ADJUSTINGLOCATIONSFillable

Annual report of adjusting locations for claims administrators

CA Division of Workers Compensation · Workers Compensation

Verified current as of August 1, 2026

Claims administrators report their annual adjusting office locations to the Division of Workers' Compensation for oversight and record-keeping purposes.

This form has fillable fields — you can complete it directly in the viewer on the right.
Loading…