The California WCAB Mandatory Settlement Conference Statement is the official Division of Workers’ Compensation form (DWC-CA Form 10250.1) that every party must complete, sign, and serve before the Mandatory Settlement Conference (MSC) so the workers’ compensation judge can see the disputed issues, stipulations, witnesses, and exhibits in one place. The form is required under Labor Code § 5502 and 8 CCR § 10759, and missing or sloppy entries can lock you out of evidence at trial because discovery closes the day of the MSC.
Filing this form wrong has real consequences. According to the DWC’s most recent WCAB caseload data, more than 220,000 cases reach an MSC each year in California, and judges routinely strike witnesses or exhibits that were not listed on the statement. Here is what this guide unpacks:
- 📋 What the MSC Statement is and exactly who must file it
- 🗂️ The documents and information you need to gather before opening the form
- ✍️ A line-by-line walkthrough of every box on DWC-CA 10250.1
- 👥 Three real filer scenarios (pro se worker, applicant attorney, defense attorney)
- ⚠️ The most common field-level mistakes and how to avoid them
What the MSC Statement Is and Who Must File It
The Mandatory Settlement Conference Statement is a pre-trial pleading filed in California workers’ compensation cases. It tells the workers’ compensation administrative law judge (WCJ) what is agreed, what is disputed, and what evidence each side will use if the case does not settle. The form is published by the Division of Workers’ Compensation and is also called the Pre-Trial Conference Statement when carried into trial.
Every party to a workers’ compensation claim that has been set for an MSC must file one. That includes the injured worker (called the applicant), the employer or its insurance carrier (the defendant), and any lien claimants who want to be heard. Pro se filers, applicant attorneys, defense attorneys, and claims adjusters all use the same DWC-CA 10250.1 form. The MSC itself is required by Labor Code § 5502(d) within 30 days after a Declaration of Readiness to Proceed is filed.
The MSC has three jobs: settle the case, narrow the issues if it does not settle, and close discovery. Under 8 CCR § 10353, the parties must file a settlement conference statement signed by the attorney or representative who will try the case. The statement must list every issue, stipulation, witness, and exhibit. Anything not listed is generally barred from trial unless the party shows it was unavailable through due diligence.
A common misconception is that the form is optional or that the judge will accept an oral statement at the MSC. That belief is wrong. The WCJ can issue sanctions under Labor Code § 5813 and 8 CCR § 10421 if a party shows up without a written, served statement.
Before You Start: Documents and Information You Need
Before you open DWC-CA 10250.1, gather the paperwork below. Missing any one of these items is the top reason MSC statements get rejected or amended on the day of the conference.
- ADJ case number. This is the EAMS case number assigned by the WCAB district office. Without it the form cannot be filed in EAMS. If you skip it, the clerk will reject the filing.
- Date of injury. Specific injuries need a single date; cumulative trauma claims need a range under Labor Code § 5412. The wrong date can void stipulations.
- Body parts claimed. List every body part on the claim form DWC-1 and any later amendments. Leaving one off can bar future medical care for that part.
- Names of all parties and attorneys. Use the exact names that appear in EAMS. A name mismatch creates an EAMS service error.
- All medical reports and QME/AME reports. Each report becomes a numbered exhibit. Reports not listed are usually excluded under Labor Code § 5502(d)(3).
- Wage statements and earnings records. These set the average weekly wage and TD/PD rates.
- Witness list with full names and addresses. Unlisted witnesses cannot testify at trial absent good cause.
- Settlement demand or offer. 8 CCR § 10353 requires a good-faith settlement position before the MSC.
- Lien information. Every lien claimant of record must be served, or the lien may be barred.
- Permanent disability rating string. If PD is in dispute, you need the most recent rating from the Disability Evaluation Unit.
The pre-filing checklist matters because the WCJ uses the MSC Statement to decide whether the case is ready for trial. Maria Lopez, a pro se warehouse worker, lost a chiropractic exhibit at trial because she forgot to attach the report to her statement. The judge cited Labor Code § 5502(d)(3) and refused to admit it.
Where to Get the Form and How to Access It
The official MSC Statement is hosted on the DWC’s forms page as a fillable PDF labeled DWC-CA Form 10250.1. The current revision date is printed in the lower-left corner of page one. Always check that you are using the latest version because older revisions miss the current Issues in Dispute checkboxes.
You can also get the form from the WCAB district office closest to where the injury happened. Each district office, from Anaheim to Van Nuys, keeps printed copies at the public counter. Pro se filers often pick up paper forms because EAMS has a steeper learning curve.
Attorneys file through EAMS, which lets them upload the PDF as a document type called “Pre-Trial / Settlement Conference Statement.” Pro se filers may file by mail, in person at the district office, or hand the form to the WCJ at the start of the MSC. Each channel produces a different proof of filing, which matters if the file later gets lost.
A misconception is that the form changes by district. It does not. The form is statewide, although local rules at offices like Los Angeles, Oakland, and San Diego can add posting deadlines that pile on top of the state rule.
Step-by-Step: How to Fill Out DWC-CA 10250.1 Line by Line
The form is organized into a caption block, an issues block, a stipulations block, witness and exhibit lists, and a signature block. Use one H3 per field below and follow the entries exactly.
Case Caption: Applicant’s Name
The form asks for the injured worker’s full legal name. Type the name exactly as it appears on the original DWC-1 claim form and in EAMS. Use first name, middle initial, and last name in capital letters: MARIA E. LOPEZ.
If the worker has changed names since the injury (marriage, divorce, court order), put the current legal name on the line and list the prior name in parentheses. A common mistake is using a nickname, which causes EAMS to reject the filing because the name will not match the case record. The misconception that “close enough” works has cost filers entire hearing dates.
Case Caption: Defendant’s Name
Enter the employer and the insurance carrier or third-party administrator on the line for the defendant. Use the names exactly as they appear on the Notice of Insurance Coverage and in EAMS, such as ACME WAREHOUSING, INC. / TRAVELERS PROPERTY CASUALTY CO. OF AMERICA.
If the employer is uninsured, write UNINSURED EMPLOYERS BENEFITS TRUST FUND and list the UEBTF as a defendant. The most common error is naming only the employer and not the carrier, which means the carrier never gets served and the MSC may be continued. The misconception that “the employer can pass it on” is wrong; service must be direct.
Case Caption: ADJ Number
This is the EAMS case number that begins with the letters ADJ followed by seven or eight digits, for example ADJ12345678. You can find it on any prior Notice of Hearing or by searching the public information case search tool.
If you have multiple injuries, list every ADJ number that has been consolidated. Forgetting a consolidated case number means that case will not be addressed at the MSC and may need a separate conference. A misconception is that the older “WCK” or “STK” district numbers still work; they do not, and EAMS will reject them.
Case Caption: Date of Injury
Write the date of injury in MM/DD/YYYY format. For a specific injury, enter the single date, for example 03/14/2024. For a cumulative trauma, enter the range from the earliest exposure to the date the worker knew the injury was work-related under Labor Code § 5412.
A common mistake is using the date the worker stopped working instead of the statutory date of injury for a cumulative trauma. The wrong date changes the applicable PD schedule and can wipe out tens of thousands of dollars in benefits. The misconception that “the last day worked” is the date of injury is one of the most expensive errors on this form.
Issues in Dispute
The form lists checkbox issues such as injury AOE/COE, parts of body injured, temporary disability, permanent disability, apportionment, future medical care, self-procured medical, liability for medical-legal costs, attorney fees, credit, Labor Code § 4061/4062 disputes, and earnings. Check every box that is actually disputed and leave unchecked the boxes the parties already agree on.
For each box you check, write a short narrative on the lines provided. Example: “PD apportionment under Labor Code § 4663 is disputed because the QME apportions 30% to a prior 2019 lumbar injury.”
A nuance arises when an issue is partly settled. List the narrowed dispute, such as “TD rate only, period agreed.” A common mistake is checking every box “to be safe,” which signals to the WCJ that nothing has been narrowed and can result in the case being taken off calendar. The misconception that adding issues helps the worker is wrong; it usually backfires by triggering a Labor Code § 5502.5 declaration of readiness denial.
Stipulations
Stipulations are facts the parties agree on, such as employment, insurance coverage, average weekly wage, and benefits already paid. Write them in numbered short sentences: “1. Maria Lopez was employed on 03/14/2024 by Acme Warehousing, Inc.”
If a fact is partially agreed, stipulate to the agreed part and list the rest as a disputed issue. The most common mistake is stipulating to the AWW without confirming the underlying wage statement, which can lock the worker into a low TD rate. The misconception that stipulations can be undone after the MSC is wrong; under 8 CCR § 10491, they bind the parties unless set aside for good cause.
Documentary Evidence / Exhibits
List every document you intend to offer at trial. Number applicant exhibits with numerals (1, 2, 3) and defense exhibits with letters (A, B, C). Include the author, title, and date of each report: “Applicant’s Exhibit 4: PQME report of Dr. Patel, dated 11/02/2025.”
Attach copies if filing by paper, or upload them in EAMS as separate documents. The number-one trial mistake is leaving a medical report off the list, which triggers exclusion under Labor Code § 5502(d)(3). The misconception that you can add exhibits at trial is only true on a narrow “good cause” showing.
Witnesses
List every witness who may testify, with full name, address, and a short description of the testimony. Example: “Carlos Mendez, foreman, 1200 Industrial Way, Fontana, CA 92335 — will testify to the date and circumstances of the injury.”
Listing the applicant and a defense doctor is standard, but third-party witnesses must also be named. Failure to list a witness usually results in exclusion at trial under the same § 5502(d)(3) bar. A common misconception is that “rebuttal witnesses” do not need to be listed; they do.
Settlement Demand and Offer
The form requires both sides to state a good-faith settlement position. Write a single dollar figure plus the type of settlement: “Applicant demands $85,000 by Compromise and Release” or “Defendant offers Stipulations with Request for Award at 22% PD plus future medical.”
If you do not have authority, write “no authority at this time” and explain why. The mistake of leaving the demand or offer blank can trigger sanctions under Labor Code § 5813. The misconception that the demand is confidential is wrong; the WCJ reads it.
Discovery Status
Confirm that discovery is complete. Most forms have a checkbox stating that all medical reports, depositions, and subpoenas have been completed. Initial the box only if every report listed in your exhibits has been served on the other side.
If discovery is not complete, request a continuance under 8 CCR § 10748 before the MSC. The mistake of certifying discovery is closed when it is not can lead to exclusion of late-arriving reports. The misconception that the MSC “automatically reopens” discovery is wrong; the Labor Code § 5502(d)(3) bar is hard to overcome.
Signature Block
The attorney or representative who will try the case must sign and date the statement. Pro se filers sign their own name. Print the name, sign, list the State Bar number if an attorney, and write the date in MM/DD/YYYY format.
A nuance is that paralegals cannot sign for the trial attorney, even with permission. Doing so violates 8 CCR § 10759. A misconception is that an electronic image of a signature is invalid; a typed “/s/ Jane Doe” is accepted in EAMS.
Proof of Service
Attach a proof of service listing every party served, the date, and the method (mail, personal delivery, or EAMS service). Use Judicial Council form or the DWC proof of service template.
Forgetting to serve a lien claimant is the most common service error and can void any later lien resolution. The misconception that EAMS automatically serves everyone is wrong; you still must select each party.
Three Filled-Out Examples Using Real Scenarios
Scenario 1: Maria Lopez, Pro Se Warehouse Worker
Maria filed a specific-injury claim for a back strain on March 14, 2024. She has one PQME report and one wage statement.
| Form Section | What Maria Enters |
|---|---|
| Applicant’s Name | MARIA E. LOPEZ |
| Defendant | ACME WAREHOUSING, INC. / TRAVELERS PROPERTY CASUALTY |
| ADJ Number | ADJ18765432 |
| Date of Injury | 03/14/2024 |
| Issues in Dispute | Permanent disability, future medical, apportionment |
| Stipulations | Employment, AWW $980, TD paid through 09/01/2024 |
| Exhibits | 1. PQME report Dr. Patel 11/02/2025; 2. Wage statement |
| Witnesses | Maria Lopez (applicant); Carlos Mendez (foreman) |
| Demand | $45,000 Compromise and Release |
| Signature | Maria Lopez, 05/12/2026 |
Scenario 2: Janet Reyes, Applicant Attorney with Cumulative Trauma
Janet represents a hospital nurse with a CT claim covering 2018 to 2024 across three body parts.
| Form Section | What Janet Enters |
|---|---|
| Applicant’s Name | AISHA JOHNSON |
| Defendant | MERCY HOSPITAL / SEDGWICK CMS |
| ADJ Number | ADJ20114455 (consolidated with ADJ20114456) |
| Date of Injury | 01/01/2018 through 06/30/2024 (CT) |
| Issues in Dispute | AOE/COE for shoulders, PD, apportionment, § 4660.1 rebuttal |
| Stipulations | Employment, insurance coverage, AWW $1,950 |
| Exhibits | 1–7 AME reports of Dr. Kim; 8 Job description; 9 DEU rating |
| Witnesses | Aisha Johnson; Dr. Kim (AME); HR director Linda Park |
| Demand | $220,000 Stipulations at 48% PD plus FMC |
| Signature | /s/ Janet Reyes, SBN 234567, 05/15/2026 |
Scenario 3: Marcus Lee, Defense Attorney on a Denied Claim
Marcus defends an insurance carrier on a denied psychiatric claim and disputes AOE/COE under Labor Code § 3208.3.
| Form Section | What Marcus Enters |
|---|---|
| Applicant’s Name | DAVID NGUYEN |
| Defendant | CITYWIDE LOGISTICS / ZURICH AMERICAN INSURANCE |
| ADJ Number | ADJ19887766 |
| Date of Injury | 07/22/2023 |
| Issues in Dispute | AOE/COE, § 3208.3 good faith personnel action, statute of limitations |
| Stipulations | Employment only |
| Exhibits | A QME report Dr. Singh; B Personnel file; C Termination letter |
| Witnesses | David Nguyen; HR manager Sandra Boyd; Supervisor Tom Riley |
| Offer | Take-nothing; alternatively $7,500 C&R nuisance value |
| Signature | /s/ Marcus Lee, SBN 345678, 05/18/2026 |
How to File the Completed Form
You can file the MSC Statement through four channels. Pick the one that matches your role and timeline.
The EAMS portal at eams.dwc.ca.gov is the standard channel for attorneys. There is no filing fee. Upload the signed PDF as document type “Pre-Trial / Settlement Conference Statement,” choose the correct ADJ case, and select every party for service. Processing is immediate, and the EAMS confirmation email is your proof of filing. Keep that email.
Filing by mail sends the original signed form to the WCAB district office handling the case. Find the address on the district offices page. There is no fee. Use certified mail with return receipt; the green card is your proof of filing. Allow seven to ten days for the clerk to docket the statement.
Filing in person means walking the form to the public counter of the district office. The clerk stamps a conformed copy and hands it back. Bring two copies, one to file and one to keep. There is no fee, and the conformed stamp is your proof of filing.
Filing at the hearing is a last resort allowed under local practice. Hand the original to the WCJ and a copy to opposing counsel. The judge initials your copy as proof. Filing this late risks exclusion of any unlisted exhibit or witness because discovery has already closed.
What Happens After You File
Once the statement is on file, the WCJ reviews both sides’ statements before the MSC. The judge looks for narrowed issues, a realistic settlement range, and confirmation that discovery is closed. If the case is not ready, the judge can take it off calendar under 8 CCR § 10755.
At the MSC, the parties either settle or get an order setting the case for trial. If the case settles, the WCJ reviews a Compromise and Release or Stipulations with Request for Award the same day. If it goes to trial, the Pre-Trial Conference Statement becomes the trial roadmap, and the parties are bound to the witnesses and exhibits listed.
After the MSC, expect a Notice of Trial within 30 to 75 days. Trial dates run shorter or longer depending on the district office; Los Angeles and Oakland tend to be the busiest, while smaller offices like Eureka and Bakersfield can set sooner. Always confirm the trial date in EAMS.
Mistakes to Avoid When Filling Out the Form
- Leaving exhibits off the list. The exhibit will be excluded at trial under Labor Code § 5502(d)(3).
- Skipping a witness. Unlisted witnesses cannot testify, sinking your factual case.
- Wrong date of injury for cumulative trauma. It changes the applicable PD schedule and can cost five-figure benefits.
- Naming only the employer, not the carrier. Service fails and the MSC is continued.
- Checking every issue in dispute “to be safe.” The judge takes the case off calendar for not narrowing issues.
- Stipulating to AWW without verifying wages. The TD/PD rate gets locked in too low.
- Filing without a signed Proof of Service. The clerk rejects the filing and you lose your hearing date.
- Certifying discovery is closed when reports are still pending. Late reports get excluded.
- Leaving the settlement demand or offer blank. Sanctions under Labor Code § 5813 follow.
- Using the wrong ADJ number. EAMS rejects the filing and the case is not heard.
- Letting a paralegal sign. 8 CCR § 10759 requires the trial attorney’s signature.
- Forgetting to serve lien claimants. Lien resolutions can be voided.
Do’s and Don’ts
- Do file early so the WCJ has time to read it; judges often skim same-day filings.
- Do match every name to EAMS exactly; a single typo causes service failures.
- Do number exhibits in the order you will use them at trial.
- Do state a real settlement number, even a low one, to satisfy the good-faith rule.
- Do confirm the form revision date on the DWC forms page.
- Do keep a conformed or EAMS-stamped copy for your records.
- Don’t check issues that are not actually in dispute; it triggers off-calendar orders.
- Don’t wait until the morning of the MSC to draft the form; you will miss exhibits.
- Don’t rely on oral stipulations; the WCJ wants them in writing.
- Don’t assume EAMS serves everyone; you must select each party.
- Don’t sign for another attorney; the signature must be the trial attorney’s.
- Don’t ignore lien claimants; they can derail settlement at the MSC.
Pros and Cons of Filing on Your Own vs. With Help
- Pro (self): No attorney fee carved out of your award.
- Pro (self): Full control over the language of stipulations and demands.
- Pro (self): Faster decisions because you do not wait on counsel.
- Pro (self): You learn the system, which helps if you face future claims.
- Pro (self): You speak directly with the WCJ at the MSC.
- Con (self): You may miss field-level traps like CT date of injury.
- Con (self): Defense attorneys are trained to use § 5502(d)(3) against you.
- Con (self): No one to negotiate the AWW or PD apportionment for you.
- Con (self): You must serve every party, including liens, correctly.
- Con (self): A bad stipulation is binding under 8 CCR § 10491.
Filing Channel Comparison
| Channel | Key Features |
|---|---|
| EAMS Online | Free, immediate docketing, email confirmation, attorney standard |
| Free, slower, certified mail recommended for proof | |
| In Person | Free, conformed copy at the counter, district office hours apply |
| At Hearing | Last resort, judge initials, risks exclusion of unlisted items |
Key Entities That Interact With This Form
The Division of Workers’ Compensation publishes the form, and the Workers’ Compensation Appeals Board hears the case. The Disability Evaluation Unit issues PD ratings used in stipulations. The Medical Unit supplies QME panels referenced in disputed issues. The Information and Assistance Unit helps pro se filers. The Uninsured Employers Benefits Trust Fund appears as a defendant when the employer carried no insurance.
Recap of Key Authority
The leading authority on exhibit and witness exclusion is San Bernardino Community Hospital v. WCAB (McKernan) (1999) 74 Cal.App.4th 928, which enforces the Labor Code § 5502(d)(3) bar. The WCAB en banc decision in Hamilton v. Lockheed (2001) 66 CCC 473 sets the framework judges still use for evaluating evidence at the MSC. Both cases stand for the same idea: list it on the MSC Statement or lose it.
FAQs
Do I have to file an MSC Statement if I am pro se?
Yes. Every party at the MSC must file a written statement under 8 CCR § 10353, including injured workers without attorneys, or risk sanctions and continuance.
Can I add an exhibit after the MSC?
No. Under Labor Code § 5502(d)(3), late exhibits are barred unless you prove the document was unavailable through due diligence.
Is there a filing fee for DWC-CA 10250.1?
No. California workers’ compensation filings have no fee; the WCAB does not charge to file an MSC Statement through EAMS, mail, or in person.
Do I list my own client as a witness in Box 7?
Yes. The applicant must be listed as a witness if you expect testimony at trial; unlisted, even the applicant can be barred from the stand.
Should I write the date of injury for a cumulative trauma in Box 4 as a single date?
No. Use a date range from earliest exposure to the Labor Code § 5412 date of knowledge; a single date can void stipulations.
Do I check every Issues in Dispute box to protect my client?
No. Check only the boxes truly in dispute; over-checking signals a non-narrowed case and judges often take it off calendar.
Can a paralegal sign the statement for the trial attorney?
No. 8 CCR § 10759 requires the signature of the attorney who will try the case, and a paralegal signature can void the filing.
Is an electronic “/s/” signature valid in EAMS?
Yes. EAMS accepts a typed “/s/ Name, SBN” signature on the PDF, and the attorney remains responsible for accuracy.
Do I need to serve lien claimants with the MSC Statement?
Yes. All lien claimants of record must be served, or any later lien resolution may be set aside for failure of service.
Can I list “to be determined” as my settlement demand?
No. 8 CCR § 10353 requires a good-faith number; “TBD” can trigger sanctions under Labor Code § 5813.
Do I have to attach exhibits, or just list them?
Yes. When filing by mail or in person, attach copies; in EAMS, upload each exhibit as a separate document so the judge and opposing party can read them.
Can I amend the statement after the MSC if I forgot a witness?
No. Amendments are only allowed on a “good cause” showing of unavailability, and judges rarely grant them under the McKernan standard.
Is the MSC Statement the same as the Pre-Trial Conference Statement?
Yes. California uses the same DWC-CA 10250.1 form for both, and the document carried into trial is the binding pleading on issues, witnesses, and exhibits.
What happens if I miss the MSC entirely?
No good outcome follows; the WCJ can issue a notice of intention to dismiss under 8 CCR § 10888 or order sanctions, and your case can be taken off calendar.
Related reading
- How to Fill Out California WCAB Application for Adjudication of Claim + FAQs
- How to Fill Out California WCAB Compromise and Release + FAQs
- How to Fill Out California WCAB Declaration of Readiness to Proceed + FAQs
- How to Fill Out California WCAB Petition to Terminate Liability + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs
- How to Fill Out California WCAB Notice of Appearance (w/Examples) + FAQs