California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 4.5 - Division of Workers' Compensation
Subchapter 2 - Workers' Compensation Appeals Board-Rules and Practice Procedure
Article 7 - Petitions, Pleadings and Forms
Section 10500 - Form Pleadings

Universal Citation: 8 CA Code of Regs 10500

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) No workers' compensation judge and no district office of the Workers' Compensation Appeals Board shall require the parties to use a form other than that prescribed and approved by the Appeals Board.

(b) Each of the following documents shall be on a form prescribed and approved by the Appeals Board:

(1) An Application for Adjudication of Claim for compensation benefits or death benefits;

(2) A lien;

(3) A Declaration of Readiness to Proceed;

(4) A Pre-Trial Conference Statement;

(5) Minutes of Hearing except Minutes of Hearing prepared by a court reporter;

(6) A Compromise and Release agreement;

(7) Stipulations with Request for Award;

(8) A petition to terminate liability for temporary disability indemnity;

(9) A special notice of lawsuit; and

(10) Any other form the Appeals Board, in its discretion, determines should be uniform and standardized.

(c) Any form prescribed and approved by the Appeals Board may be printed by the Division of Workers' Compensation for distribution at district offices of the Workers' Compensation Appeals Board. In addition, the Division of Workers' Compensation may create:

(1) Electronic versions of the prescribed and approved forms; and/or

(2) Optical character recognition versions of those forms, either in fillable format or otherwise, for posting on the Division of Workers' Compensation's Forms webpage.

(d) Any form for proceedings before the Workers' Compensation Appeals Board created by the Division of Workers' Compensation shall be presumed to have been prescribed and approved by the Appeals Board unless the Appeals Board issues an order or a formal written statement to the contrary.

1. Repealer and new section exempt from OAL review pursuant to Government Code section 11351 filed 12-19-90; operative 1-1-91 (Register 91, No. 7).
2. Amendment filed 12-16-92; operative 2-1-93 and exempt from OAL review pursuant to Government Code section 11351 (Register 92, No. 51).
3. Amendment of section and NOTE filed 12-23-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 52).
4. Amendment filed 12-19-2002; operative 1-1-2003. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2002, No. 51).
5. Amendment of section heading, section and NOTE filed 11-17-2008; operative 11-17-2008. Submitted to OAL for printing only (Register 2008, No. 47).
6. Repealer of article 6 heading, new article 7 heading, repealer of former section 10500 and renumbering of former section 10408 to section 10500, including amendment of section heading and section, filed 12-17-2019; operative 1-1-2020. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2019, No. 51).

Note: Authority cited: Sections 133, 5307, 5309 and 5708, Labor Code. Reference: Sections 3716, 4903.5, 5500, 5500.3, 5501.5 and 5502, Labor Code.

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