The California Stipulations with Request for Award (DWC-CA form 10214(s), rev. 1/2020) is the workers’ compensation settlement document that locks in permanent disability payments, future medical care, and other benefits when an injured worker and the claims administrator agree on the value of a claim and ask a Workers’ Compensation Appeals Board (WCAB) judge to issue a binding Award. You can pull the current version from the DWC forms page and confirm the revision date in the lower-left corner before signing.
Roughly 130,000 claims close through Stips or Compromise and Release each year in California, and the Division of Workers’ Compensation reports that incomplete or inconsistent Stips are one of the top reasons judges reject settlement packets at walk-through. Filing it correctly the first time can shave 30 to 60 days off your wait for the first permanent disability check under Labor Code §4650.
- 📝 How to complete every paragraph and box of the 10214(s) line by line
- 📅 The exact deadlines, interest rules, and walk-through approval timing
- 💼 Three real settlement scenarios from low-PD to cumulative trauma with apportionment
- ⚖️ How to file through EAMS JET File, the public e-form portal, walk-through, and mail
- 🚫 The 10 most common mistakes that get Stips rejected and how to avoid them
What the Form Is and Who Must File It
The Stipulations with Request for Award is the agreement that converts a disputed or accepted workers’ compensation claim into a final, enforceable Award signed by a WCAB judge. The parties stipulate to the facts (date of injury, body parts, average weekly earnings, permanent disability percentage, future medical) and request that the judge sign an Award based on those stipulated facts under Labor Code §5702. Once approved, the Award has the same force as a judgment.
Either party can prepare and file the Stips, but in practice the defendant (insurance carrier or self-insured employer) drafts it and serves it on the applicant for signature. The applicant—the injured worker—signs personally, and the applicant’s attorney also signs if represented. Pro se workers (no attorney) sign in two places: as the applicant and on the verification page. The form is then filed in EAMS, the Electronic Adjudication Management System, at the district office where the case is venued.
Stips are used when the worker wants to keep future medical care open and receive permanent disability in weekly installments, instead of cashing out everything in a Compromise and Release. The trade-off is finality of the indemnity portion only; medical treatment for the accepted body parts continues for life under Labor Code §4600. Choosing Stips over a C&R is one of the biggest decisions a worker makes, and the consequence of guessing wrong is permanent.
A misconception worth correcting: many workers think signing Stips means the case is over forever. It is not. The worker keeps the right to petition to reopen for new and further disability within five years of the date of injury under Labor Code §5410, and lifetime medical stays open. That right is lost only with a C&R.
Before You Start: Documents and Information You Need
Gather these items before you open the 10214(s). Missing any one of them is the most common reason Stips bounce back from the judge’s desk at walk-through, according to the DWC’s settlement guidance.
- The ADJ case number from EAMS. Every WCAB case has a unique ADJ number assigned when the Application for Adjudication of Claim was filed. Without it, the form cannot be matched to the case file.
- Date of injury (specific or CT period). A specific injury has one date; a cumulative trauma has a range ending on the last date of injurious exposure under Labor Code §5412. Picking the wrong date shifts the statute of limitations and the comp rate.
- Average weekly earnings (AWE). Calculated under Labor Code §§4453–4459. Pull the wage statement the carrier issued. A wrong AWE produces a wrong PD rate and the judge will catch it.
- Body parts accepted. Use the body parts listed on the carrier’s notice of acceptance and the PQME/AME report. Listing the shoulder when the report says rotator cuff is fine; adding the neck when no doctor found a neck injury will draw a rejection.
- PD percentage and the rating string. This comes from the PDRS 2005 Schedule ratings prepared by the DEU rater or the parties’ rating expert. The string proves the math.
- The medical-legal report relied on. Usually the PQME or AME report. Attach it as an exhibit so the judge can verify the rating.
- Lien and credit information. EDD (State Disability) liens, child support orders, Medi-Cal and Medicare conditional payment letters, and TTD overpayment credits all need numbers in the credit paragraph.
- Attorney fee request. Usually 12% to 15% of the PD value, supported by an itemized fee declaration under Labor Code §4906.
- Medicare set-aside (MSA) status if applicable. If the worker is a Medicare beneficiary or expected to enroll within 30 months, include CMS approval or a written explanation.
- Proof of service. A completed Proof of Service by Mail or e-service confirming every party received the signed Stips.
Where to Get the Form and How to Access It
The official 10214(s) lives on the DWC forms library under “Settlements.” Always download a fresh copy rather than reusing an old PDF, because the agency periodically updates field labels and the version stamp in the footer. The current revision date is 1/2020, printed in the bottom-left corner; if your copy says anything older, replace it.
You can complete the form three ways. The fillable PDF can be typed into and saved with Adobe Acrobat Reader. Many parties also use practice software like Sun Pro or Stips Express that auto-populates the boxes from case management data. A typewriter or pen-and-ink version is still accepted but rarely used.
For e-filing, you need an EAMS account. Trading partners (carriers, TPAs, lien claimants with high volume) use JET File, an XML-based business-to-government channel. Everyone else uses the DWC e-form web portal, which lets you upload the signed PDF directly to the case.
A misconception filers carry is that the form is interchangeable across districts. It is not. Every district office uses the same statewide 10214(s), but each district has its own walk-through calendar and local rules under Title 8 CCR §10789. Check the district office page for the venue handling your ADJ number.
Step-by-Step: How to Fill Out the 10214(s) Line by Line
The 10214(s) has a caption block, eleven numbered stipulation paragraphs, the Award page, and a verification page. Work through them in order and use the exact field names printed on the official form.
Caption: Case Caption and ADJ Number
The caption asks for the applicant’s name, the defendant’s name, and the ADJ case number. Type the worker’s full legal name as it appears on the Application for Adjudication, in CAPS, last name first. Example: MARTINEZ, CARLOS R. Enter the employer and the insurance carrier on the next line, separated by “/” (e.g., ACME PLUMBING / STATE COMPENSATION INSURANCE FUND). Drop the ADJ number in format ADJ1234567.
A common nuance: when there are multiple injuries on different dates, list every ADJ number stacked in the caption, even if only one is settling. Leaving a related ADJ off the caption can create a “phantom case” the carrier still has to defend.
The most common mistake here is mismatching the applicant’s name with EAMS. If EAMS lists the worker as Carlos Roberto Martinez and the Stips says Carlos R. Martinez, the e-form portal can reject the upload as a non-matching party. Verify the spelling against the EAMS public information case search before typing.
A misconception is that the caption is “just paperwork.” It is not. The caption establishes jurisdiction. A sloppy caption can be the basis for a later petition to set aside the Award.
Paragraph 1: Date of Injury and Employment
Paragraph 1 stipulates the date (or period) of injury and that the applicant was employed by the named defendant on that date. Enter the specific injury date as MM/DD/YYYY. For a cumulative trauma, enter the CT period as MM/DD/YYYY through MM/DD/YYYY. Example for Carlos: 03/14/2024.
The nuance is the §5412 date for occupational disease and CT claims. The “date of injury” is the date the worker first suffered disability and knew (or should have known) the disability was work-related. If the QME report fixes a §5412 date that differs from the date of last exposure, use the §5412 date.
The most common mistake is using the date of the doctor visit instead of the date of the actual injury. Consequence: the AWE calculation period shifts and the comp rate becomes wrong, voiding the math in Paragraph 6.
A misconception is that any date “close enough” works. WCAB judges cross-check this date against the DWC-1 claim form and the Application for Adjudication; a discrepancy of even one day triggers a question from the bench.
Paragraph 2: Parts of Body Injured
Paragraph 2 lists the body parts the parties stipulate were injured. Use the language from the medical-legal report: low back, right shoulder, right knee, and sleep disorder secondary to chronic pain. Match the AME/PQME’s phrasing word for word.
A nuance: psyche claims need extra care under Labor Code §3208.3, which requires six months of employment and a predominant cause finding. Do not stipulate to psyche unless the report supports it. Likewise, internal/sleep/sexual dysfunction add-ons after SB 863 cannot be rated for PD on most post-2013 dates of injury.
The biggest mistake is listing body parts the doctor never addressed. If you list “neck” but the AME report only addresses the lumbar spine and right shoulder, the judge will strike the neck or send the file back for a supplemental report. The consequence is a 30- to 90-day delay.
A misconception: workers often think more body parts equals more money. Not true. PD comes from the impairments rated; unrated body parts add nothing and can poison the settlement.
Paragraph 3: Earnings and Compensation Rates
Paragraph 3 stipulates the average weekly earnings, the temporary disability (TD) rate, and the permanent disability (PD) rate. AWE comes from the wage statement covering the year before injury under §4453. Enter dollars and cents: AWE: $1,250.00; TD rate: $833.33; PD rate: $290.00.
The nuance is the statutory cap. For 2024 dates of injury, the maximum TD rate is $1,619.15 and the minimum is $242.86. PD rates are capped at $290.00 for ratings 1%–69% and $345.00 for 70%–99%, indexed by date of injury. Use the rate in effect on the actual date of injury, not the date of settlement.
The most common mistake is applying the current year’s max to an older injury. Consequence: the entire PD math collapses and the judge will recalculate the Award down, which can also trigger a malpractice claim against the applicant attorney.
A misconception is that overtime always counts. Only earnings the worker would have earned but for the injury are includable; sporadic overtime that is not “regularly recurring” is excluded under §4453(c).
Paragraph 4: Temporary Disability Paid
Paragraph 4 lists every period of TD already paid, by start date, end date, weekly rate, and total. Format: 01/05/2024 through 09/30/2024 at $833.33/week, total $32,000.00. Pull these dates from the carrier’s benefit printout, which is required under Title 8 CCR §10607.
A nuance: salary continuation in lieu of TD under Labor Code §4850 (for safety officers) is listed separately and reduces the 104-week TD cap dollar-for-dollar.
The common mistake is omitting a TD period the carrier already paid. Consequence: the carrier later claims credit it never reserved in the Stips and the worker has to litigate to get the money. Always reconcile the benefit printout against the Stips before signing.
A misconception is that TD ends when the worker returns to work. TD ends on the earliest of return to work, MMI/permanent and stationary status, or expiration of the 104-week cap.
Paragraph 5: Need for Further Medical Treatment
Paragraph 5 stipulates whether future medical treatment is awarded and for which body parts. Standard language: Defendant shall provide further medical treatment reasonably required to cure or relieve from the effects of the injury, pursuant to Labor Code §4600, for the following body parts: low back, right shoulder. Match body parts to Paragraph 2.
The nuance is the Medical Provider Network (MPN). Future medical is delivered through the carrier’s MPN unless the worker has a valid pre-designation under Labor Code §4600(d). If you settle on Stips, MPN rules continue to govern access.
The most common mistake is stipulating to “all body parts” or leaving the list blank. Consequence: the carrier later denies treatment for a body part not specifically named, and the worker must file a Declaration of Readiness to litigate scope. Be explicit.
A misconception is that future medical means unlimited treatment. Treatment must be reasonable, evidence-based, and authorized through Utilization Review and Independent Medical Review when disputed.
Paragraph 6: Permanent Disability
Paragraph 6 is the heart of the settlement. It states the PD percentage, the total weeks of PD, the weekly rate, the total dollar value, the start date of PD payments, and any credit for PD already advanced. Example: 35% permanent disability, equivalent to 218.75 weeks at $290.00 per week, totaling $63,437.50, payable from 10/01/2024, less credit for $14,500.00 PDA paid.
A nuance is the rating string and apportionment under Labor Code §4663. Attach the rating instructions and the DEU recommended rating, or a private rating that shows the math from the WPI through the FEC, occupational, and age adjustments. If the AME apportioned 30% to non-industrial degenerative changes, that reduction must show in the string.
The most common mistake is stipulating to a PD percentage that does not match the rating string. Consequence: the judge sends the packet back with a note like “Rating string yields 38%, not 35%—correct or explain” and walk-through approval is denied.
A misconception is that the parties can pick any PD percentage they want. Stips must be supported by substantial medical evidence under Labor Code §5703; a clearly inflated or deflated PD will be rejected.
Paragraph 7: Liens
Paragraph 7 lists every lien on file: EDD, child support, medical providers, copy services, interpreters, Medi-Cal, and Medicare conditional payments. Format: EDD lien filed 06/12/2024, $8,400.00, to be adjusted by defendant. If a lien is disputed, mark it to be litigated.
The nuance is Medicare’s reporting and recovery rules under the MSP Act. If the worker is a Medicare beneficiary, the Stips should reference resolution of CMS conditional payments and address any Medicare Set-Aside when settlement involves future medical components subject to closure.
The common mistake is “forgetting” the EDD lien. Consequence: EDD garnishes the PD payments anyway, and the worker is shocked when the first check is short.
A misconception is that liens disappear at settlement. They do not. Unresolved liens survive and the carrier can be ordered to pay twice if the lien is not addressed in the Award.
Paragraph 8: Credit
Paragraph 8 captures any credit the defendant claims: TD overpayment, PDA already paid, salary continuation, third-party recovery credit under Labor Code §3861. Enter exact amounts.
The nuance is unreserved credit. If the carrier overpaid TD but never sent a notice of overpayment, the credit may be waived. The Stips locks in only what is written.
The mistake is letting the carrier insert a vague “credit for all sums paid” line. Consequence: the carrier later claims credits the worker never agreed to. Insist on dollar-specific credits.
A misconception is that credits are negotiable after the Award. They are not, absent fraud or mutual mistake under Labor Code §5803.
Paragraph 9: Attorney Fees
Paragraph 9 sets the attorney fee, paid out of the PD. Standard fees run 12% to 15% under DWC’s fee guidelines. Format: Reasonable attorney fee of $9,515.62 (15%) is awarded to the Law Offices of Jane Doe, commutable from the far end of the PD award.
A nuance is commutation. Fees are usually paid in a lump sum from the back end of the PD stream, which means the worker gets full weekly checks for most of the PD period. Commutation tables are in Title 8 CCR §10169.
A common mistake is forgetting the fee declaration. Without it, the judge cannot evaluate the reasonableness of the fee and will defer approval.
A misconception is that attorney fees come “on top of” PD. They do not. Fees come out of the worker’s PD recovery.
Paragraph 10: Other Issues / Additional Stipulations
Paragraph 10 is a free-text box for anything not covered by 1–9: thumb-drive of records, vocational issues, Supplemental Job Displacement Voucher under Labor Code §4658.7, sanctions resolution, or specific MSA language. Be precise. Vague language here is the most common reason Stips get rejected at walk-through.
The nuance is the SJDB voucher. For dates of injury on or after 1/1/2013, an injured worker with PD who is not offered regular work within 60 days of P&S is entitled to a $6,000 voucher. The Stips should state whether the voucher has issued, is waived, or remains open.
The common mistake is using boilerplate that contradicts an earlier paragraph. Consequence: the judge rejects the packet for internal inconsistency.
A misconception is that Paragraph 10 can waive future medical. It cannot. Only a Compromise and Release closes future medical.
Paragraph 11: Signatures and Verification
Paragraph 11 is the signature block. The applicant signs and dates. The applicant’s attorney (if any) signs. The defense attorney or claims administrator signs. Pro se applicants also complete the verification on the last page under penalty of perjury.
A nuance: e-signatures are accepted in EAMS as long as the signed PDF is uploaded with a Declaration re Electronic Signature per DWC e-filing rules. Wet signatures are still safest at walk-through.
The common mistake is a missing applicant signature. Consequence: the judge cannot approve the Stips and the entire packet is returned.
A misconception is that the attorney can sign for the worker. The attorney cannot. Only the worker can authorize their own settlement.
Three Filled-Out Examples Using Real Scenarios
Scenario 1: Carlos, Specific Low Back Injury, 12% PD
Carlos Martinez is a 38-year-old plumber who herniated his L5-S1 disc on 03/14/2024 lifting a cast iron sink. The PQME found him P&S at 8% WPI, rating to 12% PD after FEC, occupation, and age adjustments. He wants future medical and weekly PD.
| Form Section | What Carlos Enters |
|---|---|
| Caption | MARTINEZ, CARLOS R. v. ACME PLUMBING / SCIF, ADJ12345678 |
| Paragraph 1 | 03/14/2024 |
| Paragraph 2 | Low back |
| Paragraph 3 | AWE $1,250.00; TD $833.33; PD $290.00 |
| Paragraph 4 | 03/15/2024–09/30/2024 at $833.33/wk, total $23,333.24 |
| Paragraph 5 | Future medical for low back per §4600 |
| Paragraph 6 | 12% PD = 39.50 weeks × $290.00 = $11,455.00, less $1,500 PDA |
| Paragraph 7 | EDD lien $4,200.00, to be adjusted |
| Paragraph 9 | 15% attorney fee = $1,718.25 to Law Offices of Jane Doe |
Scenario 2: Aisha, Cumulative Trauma, 45% PD with Apportionment
Aisha Johnson is a 54-year-old hospital RN with CT to the bilateral shoulders, cervical spine, and bilateral wrists through 11/01/2023. The AME rated 60% PD before apportionment, with 25% apportioned to pre-existing degenerative disease, leaving 45% PD industrial.
| Form Section | What Aisha Enters |
|---|---|
| Caption | JOHNSON, AISHA M. v. MERCY HOSPITAL / SEDGWICK, ADJ23456789 |
| Paragraph 1 | 11/01/2022 through 11/01/2023 (CT) |
| Paragraph 2 | Bilateral shoulders, cervical spine, bilateral wrists |
| Paragraph 3 | AWE $1,800.00; TD $1,200.00; PD $290.00 |
| Paragraph 4 | 11/02/2023–05/01/2024 at $1,200.00/wk, total $31,200.00 |
| Paragraph 5 | Future medical for shoulders, neck, wrists per §4600 |
| Paragraph 6 | 45% PD = 311.25 weeks × $290.00 = $90,262.50; AME apportioned 25% non-industrial under §4663 |
| Paragraph 7 | EDD $14,000.00; Kaiser lien $3,200.00 |
| Paragraph 9 | 15% fee = $13,539.38 to applicant counsel |
Scenario 3: Marcus, Specific Knee Injury, Medicare Beneficiary, 25% PD
Marcus Lee is a 67-year-old warehouse supervisor on Medicare who tore his right meniscus on 06/20/2024. The PQME rated 25% PD. Because he is Medicare-eligible and total settlement plus future medical exceed CMS thresholds, an MSA is addressed.
| Form Section | What Marcus Enters |
|---|---|
| Caption | LEE, MARCUS T. v. BIG BOX LOGISTICS / GALLAGHER BASSETT, ADJ34567890 |
| Paragraph 1 | 06/20/2024 |
| Paragraph 2 | Right knee |
| Paragraph 3 | AWE $1,400.00; TD $933.33; PD $290.00 |
| Paragraph 4 | 06/21/2024–12/15/2024 at $933.33/wk, total $24,266.58 |
| Paragraph 5 | Future medical for right knee per §4600 through MPN |
| Paragraph 6 | 25% PD = 100 weeks × $290.00 = $29,000.00 |
| Paragraph 7 | Medicare conditional payments resolved per CMS letter dated 09/15/2024 |
| Paragraph 10 | Parties acknowledge Medicare’s interests; no MSA required because future medical remains open under §4600 |
| Paragraph 11 | Signed by applicant Marcus Lee on 11/01/2024 |
How to File the Completed Form
You can file the signed Stips through four channels. Pick the one that matches your role and volume.
EAMS JET File is the XML business-to-government channel for high-volume trading partners. There is no filing fee. Processing is same-business-day intake; judge approval typically follows within 7 to 21 days. Keep the JET acknowledgment as proof of filing. Setup details are on the JET File page.
DWC e-form portal is the web upload at eams.dwc.ca.gov. No fee. Upload the signed PDF as document type “Stipulations with Request for Award.” Save the confirmation email; that is your proof of filing. Same 7-to-21-day approval window.
Walk-through is the in-person filing at the district office that has venue, governed by Title 8 CCR §10789. No fee. The packet must include the signed Stips, the medical report relied on, the rating, the fee declaration, a proposed Award, and proof of service. If the judge approves at the bench, you walk out with a signed Award the same day. Keep the conformed copy.
Mail is allowed but slow. Send to the district office’s mailing address (look it up on the DWC district office directory). No fee. Include a self-addressed stamped envelope for the conformed copy. Plan on 30 to 60 days.
A misconception is that filing equals approval. It does not. The judge must review and sign the Award. Until then, the carrier is not legally obligated to pay PD on the stipulated schedule under the Award, although unpaid PD before approval still accrues interest.
What Happens After You File
Once filed, the case is routed to a Workers’ Compensation Administrative Law Judge (WCJ) for review. The judge checks that the Stips are supported by substantial evidence, the math is correct, and adequate provision exists for liens and attorney fees under Labor Code §5001. If everything checks out, the judge signs the Award and serves it on all parties.
The carrier then has 25 days from service of the Award to start paying PD per the schedule. Late payments accrue 10% self-imposed increase plus interest at 7% under Labor Code §5800. The worker keeps the right to medical treatment for life for the body parts named in Paragraph 5.
If the judge has questions, expect a Notice of Intention to Reject or a request for a supplemental document. You have 10 days to respond. Common fixes are an updated rating, a corrected AWE, or a clearer fee declaration.
A misconception is that the Award cannot be challenged. It can. Either party can file a Petition for Reconsideration within 20 days under Labor Code §5903, or a Petition to Reopen for new and further disability within five years under §5410.
Mistakes to Avoid When Filling Out the Form
- Wrong date of injury. Causes the entire AWE/PD rate calculation to fail and triggers rejection.
- Mismatched body parts. Listing a body part the medical report does not support draws an immediate kickback.
- Inflated PD percentage. A PD that does not match the rating string will be reduced or rejected.
- Missing PDA credit. Forgetting to note PD already advanced means the worker gets paid twice and the carrier sues to claw it back.
- Skipping the EDD lien. EDD garnishes anyway, leaving the worker with reduced checks and confusion.
- Stale comp rates. Using current-year rate caps for an older injury inflates the Award and forces a do-over.
- No fee declaration. The judge defers approval and the case sits.
- Boilerplate Paragraph 10. Vague “additional terms” language gets rejected for inconsistency.
- Missing signatures. No signature, no Award. Period.
- No proof of service. Without proof every party received the Stips, the judge cannot approve under Title 8 CCR §10500.
Do’s and Don’ts
- Do pull a fresh 10214(s) from the DWC forms page to ensure you have the 1/2020 revision.
- Do match every paragraph to the underlying medical evidence so the judge sees substantial evidence support.
- Do itemize liens with dollar amounts and filing dates, because vague liens are the top reason for rejection.
- Do use the rating string from the DEU or a qualified rater, since the judge will recalculate to verify.
- Do serve every party including lien claimants, because failure of service voids approval.
- Do keep a conformed copy of the Award, because it is your only enforcement tool.
- Don’t stipulate to PD percentages your medical report does not support, because the judge will catch the gap.
- Don’t leave the future medical body parts blank, because the carrier will deny treatment later.
- Don’t sign before reading every paragraph, because Stips are binding once approved.
- Don’t assume the carrier’s draft is correct, because errors usually favor the carrier.
- Don’t confuse Stips with a Compromise and Release, because the C&R closes future medical and Stips do not.
- Don’t miss the 25-day post-Award payment window, because §5800 interest and 10% increases stack quickly.
Pros and Cons of Filing on Your Own vs. With Help
- Pro (with attorney): An applicant attorney audits the rating, AWE, and credit lines, catching errors that a worker would miss.
- Pro (with attorney): Counsel handles MPN, lien, and EDD coordination, so the worker is not surprised by garnishments.
- Pro (with attorney): Attorney fee is contingent and capped, paid only out of recovery under §4906.
- Pro (pro se): Keeps the entire PD recovery, with no 12%–15% fee.
- Pro (pro se): Direct control over every term and pace of negotiation.
- Con (pro se): No professional check on the rating string; many pro se workers settle for less than the case is worth.
- Con (pro se): Lien handling is complex, and missed liens come back as garnishments.
- Con (pro se): The judge cannot give legal advice at walk-through.
- Con (with attorney): A 15% fee on a $90,000 PD is $13,500.
- Con (with attorney): Some delays come from coordinating attorney calendars.
Stipulations vs. Compromise and Release
| Feature | Stipulations with Award |
|---|---|
| Future medical | Open for life under §4600 |
| Indemnity | Paid weekly per Award |
| Right to reopen | Yes, within 5 years under §5410 |
| Lump sum | No, unless commuted |
| Best for | Workers needing ongoing care |
| MSA required | Rare, because medical stays open |
| Finality | Indemnity only |
| Form number | DWC-CA 10214(s) |
FAQs
Can I sign Stips without a lawyer?
Yes. Pro se workers sign as the applicant and complete the verification on the last page; the judge reviews the Award for fairness under Labor Code §5001 before approval.
Do Stips close my future medical care?
No. Stips keep medical open for life for the body parts listed in Paragraph 5; only a Compromise and Release closes future medical.
What goes in the body parts box if my doctor wrote “lumbar spine”?
Yes, copy the doctor’s exact phrasing—lumbar spine—because the judge cross-checks Paragraph 2 against the AME/PQME report word for word.
Do I have to list my maiden name in the caption?
No, only the legal name on the Application for Adjudication; if EAMS shows your married name, match it exactly to avoid e-form rejection.
Should I include sleep disorder as a body part?
No for most post-2013 dates of injury, because SB 863 bars PD add-ons for sleep, sexual, and psyche secondary to physical injury.
Is the EDD lien always listed in Paragraph 7?
Yes, if EDD paid you State Disability; missing it triggers garnishment of your PD checks and creates a recoupment fight after the Award.
Can I file the Stips by email?
No, but you can upload the signed PDF through the DWC e-form portal, which is the e-filing equivalent and has no fee.
Do I need an MSA to settle on Stips?
No in most cases, because future medical stays open and CMS’s Medicare Set-Aside review is geared toward C&Rs that close medical.
What is the deadline for the carrier to start PD after the Award?
Yes, 25 days from service of the Award; late payments accrue a 10% self-imposed increase plus 7% interest under §5800.
Can I reopen my case after Stips are signed?
Yes, within five years of the date of injury for new and further disability under §5410, provided the worsening is documented medically.
Do I have to attach the AME/PQME report?
Yes, the judge needs it to verify the PD rating; filing without it is the second-most-common reason for walk-through rejection.
Can the carrier change Paragraph 6 after I sign?
No, alterations after signature without your initials void the document; insist on a clean re-execution if any number changes.
What if my employer disputes one body part?
Yes, you can stipulate to the agreed parts and reserve the disputed part for trial under a separate Findings and Award proceeding.
Is there a filing fee for Stips?
No, the WCAB charges no filing fee for settlement documents through EAMS, JET File, walk-through, or mail.
Can I get my PD as a lump sum?
Yes, through commutation under Title 8 CCR §10169, but commutation reduces the total because future payments are discounted to present value.
Related reading
- 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 Permanent and Stationary Report + FAQs
- How to Fill Out California WCAB Petition to Terminate Liability + FAQs
- How to Fill Out California WCAB Request for Increased Permanent Disability + FAQs
- How to Fill Out California WCAB DWC-AD 10133.32 (w/Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs