California EAMS: Top 10 FAQs re the OCR Forms

1. OCR Forms Mandatory

Q: Are the new OCR forms mandatory now that the DWC Regulations are approved?
A: Yes, the OCR forms became mandatory Nov. 17. An instruction manual for completing OCR forms can be found on the DWC website – www.dir.ca.gov/eams. There will be a three-month transition period for unrepresented injured workers filing legacy forms. For everyone else, legacy forms will be accepted until Friday, Dec. 12.

2. Application Packet

Q: If I am filing a new application, what needs to be included in the application packet?
A: The following pages need to be included:

• Cover sheet
• Document separator sheet
• Application for adjudication of claim
• Document separator sheet
• DWC-1
• Document separator sheet
• 4906(g) declaration
• Document separator sheet
• Fee disclosure statement
• Document separator sheet
• Proof of service#

Other examples can be found under the "working in EAMS" section of the DWC Web site. Click on the link and scroll down to the “For OCR form filers” banner.

3. Unassigned Case Numbers

Q: If I am filing a new case that has not yet been assigned a case number, do I still write "Unassigned" in the space for the case number?
A: No.  Check the "Yes" box at the top of the document cover sheet indicating a new claim, then leave any spaces for the case number blank.  EAMS will automatically assign a case number.

4. Injured Worker Has 2 New Injuries

Q: If an injured worker has two injuries, do I complete two separate cover sheets and would they be given two separate ADJ numbers?
A. Yes. For instance, if an injured worker had a specific injury to the right wrist on June 6, 2008 and a cumulative trauma (CT) injury to the right wrist, June 6, 2008, both the specific injury and the CT would each require a separate application packet and each would be designated with a separate ADJ number.

5. Amending Application According to Proof

Q: What if the date of injury changes? For instance, a worker injures his back reaching for a file at work on May 24, 2008 and he files a claim form with that specific date of injury. Later, a doctor examines the injured worker and tells him that his injury is NOT a specific injury, but is actually a cumulative trauma to the back, ending on his last day of work, August 4, 2008.
A: In that case, file an amended application form to reflect the change, but the ADJ number would stay the same. If there was a second injury, then a new application would have to be filed and the injured worker would be assigned a second ADJ number to reflect that new (as opposed to amended) date of injury.

6. Body Parts Injured

Q: If the injured worker has injured more than five body parts, do I insert Body Part Code #700 in the first slot?
A: No, be as specific as possible in the first four body part sections. Then, if there are still additional body parts affected, but not listed, insert Body Part Code #700 ("multiple parts more than five major parts") in the fifth position. The same is true for the other "misc" categories such as #140 – "Face – not specified," #198 – "Head – multiple injury any combination of above parts," #300 – "Upper Extremities – not specified," and #598 – "Lower Extremities  multiple parts any combination of above parts." List specific parts in first four sections, and the general category last.  Please do not hand write specific information such as "left wrist." That information can go in the "explain" section on page 3.

7. Document Separator Sheet for an ADJ Case Document Type

Q: In order to complete the line for document type, do I only have 4 choices: "LEGAL DOCS," "LIENS AND BILLS," "MEDICAL DOCS," and "MISC?"
A: Yes.

8. Document Separator Sheet – Document Title

Q: What is the "document title" for the following documents: fee disclosure statement, trial brief, report of VR expert?
A: The titles are as follows:

Fee disclosure statement = Document type "LEGAL DOCS," Document title "FEE DISCLOSURE STATEMENT"

Trial Brief = Document type "LEGAL DOCS," Document title "POINTS AND AUTHORITIES"

Report of VR Expert = Document type "MISC," Document title "CORRESPONDENCE"

9. Document Separator Sheet – Author

Q: If the document is a walk through document for the Judge to sign, is the Judge listed as the "author?"
A: No, the author of the walk through document is the "uniform assigned name" of the entity who prepared the document for walk through (assuming the entity is a claims administrator or representative).

10. Service of Application Packet

Q: Do I need a separator sheet before the proof of service? When I serve the entire packet on all the other parties, do I also need to include cover sheets & separator sheets?
A: When you file the proof of service for one document, you don't need a separator sheet between the document and proof of service. However, if you are serving MORE than one document, and the proof of service reflects that, you need a separator sheet between each document and the proof of service. It is not necessary to serve the cover sheet and separator sheet when you serve the related documents on the other parties in the case.

This blog has been approved by the California Division of Workers' Compensation.