent is required to furnish the attorney fee disclosure statement form set forth in Section ...more | |
| 10135.1....Service of Form | |
| Within 15 days of the employee's and attorney's execution of the disclosure form, a copy of the disclosure form shall be mailed to the employer or, if known, to the ...more | |
| 10136....General: Definitions | |
| As used in this Article, the following definitions apply: Â (a) Claims Administrator. The official Division of Workers' Compensation DWC Form 1 Employee's Claim for ...more | |
| 10137....General: Employer Obligation | |
| Nothing in this article shall abrogate the duty of an employer to provide timely compensation to an injured worker, even if the employee has not completed and filed the ...more | |
| 10138....Claim Form and Notice of Potential Eligibility for Benefits | |
| The employee's form for filing a workers' compensation claim (DWC 1) and the Notice of Potential Eligibility for Benefits is a mandatory form set forth in Section 10139 ...more | |
| 10139....Workers' Compensation Claim Form (DWC 1) and Notice of Potential Eligibility | |
| Claim Form (DWC 1) Note: Authority cited: Sections 133, 5307. 3 and 5401, Labor Code. Reference: Sections 132(a), 139. 48, 139. 6, 4600, 4600. 3, 4601, 4604. 5, 4616, ...more | |
| 10140....Employer's Responsibility to Process Claim Form, Claims Administrator's Duty to Provide Claim Form | |
| (a) Within one working day of receipt of a claim form, the employer shall date the claim form and provide a dated copy of the form to the employee and the employer's ...more | |
| 10141....Dismissal of Inactive Claim by Operation of Law After Notice | |
| We have not heard from you since we sent you a letter denying your claim on ________ [Date]. If you are still claiming benefits, you must file an Application for ...more | |
| 10142....Date of Denial for Purposes of End of Tolling of Limitations Period | |
| Â The written denial notice must be issued in accordance with the notice regulations in Title 8, CCR, Subchapter 1, Article 8, Sections 9810 et seq. in order to cease ...more | |
| 10150....Disability Evaluation Unit | |
| The Disability Evaluation Unit, under the direction and authority of the administrative director, will issue permanent disability ratings as required under this ...more | |
| 10150.1....Signature Disputes and the Signatures of Consultants | |
| (a) Anyone who disputes the authenticity of any signature must file with the Manager of the Disability Evaluation Unit an objection to the pleading or other document ...more | |
| 10150.2....Technical Unavailability of EAMS | |
| Technical problems with filing documents shall be governed by section 10225 of title 8 of the California Code of Regulation. Â Note: Authority cited: Sections 133 and ...more | |
| 10150.3....Disability Evaluation Unit File Retention | |
| (a) Following a period of fifty (50) years after the filing of a document used to open a case or file, the Division of Workers' Compensation may destroy the electronic ...more | |
| 10150.4....Misfiled or Misdirected Documents | |
| The authority to approve moving a document from one file to another file shall reside with the Manager of the Disability Evaluation Unit or his or her designee. Â ...more | |
| 10151....Filing Requirements | |
| Case opening document shall be assigned a case number by the Division of Workers' Compensation after filing. Documents or forms filed without a case number will be ...more | |
| 10151.1....Electronic Filing Exemption | |
| If a document is filed with EAMS as part of the electronic filing trial, that document does not need to be filed in compliance with sections 10228 and 10232 of title 8 of ...more | |
| 10152....Disability, When Considered Permanent | |
| A disability is considered permanent when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change ...more | |
| 10154....Permanent Disability Rating Determinations, Kinds | |
| 4061, 5452, 5701 and 5703. 5, Labor Code. New section is exempt from review by OAL pursuant to Government Code section 11351. Submitted to OAL for printing only pursuant ...more | |
| 10156....Formal Rating Determinations | |
| A formal rating determination will be prepared by the Disability Evaluation Unit when requested by the Appeals Board or a Workers' Compensation Judge on a form specified ...more | |
| 10158....Formal Rating Determinations As Evidence | |
| Formal rating determinations prepared by disability evaluators shall be deemed to constitute evidence only as to the relation between the disability or impairment ...more | |
| 10159....Time Period for Issuing a Summary Rating Determination Pursuant to Labor Code § 4061(e) | |
| Â Note: Authority cited: Sections 111, 133, 5307. 3 and 5307. 4, Labor Code. Reference: Sections 124 and 4061, Labor Code. New section filed 12-31-2012 as an ...more | |
| 10160....Summary Rating Determinations, Comprehensive Medical Evaluation of Unrepresented Employee | |
| A properly prepared request shall consist of: Â (1) A completed Request for Summary Rating Determination, DWC AD Form 101 (DEU); Â (2) A completed Employee's ...more | |
| 10160.1....Summary Rating Determinations, Report of Primary Treating Physician for Unrepresented Employee | |
| (a) For injuries on or after January 1, 1994, the insurance carrier, self-insured employer or the employee may request a summary rating of the primary treating ...more | |
| 10160.5....Summary Rating Determinations, Represented Employees | |
| A summary rating determination will be prepared only upon receipt of a properly prepared request. A properly prepared request shall consist of: Â (1) A completed ...more | |
| 10161....Forms | |
| (b) Request for Summary Determination of Qualified Medical Evaluator's Report (DWC AD Form 101 (DEU)). Reference: Sections 124, 4061, 4062, 4062. 01, 4062. 1, 4062. ...more | |
| 10161.1....Reproduction of Forms | |
| Note: Authority cited: Sections 133 and 5307. 3, Labor Code. Reference: Sections 124, 4061, 4062, 4062. 01, 4062. 1, 4062. 2, 4062. 5, 4064, 4067, 4660, 4662, 4663 and ...more | |