DWC Fact Sheets 

DWC Fact Sheets are documents that can be used by both the injured workers and the Policyholders to provide an overview of the laws that govern the claims administration process in the State of California. These forms are also available on the DWC website at www.dir.ca.gov

Employee Fact Sheet – English | Spanish

Fact Sheet A: Utilization Review Fact Sheet – English | Spanish

Fact Sheet B: Glossary of Workers’ Comp Terms – English | Spanish

Fact Sheet C: Temporary Disability Fact Sheet – English | Spanish

Fact Sheet D: Permanent Disability Fact Sheet – English | Spanish

Fact Sheet E: Qualified Medical Evaluation/Agreed Medical Evaluation Fact Sheet – English | Spanish

Medical Records Release of Injured Worker 

When injured workers sign this form, they give PacificComp permission to obtain their medical records so that PacificComp can evaluate their claim.

English | Spanish | English and Spanish

Mileage Reimbursement Request for Injured Worker Use 

Injured workers should use this form to log their mileage for travel related to their medical treatment so that PacificComp can reimburse them.

English and Spanish