Application for Adjudication of Claim

An Application for Adjudication of Claim form is used in a California workers' compensation case to begin a formal proceeding against the employer with the Workers' Compensation Appeals Board. Not only does the Application for Adjudication of Claim detail information about the worker's injuries, it also provides information about the case to all parties involved in the claim. The application will also determine the venue for the case which could be the county where the employee resides, the county where the injury occurs or the county of the principal place of business of the worker's lawyer.

When the Workers' Compensation Appeals Board receives the Application for Adjudication of Claim form they will assign it a case number. They will also be given the power to resolve issues and disputes related to the worker's claim. This form, along with the supporting information, will be reviewed by the Workers' Compensation Appeals Board.

Injured workers who must complete the Application for Adjudication of Claim form may be able to get some assistance from the Division of Workers' Compensation Information and Assistance Unit which provides a free seminar about the system and employees' rights. They may also be able to schedule an appointment with a representative for further assistance. Other injured employees may wish to contact a workers' compensation attorney who can file the form on their behalf.