What Is an Application for Adjudication of Claim in a Workers’ Compensation Case?

In California workers’ compensation cases, an Application for Adjudication of Claim (often called an application or app) is a legal document that formally opens a case with the Workers’ Compensation Appeals Board (WCAB). Injured workers file this application when there is a dispute over benefits, such as a denied claim or disagreements about medical treatment, disability ratings, or compensation.

When Should an Injured Worker File an Application for Adjudication of Claim?

An injured worker may need to file an application if:

• Their workers’ compensation claim is denied by the insurance company.
• They are not receiving benefits they believe they are entitled to.
• There is a dispute over medical treatment or the extent of their injury.
• The insurance company stops or delays payments without a valid reason.
• Must be filed within one year of last treatment. 

Filing an application ensures that the WCAB can review the case, make a legal determination, and protect the statute of limitations from being run.

How to File an Application for Adjudication of Claim

To file an application, the injured worker (or their attorney) must:

1. Complete the Application Form (DWC-1 & WCAB Form 1) – This includes details about the injury, employer, and disputed issues.
2. File the application with the correct WCAB district office – The office location depends on where the injury occurred.
3. Serve a copy to all involved parties – The employer and workers’ compensation insurance carrier must receive notice.
4. Receive a case number – The WCAB assigns a case number, which is used for all future legal proceedings.

What Happens After Filing an Application for Adjudication of Claim?

Once the application is filed, the case moves forward in the workers’ compensation appeals process. This may involve:

• Settlement negotiations – The injured worker and insurance company may try to resolve the dispute.
• Medical evaluations – A Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) may provide an independent opinion.
• A hearing before a workers’ compensation judge – If the dispute is not resolved, a judge may decide the case.

Do You Need an Attorney to File an Application?

While it is possible to file an application without legal representation, the process can be complex. A workers’ compensation attorney can help gather medical evidence, complete paperwork correctly, and represent the injured worker in hearings.If your claim has been denied or delayed, the Law Offices of Norman J. Homen can assist you in filing an Application for Adjudication of Claim and fighting for your benefits. Contact us today for a free consultation.