California DWC-AD 10133.32 is the Supplemental Job Displacement Nontransferable Voucher form that a workers’ compensation claims administrator issues to an injured worker who suffers permanent partial disability and is not offered regular, modified, or alternative work by the employer. The form unlocks a $6,000 non-transferable voucher for retraining, skill enhancement, tools, computer equipment, and related licensing fees, and it applies to dates of injury on or after January 1, 2013 under Labor Code §4658.7.
The official form is hosted by the California Division of Workers’ Compensation forms library, and the regulation governing it lives at 8 CCR §10133.32. A California Workers’ Compensation Institute review found that more than 30,000 SJDB vouchers are issued each year, and a missed signature line or missing claims-administrator contact block is one of the most common reasons a voucher gets bounced back, delaying retraining by weeks. This guide walks you through every box, every signature, and every consequence.
- 📝 How to fill out every field of DWC-AD 10133.32 line by line, in plain English
- ⏰ The exact 60-day and 20-day deadlines that decide whether the voucher is owed
- 💵 How the $6,000 voucher splits across tuition, tools, computer, counseling, and miscellaneous expenses
- 🧾 Three full named-person walkthroughs covering the most common injury scenarios
- 🚫 The 10 mistakes that get vouchers rejected and how to avoid each one
What the Form Is and Who Must File It
DWC-AD 10133.32 is the official California voucher document used to deliver the Supplemental Job Displacement Benefit (SJDB) to an eligible injured worker. The form is required by 8 CCR §10133.32 and is the only document the Administrative Director of the DWC recognizes as a valid voucher for injuries on or after January 1, 2013. The current revision is dated 1/2013 and is printed on the bottom of every page of the official PDF.
The claims administrator (the insurance carrier or self-insured employer’s third-party administrator) prepares and signs the voucher. The injured worker signs to redeem it. The training provider, school, or vocational counselor signs and stamps the form when accepting it for payment. The form is not completed by the treating physician, but it is triggered by the physician’s permanent and stationary report under Labor Code §4061.
The voucher must be served on the injured worker within 20 days after the end of the 60-day window the employer has to make a bona fide offer of regular, modified, or alternative work, as confirmed in the Bradford & Barthel SJDB cheat sheet. If the employer does make a qualifying offer on form DWC-AD 10133.35, no voucher is owed and DWC-AD 10133.32 is not issued. The Dennis v. State of California WCAB en banc decision, summarized by RJY Law, confirmed that the offer must be bona fide to defeat entitlement.
Before You Start: Documents and Information You Need
Before you open the DWC-AD 10133.32 PDF, gather every document below. Missing any one of these usually triggers a rejection or a delay in the 45-day reimbursement clock under Labor Code §4658.7(d).
- Injured worker’s full legal name and address. It must match the name on the claim and on the worker’s ID. A mismatch will cause schools on the Eligible Training Provider List to refuse the voucher.
- WCAB case number (ADJ number). Without the ADJ number, the claims administrator’s ledger cannot tie the voucher to the claim, and reimbursements stall.
- Date of injury. Eligibility for the $6,000 voucher requires a date of injury on or after January 1, 2013. Earlier dates use the older voucher schedule from former Labor Code §4658.5.
- Employer name and FEIN. This identifies the policy and is required for the carrier’s recovery rights.
- Claims administrator name, adjuster, phone, and email. The voucher requires a live contact so schools can request direct payment.
- Permanent and stationary report (PR-4 or final med-legal). This is the trigger document; the 60-day offer clock starts when the carrier receives it, per Nolo’s SJDB summary.
- DWC-AD 10133.35 (Notice of Offer of Regular, Modified, or Alternative Work), if any. If the employer made a qualifying offer, no voucher issues; if not, attach the non-offer documentation.
- Date the voucher is being furnished. The two-year voucher expiration runs from this date.
- Date of injury for the five-year backstop. The voucher expires the later of two years after furnishing or five years after the date of injury, per Labor Code §4658.7(g).
- Worker’s preferred school or counselor. Pulled from the ETPL list or the DWC vocational counselor directory.
Where to Get the Form and How to Access It
The only authoritative copy of DWC-AD 10133.32 is the PDF posted on the Division of Workers’ Compensation forms page. The direct link to the English version is the official 10133.32 PDF, and the Spanish version is also available through the DWC SJDB forms folder.
The form is fillable but not e-signable through the DWC site. Most claims administrators print, complete, and serve it by U.S. Mail with a proof of service, by secure email or claims portal, or by fax, and they keep a stamped copy in the claim file. The form may be reproduced without a permit so long as the content is unchanged, as confirmed by 8 CCR §10133.32.
You should never download the form from a third-party site that hosts an outdated revision. The current revision date is 1/2013, printed at the bottom of every page. If your copy shows any other revision, replace it with the current version on the DWC site before serving it. An outdated revision is grounds for a school to refuse the voucher.
Step-by-Step: How to Fill Out DWC-AD 10133.32 Line by Line
The form is 5 pages. Page 1 is the voucher cover with employee, employer, and claims administrator information. Pages 2–4 contain the Voucher Expense Summary and itemized expense ledgers. Page 5 is the Request for Reimbursement of Up to $500 for Miscellaneous Expenses declaration. Each field below uses the exact label printed on the form, in the order it appears.
Field 1: Employee Name
This box asks for the full legal name of the injured worker as it appears on the claim file and government ID. Enter it last name first, then first name, then middle initial, in capital letters, exactly as the workers’ compensation claim docket reads.
For example, LOPEZ, MARIA E. is how Maria Lopez writes her name in this box. If she is also known as Maria Reyes-Lopez on her diploma, she should still use the legal name on the claim and add the AKA on the line below if space exists.
A common edge case is a worker who has changed their name after the injury. The voucher must use the legal name on file with the claims administrator, and the worker should attach a copy of the court-ordered name change so the school can match documents. A common mistake is writing only a first and last name with no middle initial, which causes the ETPL school to flag the voucher as a possible identity mismatch and pause direct payment.
A misconception some workers carry is that the name on the voucher must match a married name on a recent paystub. It does not. The name on the voucher must match the name on the WCAB claim, which is the name the carrier already uses for indemnity payments.
Field 2: Employee Address
This field captures the mailing address where the worker receives all workers’ compensation correspondence. Use the standard USPS format: street number and name on the first line, apartment or unit on the second line, then city, state, and ZIP on the third line.
A complete entry looks like 1428 W. 7TH ST., APT 3, LOS ANGELES, CA 90017. Do not abbreviate the city, and do not omit the apartment number, because the claims administrator uses this address to mail the reimbursement check.
The most common edge case is a worker with a P.O. Box. A P.O. Box is acceptable for mail, but the worker should add a physical residence address on a separate attachment so the school can verify California residency for ETPL eligibility. The most common mistake is entering an old address from before the injury, which causes reimbursement checks to be returned and the 45-day payment clock under Labor Code §4658.7(d) to restart.
A misconception is that the address can be the attorney’s address. It cannot. The voucher is non-transferable and must be mailed to the worker, even when the worker is represented.
Field 3: Claim Number
This box asks for the carrier-assigned claim number, not the WCAB ADJ number. The claim number is the internal file number the insurance company uses, and it is printed on every benefit notice the worker has received.
For example, WC-2025-0098765 is how a Sedgwick claim might appear in this field. Use exactly the format the carrier prints, including dashes and prefixes, because the carrier’s accounting system will not recognize variations.
The most common edge case is a claim that has been transferred between TPAs. If the claim number changed mid-claim, use the current claim number and reference the prior number in a cover letter so the file stays linked. A common mistake is writing the WCAB ADJ number here instead, which causes the carrier’s voucher-tracking software to fail to match the voucher to a claim and freezes payment.
A misconception is that the claim number and the ADJ number are interchangeable. They are not. The ADJ number is assigned by the WCAB EAMS system, while the claim number is assigned by the carrier.
Field 4: Date of Injury
This box requires the date of injury in MM/DD/YYYY format. For a cumulative trauma injury, use the last day of injurious exposure the parties have stipulated to or the date pleaded on the Application for Adjudication of Claim.
Maria Lopez, who fell from a ladder on March 14, 2024, writes 03/14/2024. If the date is contested, use the date alleged on the DWC-1 claim form until the WCAB resolves it.
The most common edge case is a date that crosses the January 1, 2013 statutory line. Only injuries on or after that date use this voucher; earlier injuries fall under the older Labor Code §4658.5 schedule. A common mistake is using the date the worker first reported the injury rather than the date of injury, which can shift the five-year backstop and shorten the voucher’s life.
A misconception is that the date of injury is the date the worker became permanent and stationary. It is not. The P&S date controls the 60-day offer clock; the date of injury controls voucher eligibility and expiration.
Field 5: Employer Name and Address
Enter the legal name of the employer at the time of injury, not the trade name or DBA, followed by the employer’s mailing address. The employer’s name controls subrogation and recovery rights under Labor Code §3852.
For example, ACME WAREHOUSE LOGISTICS, INC., 5500 E. SLAUSON AVE., COMMERCE, CA 90040 is the proper entry for a worker injured at Acme. If the employer has been acquired since the injury, use the entity that held the policy on the date of injury.
The most common edge case is a staffing-agency worker. The special employer (the worksite) and the general employer (the staffing agency) may both appear; list the carrier’s named insured. A common mistake is writing the parent corporation when the policy is held by a subsidiary, which causes the carrier to reject the voucher as not matching its policy file.
A misconception is that the employer’s name does not matter once the carrier accepts the claim. It still matters because the voucher is part of the claim file the carrier sends to the Workers’ Compensation Insurance Rating Bureau (WCIRB) for experience rating.
Field 6: Claims Administrator Name, Address, Phone, and Email
This block identifies the claims administrator that schools and counselors will contact for direct payment. Enter the legal entity name (e.g., Sedgwick Claims Management Services, Inc.), the mailing address for reimbursement requests, a live phone line, and an optional email.
A complete entry reads SEDGWICK CMS, P.O. BOX 14441, LEXINGTON, KY 40512, (800) 555-0123, sjdb@sedgwick.com. The phone number must be answered during business hours because the ETPL school typically calls before enrolling the worker.
The most common edge case is a self-insured employer that uses an in-house adjuster. List the in-house unit’s name and the adjuster’s direct line. A common mistake is leaving the email blank when the carrier prefers electronic invoices, which delays the 45-day reimbursement clock under Labor Code §4658.7(d).
A misconception is that the claims administrator can be the carrier’s broker. It cannot. The claims administrator is the entity licensed under 10 CCR §2592.01 to administer claims, not the broker that sold the policy.
Field 7: Date Voucher Furnished
This box anchors the two-year voucher expiration under Labor Code §4658.7(g). Enter the date the voucher is served on the injured worker, in MM/DD/YYYY format.
For example, if the carrier mails the voucher on 05/26/2026, that exact date goes in this box. The two-year expiration is calculated from this date, with the five-year-from-injury backstop as the alternative.
The most common edge case is a voucher that was prepared earlier than served. Use the service date, not the preparation date, because §4658.7(g) keys expiration to furnishing. A common mistake is leaving this field blank, which makes the voucher facially defective and unenforceable, as a school will not accept an undated voucher.
A misconception is that the two-year clock is absolute. The WCAB’s Lona v. Disneyland Resort decision, summarized by Sullivan on Comp, tolled the expiration during the COVID stay-at-home order, showing the clock can be equitably extended.
Field 8: Voucher Expiration Date
The expiration date is the later of two years after the Date Voucher Furnished or five years after the Date of Injury. Calculate both dates and enter the later one in MM/DD/YYYY format.
For Maria Lopez, with a date of injury of 03/14/2024 and a furnishing date of 05/26/2026, two years from furnishing is 05/26/2028 and five years from injury is 03/14/2029. The later date, 03/14/2029, goes in the box.
The most common edge case is a delayed voucher served years after the injury, where the two-year date is later than the five-year date. Use the two-year date in that situation. A common mistake is writing only the two-year date and ignoring the five-year backstop, which shortens the worker’s voucher rights.
A misconception is that the voucher dies the moment it expires. It does for new expenses, but expenses already incurred and submitted with documentation before expiration must still be paid, per §4658.7(g).
Field 9: Voucher Amount ($6,000)
The voucher amount is fixed at $6,000 for all injuries on or after January 1, 2013, regardless of the permanent disability rating. The form pre-prints this number; do not alter it.
The pre-printed $6,000.00 should remain untouched. Older sources sometimes describe a sliding scale ($4,000–$10,000) tied to PD rating; that scale applied only to pre-2013 dates of injury, as explained by Humphrey & Associates.
The most common edge case is a Return-to-Work Supplement of an additional $5,000 under Labor Code §139.48, which is a separate program administered by the DIR Return-to-Work Supplement Program and is not paid through this voucher. A common mistake is striking through the $6,000 to negotiate a higher amount; the voucher cannot be settled or commuted under §4658.7(g).
A misconception is that the voucher can be cashed out. It cannot. It is non-transferable and pays only for eligible educational and skill-building expenses.
Field 10: Claims Administrator Signature and Date
The adjuster or designee signs and dates the voucher to certify its issuance. The signature must be wet-ink or a digital signature that complies with California UETA.
A clean entry reads Jordan Patel, Senior Examiner, 05/26/2026. The printed name and title must accompany the signature so a school can verify authority.
The most common edge case is a voucher signed by a supervisor while the assigned adjuster is on leave. The supervisor must add their own title and a note that they sign in the assigned adjuster’s absence. A common mistake is using a stamped facsimile signature without authorization, which can void the voucher under Insurance Code §11760.
A misconception is that an unsigned voucher still triggers the worker’s two-year clock. It does not; an unsigned voucher is not furnished within the meaning of §4658.7(g).
Field 11: Employee Signature and Date
The injured worker signs and dates the voucher when redeeming it. The signature is required before any school, counselor, or vendor can submit invoices for direct payment.
Maria Lopez signs Maria E. Lopez, 06/02/2026 on the line. She uses the same name format she used in Field 1 to avoid mismatches.
The most common edge case is a worker who is unable to sign because of a disability. A power-of-attorney holder may sign with proof of authority attached. A common mistake is signing before selecting a school, which is harmless, but signing in the wrong block (the claims administrator’s block) voids the voucher and a fresh form must be issued.
A misconception is that the worker’s attorney can sign instead. The attorney cannot, because the voucher is non-transferable and personal to the worker.
Field 12: Voucher Expense Summary (Page 2)
Page 2 is the running ledger showing how much of the $6,000 has been used and how much remains across five expense categories. Each row shows the category cap, the amount spent, and the running balance.
The five categories are: tuition/fees/books/tools/required supplies (capped at the full $6,000 minus other category use), licensing/certification/exam fees (within the $6,000), vocational/return-to-work counselor and resume services (capped at $600), computer equipment (capped at $1,000), and miscellaneous expenses (capped at $500 and paid without receipts via Page 5), as detailed in the official 10133.32 PDF.
The most common edge case is a worker who tries to spend more than $1,000 on a laptop. The carrier pays $1,000 and the worker covers the balance personally; the carrier cannot exceed the cap. A common mistake is leaving the running balance blank, which causes the next vendor to over-bill and triggers a denial letter.
A misconception is that unused balances roll over after expiration. They do not, per §4658.7(g).
Field 13: Itemized Expense Ledger (Pages 3–4)
Pages 3 and 4 list each invoice with the vendor name, date, description, amount, and the category it draws from. The ledger is filled in by the claims administrator as it pays invoices.
A typical row reads Los Angeles Trade-Tech College, 06/15/2026, Welding I tuition, $1,250.00, Tuition. Each entry must include the vendor’s tax ID if the carrier issues a 1099-MISC.
The most common edge case is a vendor that is not on the ETPL list but is a California public school. Public schools qualify automatically and need not be on the ETPL. A common mistake is approving a vendor that is neither a California public school nor on the ETPL, which the carrier must claw back.
A misconception is that the worker can be reimbursed for transportation to school. They cannot under this voucher; mileage is paid only as medical mileage under Labor Code §4600.
Field 14: Page 5 — Request for Reimbursement of Up to $500 for Miscellaneous Expenses
Page 5 lets the worker claim up to $500 for miscellaneous expenses without receipts by signing a declaration under penalty of perjury. The declaration recites that the expenses were incurred for retraining or skill enhancement.
The worker writes the amount (e.g., $425.00), the date, and signs Maria E. Lopez under the perjury declaration. The carrier must pay within 45 days of receipt under Labor Code §4658.7(d).
The most common edge case is a worker who has already used the $500 cap. The cap is once-per-voucher, so a second declaration is rejected. A common mistake is failing to sign under penalty of perjury, which voids the request even if the dollar amount is correct.
A misconception is that the $500 is in addition to the $6,000. It is part of the $6,000, not on top of it.
Three Filled-Out Examples Using Real Scenarios
Scenario A: Carlos, Warehouse Worker, Permanent Restrictions, No Accommodation
Carlos Ramirez, age 42, ruptured a lumbar disc lifting a pallet at Acme Warehouse Logistics, Inc. on March 14, 2025. His treating doctor declared him P&S on April 1, 2026 with a permanent 20-pound lifting limit. Acme could not accommodate, so the carrier issued the voucher.
| Form Section | What Carlos Enters |
|---|---|
| Employee Name | RAMIREZ, CARLOS J. |
| Employee Address | 742 E. 41ST ST., LOS ANGELES, CA 90011 |
| Claim Number | WC-2025-0044118 |
| Date of Injury | 03/14/2025 |
| Employer Name and Address | ACME WAREHOUSE LOGISTICS, INC., 5500 E. SLAUSON AVE., COMMERCE, CA 90040 |
| Claims Administrator | SEDGWICK CMS, (800) 555-0123, sjdb@sedgwick.com |
| Date Voucher Furnished | 05/26/2026 |
| Voucher Expiration | 05/26/2028 |
| Voucher Amount | $6,000.00 (pre-printed) |
| Employee Signature | Carlos J. Ramirez, 05/30/2026 |
Scenario B: Aisha, Nurse, Modified Work Offered and Accepted
Aisha Johnson, a registered nurse at Bay Medical Center, suffered a needle-stick injury on June 1, 2025 and was P&S on March 1, 2026 with a permanent restriction against direct patient blood draws. Bay Medical offered modified work as a nursing-education coordinator at 100% of pre-injury wages on DWC-AD 10133.35. Because the offer was timely and bona fide, no voucher issued; the form below shows what would have issued if the offer had been rejected as non-bona-fide under Dennis, summarized by RJY Law.
| Form Section | What Aisha Enters |
|---|---|
| Employee Name | JOHNSON, AISHA M. |
| Employee Address | 1908 BROADWAY, OAKLAND, CA 94612 |
| Claim Number | BMC-25-7741 |
| Date of Injury | 06/01/2025 |
| Employer Name and Address | BAY MEDICAL CENTER, 2900 SUMMIT ST., OAKLAND, CA 94609 |
| Claims Administrator | INTERCARE HOLDINGS, (916) 555-0199 |
| Date Voucher Furnished | 05/26/2026 |
| Voucher Expiration | 06/01/2030 (5-year-from-injury backstop) |
| Voucher Amount | $6,000.00 |
| Employee Signature | Aisha M. Johnson, 06/05/2026 |
Scenario C: Janet, Office Worker, Cumulative Trauma, Employer Out of Business
Janet Pham, age 55, suffered a cumulative-trauma carpal tunnel injury with last day of injurious exposure December 31, 2024 at Pinewood Realty, LLC, which closed in 2025. Her doctor found permanent partial disability and no offer of work was possible, so the carrier issued the voucher.
| Form Section | What Janet Enters |
|---|---|
| Employee Name | PHAM, JANET T. |
| Employee Address | 3201 LAKE BLVD., APT 14, SACRAMENTO, CA 95821 |
| Claim Number | PR-2025-002298 |
| Date of Injury | 12/31/2024 |
| Employer Name and Address | PINEWOOD REALTY, LLC, 4400 J ST., SACRAMENTO, CA 95819 |
| Claims Administrator | GALLAGHER BASSETT, (800) 555-0145 |
| Date Voucher Furnished | 05/26/2026 |
| Voucher Expiration | 05/26/2028 |
| Voucher Amount | $6,000.00 |
| Employee Signature | Janet T. Pham, 06/01/2026 |
How to File the Completed Form
The claims administrator delivers the voucher to the worker; the worker then presents it to a school or counselor; the school invoices the claims administrator. There are four working channels for moving the form, and each has its own proof of delivery you should keep.
By U.S. Mail. Mail the original voucher to the worker’s address with a DWC Proof of Service attached. Postage is paid by the carrier and there is no filing fee. Expect 3–5 business days. Keep the certified-mail green card as proof of service.
By Secure Email or Claims Portal. Most large carriers (Sedgwick, Gallagher Bassett, Intercare) deliver via portal under 10 CCR §10205. There is no fee. Delivery is instantaneous. Save the portal receipt PDF as proof.
By Fax. Some smaller carriers still fax the voucher to the worker’s representative, with a confirmation sheet. No fee, no processing time. Keep the transmission report.
In Person. Hand-delivery at a deposition or hearing is permitted; the worker signs an acknowledgment. The acknowledgment is the proof of service. Reimbursement requests, once invoices are submitted, must be paid within 45 days under Labor Code §4658.7(d) regardless of channel.
What Happens After You File
Once the voucher is served, the worker has up to two years (or five years from injury, whichever is later) to use it. The worker selects a school from the Eligible Training Provider List or a California public school, or a counselor from the DWC vocational counselor directory.
The school invoices the claims administrator directly using the voucher number and claim number. The claims administrator pays within 45 days under Labor Code §4658.7(d). Disputes about voucher entitlement go to the WCAB under the Dennis en banc precedent, summarized by RJY Law, which placed adjudication with the WCAB rather than the Administrative Director.
The worker may also be eligible for the additional $5,000 Return-to-Work Supplement administered by DIR. That program has its own application and a one-year deadline from voucher issuance.
Mistakes to Avoid When Filling Out the Form
- Using an outdated revision. The current revision is 1/2013; an older form is invalid and a school will refuse it.
- Leaving the Date Voucher Furnished blank. Without this date the two-year clock cannot run and the voucher is facially defective.
- Computing the wrong expiration date. Using only the two-year date and ignoring the five-year-from-injury backstop shortens the worker’s rights.
- Wrong employer name. Listing a parent or DBA instead of the named insured kicks the voucher back from the carrier’s policy file.
- Missing claims administrator phone. Schools cannot verify direct payment authority and refuse the voucher.
- Worker signs in adjuster block. Signing in the wrong block voids the voucher; a fresh one must be issued.
- Stamped signature without authorization. Voids the voucher under Insurance Code §11760.
- Trying to settle the voucher in a C&R. Prohibited by §4658.7(g); the C&R term is unenforceable.
- Approving a non-ETPL, non-public-school vendor. The carrier must claw the payment back from the worker.
- Skipping the perjury declaration on Page 5. The $500 miscellaneous reimbursement is denied even if the dollar amount is correct.
- Missing the 20-day issuance window. Issuance more than 20 days after the 60-day offer window risks penalties under Labor Code §5814.
- Confusing claim number with ADJ number. The carrier’s accounting cannot match the voucher and pay stalls.
Do’s and Don’ts
- Do verify the form revision date is 1/2013 before serving, because schools reject older versions.
- Do use the worker’s legal name on the WCAB claim, because the ETPL cross-checks ID.
- Do calculate both the two-year and five-year expiration dates and use the later one.
- Do include a live phone number and email for the claims administrator, because schools call before enrolling.
- Do keep proof of service (certified mail receipt or portal screenshot), because the WCAB demands it in disputes.
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Do issue within 20 days of the end of the 60-day offer window, because late issuance triggers §5814 penalties.
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Don’t alter the pre-printed $6,000 amount, because the voucher cannot be settled or commuted.
- Don’t include the voucher in a Compromise & Release, because §4658.7(g) prohibits it.
- Don’t send the voucher to the worker’s attorney instead of the worker, because the voucher is non-transferable.
- Don’t approve vendors that are not California public schools or on the ETPL, because the carrier must claw payment back.
- Don’t leave Page 5 blank when the worker requests miscellaneous expenses, because the perjury declaration is mandatory.
- Don’t assume the voucher rolls over past expiration, because unused balances die at expiration.
Pros and Cons of Filing on Your Own vs. With Help
- Pro (self-filing): No attorney fee comes out of the voucher because vouchers are non-commutable.
- Pro (self-filing): The worker controls school choice through the ETPL list.
- Pro (self-filing): Direct contact with the adjuster speeds reimbursement under the 45-day rule.
- Pro (self-filing): The worker keeps the entire $6,000 for retraining.
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Pro (self-filing): The form is short (5 pages) and accessible on the DWC site.
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Con (self-filing): Disputes over bona fide offers under Dennis can require WCAB litigation, which is hard pro se.
- Con (self-filing): Calculating the later of the two-year and five-year expirations confuses many workers.
- Con (self-filing): Tracking the $600/$1,000/$500 sub-caps requires ledger discipline.
- Con (self-filing): Late issuance penalties under §5814 require legal pleading to recover.
- Con (self-filing): Coordinating the Return-to-Work Supplement requires a separate application.
Voucher vs. Return-to-Work Supplement at a Glance
| Feature | DWC-AD 10133.32 Voucher / §4658.7 — $6,000 for retraining, paid as a non-transferable voucher |
|---|---|
| Return-to-Work Supplement | DIR RTWSP / §139.48 — $5,000 cash supplement, separate one-year application |
| Trigger | Voucher: PD with no bona fide offer of work; RTWSP: receipt of voucher |
| Form | Voucher: DWC-AD 10133.32; RTWSP: online application at DIR |
| Expiration | Voucher: 2 years from furnishing or 5 years from injury, whichever is later; RTWSP: 1 year from voucher issuance |
FAQs
Is DWC-AD 10133.32 the only voucher form for California injuries on or after January 1, 2013?
Yes. It is the exclusive Administrative-Director-approved voucher under 8 CCR §10133.32 and Labor Code §4658.7.
Can the voucher be settled in a Compromise & Release?
No. Labor Code §4658.7(g) prohibits commuting or settling the SJDB voucher; any C&R term to that effect is unenforceable.
Is the voucher worth more than $6,000 for severe disabilities?
No. The amount is fixed at $6,000 regardless of PD rating for injuries on or after January 1, 2013, unlike the older sliding scale under former §4658.5.
Do I write my legal name or my school-records name in the Employee Name box?
Yes. Use the legal name on the WCAB claim file, because the ETPL school cross-checks the voucher name against your government ID.
Should I list the staffing agency or the worksite in Employer Name?
Yes, list the carrier’s named insured employer on the date of injury, which is usually the staffing agency for staffing-agency workers.
Can I write my attorney’s address in Employee Address?
No. The voucher is non-transferable and must be mailed to the worker; an attorney address voids service.
Is the Date Voucher Furnished the date the form was prepared?
No. It is the date the voucher is served on the worker, because §4658.7(g) keys expiration to furnishing.
Can the $1,000 computer cap be raised?
No. The $1,000 limit is set by regulation, but the worker may pay the overage personally and keep the equipment.
Does the $500 miscellaneous request require receipts?
No. Page 5 requires only a perjury declaration, not receipts, for up to $500.
Will the carrier pay schools directly?
Yes. Schools on the ETPL and California public schools invoice the claims administrator, which pays within 45 days under §4658.7(d).
Does the voucher expire if the worker doesn’t sign by a certain date?
Yes. It expires the later of two years after furnishing or five years after the date of injury under §4658.7(g).
Can I get the voucher if my employer offered modified work?
No. A timely, bona fide offer of regular, modified, or alternative work on DWC-AD 10133.35 defeats voucher entitlement, per Dennis as summarized by RJY Law.
Is the Return-to-Work Supplement paid through this same form?
No. The $5,000 RTWSP supplement is a separate application administered by DIR under Labor Code §139.48.
Do disputes about the voucher go to the Administrative Director?
No. After Dennis, voucher disputes are adjudicated by the WCAB, not the Administrative Director.
Related reading
- How to Fill Out California WCAB DWC-1 (w/Examples) + FAQs
- How to Fill Out California WCAB Stipulation with Request for Award + FAQs
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