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The California Department of Insurance administers workers compensation insurance in the state. We have provided the most common workers compensation forms for employers and employees that are commonly utilized in California. We make every effort to keep our forms library updated with the most current versions of our California workers comp forms.
We have also included helpful guides and resources to help educate employers about work comp coverage, claims, and the CA Experience Rating Plan. For additional forms and help please contact one of our Workers Comp Specialists at 888-611-7467.
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The standard Acord 130 application form for workers comp coverage in California.
Information for Employers about Workers Compensation in CA and the Division of Workers' Compensation Insurance.
Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.
Exemption form for California Contractors State Licensing Board. Contractors must file proof of coverage and complete the exemption form if they are exempt from work comp coverage.
This form allows employers to report an injury or illness to their carrier and or the CA Department of Insurance.
California Employees may use this form to report a claim to the State in order to determine eligibility for coverage.
Doctors should use this form to report injury and illness treatment to the insurance company and the employer.
California provides for certain credits associated with drug free workplaces. This form is the required certification for Employers.
The official employee guide for injured workers in California.
This Form must be filed with your insurance carrier in the event their is a change in ownership or when two entities should be combined on a single policy due to common ownership.
California employees with disabilities should file this form with their employer in the event special work accommodations are needed.
An information guide for employers designed to explain California Experience Rating Plan.
State Resources for California
California Department of Insurance
Consumer Communications BureauLos Angeles, CA 90013213-897-8921 800-927-4357
CA Division of Workers Compensation
Post Office Box 420603 San Francisco, California 94142 415-703-4600 DWC Home Page
State Compensation Insurance Fund (SCIF)
1275 Market StreetSan Francisco, CA 94103 415-565-1234 California State Fund
Workers' Compensation Insurance Rating Bureau of California
525 Market Street, Ste. 800San Francisco, CA 94105-2716415-777-0777 WCIRB
Workers’ Compensation Appeals Board (WCAB)
455 Golden Gate Avenue, Suite 9328San Francisco, California 94102-3660800-736-7401 California Appeals Board
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