California Workers Comp Forms

Get California workers compensation forms and coverage guides.

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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California Workers Compensation Insurance Forms

CA Acord 130 Workers Compensation Application

The standard Acord 130 application form for workers comp coverage in California.

California Employer Fact Sheet for Employers

Information for Employers about Workers Compensation in CA and the Division of Workers' Compensation Insurance.

California Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.

CA Affidavit of Exemption for Workers' Compensation Insurance

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.

CA First Report of Injury Form

This form allows employers to report an injury or illness to their carrier and or the CA Department of Insurance. 

Employee Claim Form for Potential Eligibility for Coverage

California Employees may use this form to report a claim to the State in order to determine eligibility for coverage.

CA Doctors First Report of Injury or Illness

Doctors should use this form to report injury and illness treatment to the insurance company and the employer.

California Drug-Free Workplace Certification Form

California provides for certain credits associated with drug free workplaces.  This form is the required certification for Employers.

California Guide for Injured Workers

The official employee guide for injured workers in California.

CA Notification of Change in Ownership or Combinability- Form 601

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.

CA Request for Accommodations for Disabilities

California employees with disabilities should file this form with their employer in the event special work accommodations are needed.

California State Fund Guide to Experience Modifiers

An information guide for employers designed to explain California Experience Rating Plan.

State Resources for California

California Department of Insurance

Consumer Communications Bureau
Los Angeles, CA 90013
213-897-8921
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 Street
San Francisco, CA 94103
415-565-1234
California State Fund

Workers' Compensation Insurance Rating Bureau of California

525 Market Street, Ste. 800
San Francisco, CA 94105-2716
415-777-0777
WCIRB

Workers’ Compensation Appeals Board (WCAB)

455 Golden Gate Avenue, Suite 9328
San Francisco, California 94102-3660
800-736-7401
California Appeals Board

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Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.
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