How to Fill Out California WCAB Request for Increased Permanent Disability + FAQs

The California WCAB Petition to Reopen (DWC/WCAB Form 42, Rev. 8-85) is the document an injured worker files with the Workers’ Compensation Appeals Board to request increased permanent disability benefits when a prior injury has caused new and further disability. It is filed under Labor Code §5410, and it must be filed within five years of the date of injury or the WCAB loses jurisdiction to award more permanent disability.

If your back, shoulder, knee, or psyche injury has gotten worse since your award, this form is how you ask the judge to reopen your case and pay you more. Filing it correctly can mean the difference between thousands of dollars in additional permanent disability indemnity and a denied petition. The WCAB receives thousands of petitions to reopen each year, and a 2024 review of DWC panel decisions shows that a large share are denied for missing the five-year statute or failing to attach a medical report showing a demonstrable change in condition.

Here is what you will learn in this guide:

• 📝 How to fill out every box on DWC/WCAB Form 42 line by line
• ⏰ The exact five-year deadline rules under Labor Code §§5410, 5803, and 5804
• 📎 Which medical reports and attachments must travel with the petition
• 💻 How to file through EAMS JET File, OCR upload, mail, or in person
• ⚖️ Three real scenarios showing what a worker writes on the form

What the Form Is and Who Must File It

The Petition to Reopen is the pleading that invokes the WCAB’s continuing jurisdiction under Labor Code §5410 for new and further disability, or under Labor Code §5803 for good cause. The form itself is short, but it is governed by 8 CCR §10536, which requires the petitioner to set forth specifically and in detail the facts that support new and further disability.

Any party with an interest in a closed workers’ compensation case can file it. Most often it is the injured worker (the applicant) who wants more permanent disability money because the original injury has worsened. Defendants and lien claimants can also file when good cause exists, such as a clerical error in the original Findings & Award.

The form is paired with the Application for Adjudication of Claim when no prior case exists. When a prior ADJ case is on file, the petition is filed inside that same case number so the WCAB can pull the existing record.

The injured worker carries the burden of proving a demonstrable change in condition before the five-year mark, as the Court of Appeal held in Applied Materials v. WCAB (2021) 64 Cal.App.5th 1042. The petition is the trigger, but the medical evidence is the engine.

Before You Start: Documents and Information You Need

Pulling these items before you open the form keeps the petition tight and reduces the chance of summary dismissal under 8 CCR §10455.

• Original ADJ case number. Each WCAB case has an ADJ number assigned in EAMS. Without it, the petition cannot be linked to the closed file.
• Date of injury. This is the anchor date for the five-year statute under §5410. Specific injuries use the trauma date; cumulative trauma uses the §5412 date of injury.
• Prior Findings & Award, Stipulated Award, or Compromise & Release. The judge needs to see what was awarded before to measure the increase.
• Updated medical report. A treating physician, Panel QME, or AME report dated before the five-year cutoff that shows worsening impairment or a higher whole person impairment rating.
• Names and addresses of all parties and lien claimants. Proof of service must reach every party.
• Insurance carrier or self-insured employer information. Including claim number and adjuster contact.
• Your current address, phone number, and email. EAMS uses these to send hearing notices.
• Attorney information, if represented. Including State Bar number and EAMS firm number for JET filers.
• Description of the new or further disability. A short factual narrative, dated, that ties the worsening to the original injury.
• Proof of service template under 8 CCR §10628. A separate page declaring how and when each party was served.

If any of these is missing, the petition is still accepted for filing, but the judge can deny it on the merits. A missing medical report is the single most common reason petitions to reopen fail.

Where to Get the Form and How to Access It

The official form is DWC/WCAB Form 42, Petition to Reopen, hosted on the Division of Workers’ Compensation forms page. The current version still carries a revision date of 8-85, which surprises new filers, but the form has not been replaced.

You can also find the form on the DWC forms index along with the Application for Adjudication of Claim, the DOR (Declaration of Readiness), and the Proof of Service. Many county law libraries keep printed copies, and most legal stationers in Los Angeles, San Francisco, San Diego, and Sacramento sell pre-formatted versions.

Attorneys and self-represented filers who use EAMS JET File can submit the petition as a structured PDF. Walk-in filers can hand-deliver paper copies at any of the 24 DWC district offices. Mail filers should use certified mail with return receipt to the district office that holds the case.

The form is free. The WCAB does not charge a filing fee for a petition to reopen, which is set by Labor Code §5500.5 and longstanding agency practice. Anyone who tries to charge you to file the form is not the WCAB.

Step-by-Step: How to Fill Out DWC/WCAB Form 42 Line by Line

The form is a one-page pleading with a caption block, a body paragraph, and a Proof of Service block governed by 8 CCR §10628. Each field below gets its own walkthrough.

Caption: “Division of Workers’ Compensation — Workers’ Compensation Appeals Board — State of California”

Plain English. This is the header that tells the clerk which court hears the case.

How to answer it. Leave it as it appears on the official PDF. Do not retype it, do not shrink it, and do not move it to a side margin. JET filers keep the structured header that EAMS provides.

Example. Maria Lopez opens the PDF, sees the heading already printed, and types nothing in this area.

Nuance. If you are using a word-processor version provided by your attorney, confirm the heading reads exactly as it does on the official Form 42. A petition filed under “Workers’ Compensation Board” with no “Appeals” has been rejected by clerks in the past.

Common mistake and consequence. Filers add a county name (for example, “County of Los Angeles”) to the heading. The WCAB is a statewide tribunal, not a county court, and adding a county can cause the clerk to flag the document for non-conformity.

Misconception. Some filers think they must list the specific district office in the heading. The case caption never names the district office; venue is shown by where you mail or upload the petition.

Case No.

Plain English. This is the ADJ number that the WCAB assigned to your original claim.

How to answer it. Write ADJ followed by the seven- or eight-digit number, with no spaces and no dashes. EAMS issues numbers in the format ADJ1234567 or ADJ12345678.

Example. Carlos Reyes writes ADJ8842317 in the Case No. line.

Nuance. If your injury predates EAMS (before August 25, 2008), you may have a legacy case number such as LAO 0123456. Write the legacy number on the line and add the ADJ conversion number in parentheses if you have it.

Common mistake and consequence. Filers leave the case number blank because they cannot find the old award letter. A blank case number forces the clerk to open the petition as a new application, which can mean a new ADJ number, a duplicate file, and dismissal under 8 CCR §10455.

Misconception. Many believe the insurance claim number goes here. It does not. The Case No. line is reserved for the WCAB ADJ number only.

Applicant (Name of Injured Worker)

Plain English. This box names the injured worker whose case is being reopened.

How to answer it. Type the worker’s full legal name in FIRST MIDDLE LAST order, exactly as it appears on the original Application for Adjudication of Claim. Do not use nicknames.

Example. Aisha N. Whitfield enters her name as AISHA NICOLE WHITFIELD because that is how it reads on her 2021 application.

Nuance. If the worker has changed names since the original filing (marriage, divorce, court order), include the prior name in parentheses, such as AISHA NICOLE WHITFIELD (formerly AISHA NICOLE BROOKS).

Common mistake and consequence. Filers shorten the name (for example, Aisha Whitfield instead of Aisha Nicole Whitfield). The clerk’s EAMS system matches by exact name, and a mismatch can route the petition to the wrong file.

Misconception. Some filers think the petitioner’s name belongs here. The Applicant line names the injured worker even when the defendant is the one filing the petition.

Defendants (Employer and Carrier)

Plain English. This block lists the employer and the workers’ compensation insurance carrier (or self-insured administrator).

How to answer it. List the legal employer name first, then the carrier on the next line, formatted as EMPLOYER NAME; CARRIER NAME. Use the names from the original Findings & Award.

Example. Marcus Tate writes VALLEY LOGISTICS INC.; STATE COMPENSATION INSURANCE FUND in the Defendants block.

Nuance. If the carrier has changed since the award (common with run-off books and TPA changes), list both the original carrier and the current one, joined by n/k/a (now known as).

Common mistake and consequence. Filers list only the insurance carrier and skip the employer. The judge needs the employer name to confirm jurisdiction and to bind the right party to any new award.

Misconception. Some think they must add the adjuster’s personal name. The adjuster is not a party. Only the employer and carrier go in this block.

Petition Body — “Petitioner hereby requests that the above-entitled action be reopened for the following reasons”

Plain English. This is the heart of the petition. You state, in plain detail, why your case should be reopened for increased permanent disability.

How to answer it. Write a numbered set of factual paragraphs that meet the 8 CCR §10536 “specifically and in detail” standard. Cover the date of injury, the body parts injured, the prior award, the date and nature of the new and further disability, and the medical report that documents the change.

Example. Maria Lopez writes: “1. Applicant sustained an admitted industrial injury to her lumbar spine on 04/12/2022. 2. A Stipulated Award issued on 06/15/2024 for 25% permanent disability. 3. On 02/03/2026, treating physician Dr. Singh reported new lumbar radiculopathy with a whole person impairment of 22% (up from 14%). 4. Applicant therefore petitions to reopen for new and further disability under Labor Code §5410.”

Nuance. If you are filing under Labor Code §5803 good cause rather than §5410, say so and identify the good cause (newly discovered evidence, mistake of fact, fraud).

Common mistake and consequence. Filers write a single sentence such as “My back is worse, please reopen.” That fails the §10536 specificity test, and the WCAB can summarily deny the petition or strike it on defendant’s motion.

Misconception. Many believe the medical report itself must be quoted verbatim in the petition. The petition only needs to reference and attach the report, not transcribe it.

Verification

Plain English. This is the line where the petitioner swears the facts are true.

How to answer it. Add a verification clause under Code of Civil Procedure §446: “I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.” Sign, print your name, and date it.

Example. Carlos Reyes signs “Executed at Fresno, California, on May 14, 2026. /s/ Carlos Reyes.”

Nuance. Form 42 (Rev. 8-85) does not pre-print a verification line. You must add one because 8 CCR §10450 requires petitions to be verified.

Common mistake and consequence. Filers sign the form without a verification clause. An unverified petition can be stricken, costing weeks of delay while the worker re-files.

Misconception. Some think a notary is required. WCAB verifications are signed under penalty of perjury and do not need notarization.

Petitioner Signature Block

Plain English. This is where the person filing the petition signs and prints their name and address.

How to answer it. Sign with a wet signature on paper or an /s/ Name on JET-filed PDFs. Print the name, mailing address, phone, and email below the signature line.

Example. Aisha Whitfield signs /s/ Aisha N. Whitfield and prints 123 Maple St., Oakland, CA 94601, (510) 555-0142, aisha.w@email.com.

Nuance. If an attorney signs, the State Bar number must appear under the printed name, as required by 8 CCR §10390.

Common mistake and consequence. Filers print but forget to sign. An unsigned petition is treated as no petition at all, which is fatal if the five-year deadline expires before correction.

Misconception. Some think a typed name in EAMS counts as a signature without the /s/ convention. JET File rules require the /s/ indicator before the typed name.

Proof of Service Block (WCAB Rule 10628)

Plain English. This proves you served every party with a copy of the petition on the same day you filed it.

How to answer it. Fill in the date, place, name of the server, and the names and addresses of every party served. Sign at the bottom. The block on Form 42 cites the older “WCAB Rule 10514,” which is now codified at 8 CCR §10628.

Example. Marcus Tate writes: “On 05/14/2026 at Fresno, CA, I served a true copy by U.S. Mail on State Compensation Insurance Fund, P.O. Box 8192, Pleasanton, CA 94588, and on Valley Logistics Inc., 4400 Industrial Way, Fresno, CA 93725.”

Nuance. Email service is allowed if the parties have consented in writing or if the case is in EAMS with email addresses on file.

Common mistake and consequence. Filers serve only the carrier and skip the employer or lien claimants. Defective service can void the petition’s filing date for the unserved party, which can push the case past the five-year wall.

Misconception. Many think the WCAB clerk serves the other parties. The clerk does not. Service is the petitioner’s job.

Three Filled-Out Examples Using Real Scenarios

Scenario 1 — Maria Lopez, Warehouse Worker With Worsening Back

Maria suffered a lumbar injury on April 12, 2022. She received a 25% permanent disability award in 2024. In early 2026, her treating doctor reported new radiculopathy.

Form Section	What Maria Enters
Case No.	ADJ15998421
Applicant	MARIA ELENA LOPEZ
Defendants	WESTBAY WAREHOUSING LLC; ZURICH AMERICAN INSURANCE CO.
Petition Body ¶1	Industrial injury to lumbar spine on 04/12/2022
Petition Body ¶2	Stipulated Award 06/15/2024 at 25% PD
Petition Body ¶3	Dr. Singh report 02/03/2026 shows WPI increased from 14% to 22%
Petition Body ¶4	Petition to reopen under Labor Code §5410
Verification	Signed under penalty of perjury, Oakland, CA, 02/20/2026
Proof of Service	Served on Zurich and Westbay by U.S. Mail 02/20/2026

Scenario 2 — Carlos Reyes, Construction Worker Filing Near the Deadline

Carlos hurt his right shoulder on May 30, 2021. He took a Compromise & Release in 2023 that left medical care open. By April 2026, the AME found a new rotator cuff tear.

Form Section	What Carlos Enters
Case No.	ADJ14210077
Applicant	CARLOS ANDRES REYES
Defendants	PACIFIC FRAMING INC.; TRAVELERS PROPERTY CASUALTY
Petition Body ¶1	Right shoulder injury 05/30/2021, accepted
Petition Body ¶2	Compromise & Release 09/12/2023, medical left open
Petition Body ¶3	AME Dr. Patel report 04/18/2026: new full-thickness rotator cuff tear
Petition Body ¶4	New and further disability under §5410; filed before 5-year deadline of 05/30/2026
Verification	Signed under penalty of perjury, Fresno, CA, 05/14/2026
Proof of Service	Served on Travelers and Pacific Framing by JET File 05/14/2026

Scenario 3 — Aisha Whitfield, Nurse With New Psychiatric Component

Aisha was assaulted at work on June 9, 2022, and received a 35% PD award in 2024 for orthopedic injuries. In 2026, a Panel QME diagnosed a compensable consequence psychiatric injury.

Form Section	What Aisha Enters
Case No.	ADJ16002914
Applicant	AISHA NICOLE WHITFIELD
Defendants	EASTBAY MEDICAL CENTER; SEDGWICK CMS (TPA FOR SELF-INSURED)
Petition Body ¶1	Industrial injury 06/09/2022 to neck and right wrist
Petition Body ¶2	Findings & Award 11/01/2024 at 35% PD
Petition Body ¶3	Panel QME Dr. Romero 03/22/2026: new psychiatric WPI of 18% as compensable consequence
Petition Body ¶4	Petition to reopen for new and further disability under §5410
Verification	Signed under penalty of perjury, Oakland, CA, 04/05/2026
Proof of Service	Served on Sedgwick and Eastbay by email per stipulation 04/05/2026

How to File the Completed Form

The WCAB accepts the Petition to Reopen through four channels. Choose one and keep proof.

EAMS JET File. Attorneys and high-volume filers transmit a structured PDF through the JET File system. There is no fee. Processing is usually same day. Save the JET acknowledgment as proof of filing.

OCR Upload at the Public EAMS Portal. Self-represented workers can scan the petition and upload it through E-Form Filing for Public Users. No fee. Processing typically takes 3 to 5 business days. Save the upload confirmation.

Mail. Send the original by certified mail with return receipt to the district office that handled the original case. No fee. Allow 7 to 10 business days for filing. Keep the green return-receipt card as proof.

In Person. Walk into the district office during business hours and have the clerk file-stamp two copies. No fee. Same-day filing. Keep the stamped copy as your proof.

Whichever channel you pick, the filing date is the date the WCAB receives the petition, not the date you mailed it. That distinction matters when the five-year deadline is days away. When in doubt, file in person or by JET.

What Happens After You File

After filing, the WCAB clerk dockets the petition in EAMS and sends notice to all parties. The defendant has the chance to file an Answer, often raising the statute of limitations under §5410 or the lack of a demonstrable change under Applied Materials.

If the parties cannot resolve the petition informally, either side files a Declaration of Readiness to Proceed to set the case for a Mandatory Settlement Conference. The MSC is usually held within 30 to 60 days. Discovery often includes a new Panel QME or AME evaluation focused on whether the impairment has truly increased.

If the case does not settle, the workers’ compensation judge holds a trial. The judge then issues Findings & Award (or Findings & Order) within 30 to 90 days. The judge can grant additional permanent disability, additional medical care, or both, or deny the petition. Either party can file a Petition for Reconsideration within 25 days under Labor Code §5903.

If the petition is granted, increased indemnity is paid retroactively to the date the new and further disability began, subject to credit for amounts already paid.

Mistakes to Avoid When Filling Out the Form

• Filing after the five-year deadline. Labor Code §5410 is jurisdictional, and a late petition is dead on arrival.
• Skipping the medical report. Without a treating, AME, or QME report dated before the five-year wall, the petition fails the Applied Materials test.
• Using the wrong ADJ number. A wrong number routes the petition to the wrong file and can cost weeks.
• Vague petition body. “I’m worse” violates 8 CCR §10536 and invites summary denial.
• Missing verification. Unverified petitions can be stricken under 8 CCR §10450.
• Defective proof of service. Failing to serve every party can void the filing date for the unserved party.
• Confusing §5410 with §5803. §5410 is for new and further disability; §5803 is for good cause to alter an award.
• Forgetting lien claimants. Lien claimants are parties for service purposes when their liens are unresolved.
• Filing on the wrong form. A Petition for Reconsideration is not a Petition to Reopen; the two have different deadlines and standards.
• Not requesting specific relief. State plainly that you seek increased permanent disability, additional TD, or additional medical care.
• Ignoring the Applied Materials demonstrable-change rule. A worsening symptom alone is not enough; you must show a measurable change in impairment, treatment, or work capacity.
• Missing Subsequent Injuries Benefits Trust Fund issues. If a pre-existing disability combines with the new disability above 70%, consider an SIBTF claim alongside the petition.

Do’s and Don’ts

Do’s

• Do file before the five-year deadline, even if your medical report is not finalized; the petition tolls jurisdiction.
• Do attach the medical report that shows new and further disability so the judge sees the evidence on day one.
• Do verify the petition under penalty of perjury to avoid a strike under 8 CCR §10450.
• Do serve every party and lien claimant; defective service can sink the filing date.
• Do use the official DWC/WCAB Form 42 so clerks accept it without question.
• Do keep your JET or certified-mail proof of filing forever; it is your only safety net if EAMS loses the document.

Don’ts

• Don’t wait until day 1,825; file at least 30 days before the deadline so service errors can be cured.
• Don’t substitute a letter for the form; informal letters are routinely rejected.
• Don’t mix a Petition for Reconsideration with a Petition to Reopen; they serve different purposes.
• Don’t forget the verification clause; the printed form does not include one.
• Don’t rely on the carrier to tell you the deadline; the burden is on the worker.
• Don’t omit the ADJ number; it is the only way EAMS connects the petition to your closed file.

Pros and Cons of Filing on Your Own vs. With Help

Filing pro se

• Pro: No attorney fee; the form is short and free.
• Pro: You control the timing and the narrative.
• Pro: Same access to JET File and EAMS as attorneys.
• Pro: Information and free guidance from the DWC Information & Assistance Office at every district office.
• Pro: Quick learning curve for one-time filers.
• Con: Easy to miss the §5410 deadline by miscounting from the wrong date of injury.
• Con: Hard to draft a §10536-compliant body without legal training.
• Con: Difficult to coordinate Panel QME timing and reports.
• Con: Defendants often have experienced lawyers who exploit drafting errors.
• Con: No one to spot SIBTF or compensable-consequence add-ons.

Filing with an attorney

• Pro: Attorneys carry malpractice insurance and know the deadlines.
• Pro: Attorney fees are paid out of the increased award, usually 12% to 15% under Labor Code §4906.
• Pro: Attorneys can package the petition with a Declaration of Readiness and discovery requests in one motion.
• Pro: Faster JET File workflow.
• Pro: Better positioned to negotiate a stipulated increase without trial.
• Con: You give up some control over strategy.
• Con: Fees come out of the eventual award.
• Con: The attorney needs time to review the file; do not retain on day 1,820.

Filing on Paper vs. Filing Through EAMS

Filing Channel	Key Features
Paper (mail or in person)	No fee, accepted at any of the 24 DWC district offices, filing date is the date received, keep the file-stamped copy as proof
EAMS JET File	No fee, structured PDF, same-day filing acknowledgment, requires a JET trading partner agreement
EAMS OCR Upload	No fee, scan-and-upload through the public portal, 3 to 5 business days to docket

Key Agencies, Statutes, and Cases That Shape This Form

The Workers’ Compensation Appeals Board is the tribunal that decides the petition. The Division of Workers’ Compensation administers the form and operates EAMS. The Department of Industrial Relations is the umbrella agency.

Labor Code §5410 sets the five-year window for new and further disability. Labor Code §5803 gives the WCAB continuing jurisdiction to alter awards for good cause. Labor Code §5804 caps amendments to awards at five years from the original award unless a petition is pending. 8 CCR §10536 sets the pleading standard.

The leading case is Applied Materials v. WCAB (2021) 64 Cal.App.5th 1042, which defines new and further disability as a demonstrable change in the worker’s condition. Earlier cases such as Hartsuiker v. WCAB (1993) 12 Cal.App.4th 209 and Nicky Blair’s Restaurant v. WCAB (1980) 109 Cal.App.3d 941 hold that the petition itself must be filed within the five-year window even if the medical proof comes later. The WCAB’s panel decision in Pascacio v. Jacobo Farm Services (2022) reinforces that ongoing treatment alone is not new and further disability.

FAQs

Is there a filing fee for a Petition to Reopen at the WCAB?

No. The WCAB does not charge a fee to file DWC/WCAB Form 42. Filing is free through JET, OCR upload, mail, or in person at any district office.

Can I file the petition more than five years after my date of injury?

No. Labor Code §5410 bars new and further disability claims after five years. Limited §5803 good-cause petitions exist but rarely succeed for an increase in PD.

Do I have to attach a medical report?

Yes. While the form does not require it on its face, Applied Materials v. WCAB and §10536 mean a petition without a medical report showing demonstrable change will be denied.

Is the verification really required if Form 42 has no verification line?

Yes. 8 CCR §10450 requires petitions to be verified under penalty of perjury. Add the verification clause manually before signing.

Do I write the insurance claim number in the Case No. box?

No. The Case No. line is reserved for the WCAB ADJ number. The insurance claim number can be referenced in the petition body but never replaces the ADJ.

Should I list the adjuster’s name in the Defendants block?

No. Only the legal employer and the carrier or self-insured administrator belong there. The adjuster is a contact, not a party.

Can I file a Petition to Reopen after a Compromise & Release?

Yes. If the C&R left medical care open or if good cause exists under §5803, you can petition. Pure full-and-final C&Rs usually preclude reopening for indemnity.

Do I need to serve lien claimants?

Yes. Lien claimants are parties in interest. Failing to serve them can void the filing date as to those parties and complicate any new award.

Can I sign with /s/ on a JET-filed petition?

Yes. JET File accepts /s/ Name as the signature on structured PDFs. Keep the original wet-signed copy in your file.

Does filing the petition automatically restart my benefits?

No. Filing only invokes jurisdiction. Increased benefits flow only after a stipulated award or a judge’s Findings & Award.

Can the defendant file a Petition to Reopen against me?

Yes. Defendants can petition under §5803 for good cause, such as a reduction in PD if the worker’s condition has improved or a clerical error in the original award.

What if my Panel QME report is dated after the five-year mark?

Yes, the petition can still succeed if the medical report describes a demonstrable change that occurred before the five-year mark. The report’s date is less important than the date of the change.

Do I file in the same district office as the original case?

Yes. Venue stays with the original ADJ case unless the WCAB orders a transfer. Filing at the wrong office can delay docketing.

Can I add new body parts in a Petition to Reopen?

Yes, if the new body part is a compensable consequence of the original injury and the demonstrable change occurred within five years. A truly new injury requires a separate Application for Adjudication of Claim.

How long does the WCAB take to decide a Petition to Reopen?

No fixed timeline applies. Most petitions move to a Mandatory Settlement Conference within 30 to 60 days, with trial and decision usually within 6 to 12 months of filing.