Freeman Rehabilitation Services
Debbie Freeman
P.O. Box 370, San Carlos CA 94070
Phone: 650-595-4447 ~ Fax:
866-804-0574
dfreeman@freemanrehabilitationservices.com
Electronic
Adjudication Management System - EAMS Forms
Electronic Adjudication Management System or "EAMS" means the computer case management system used by the Division of Workers' Compensation to electronically store and maintain the Division of Workers' Compensation or appeals board's case files and to perform other case management functions. The EAMS forms became mandatory effective 11/17/08.
The Supplemental Job Displacement Benefit EAMS
Forms for all dates of injury have been revised effective 1/1/14.
Freeman Rehabilitation Services
/ Debbie Freeman is an expert in preparing all of the revised Supplemental Job Displacement
Benefit EAMS forms:
http://www.dir.ca.gov/dwc/DWCPropRegs/SJDB_Regs/SJDBFinalTextRegulationsFinalClean.pdf
1/1/04 – 12/31/12 Dates of Injury
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A “Notice of Offer of Modified or Alternative Work” or the DWC-AD
10133.53 form must be prepared on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.53.pdf
A “Notice of Offer of Regular Work or the DWC-AD 10118 form must be
prepared on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10118.pdf
A “Supplemental Job Displacement Non-Transferrable Voucher Form” or the
DWC-AD 10133.57 form must be prepared on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.57.pdf
Post 1/1/13 Dates of Injury
A “Notice of Offer of Modified or Alternative Work” or the DWC-AD
10133.35 form must be prepared on the revised EAMS form:
http://http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.35.pdf
A “Notice of Offer of Regular Work or the DWC-AD 10133.35 form must be
prepared on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.35.pdf
A “Supplemental Job Displacement Non-Transferrable Voucher Form” or the
DWC-AD 10133.32 form must be prepared on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.32.pdf
A “Description of Employee’s Job Duties or the DWC-AD 10133.33 is an
optional form on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.33.pdf
A “Physician’s Return-to-Work & Voucher Report” or the DWC AD 10133.36 is
a mandatory form that needs to be filled out by the first physician (Primary
Treating physician, Panel Qualified Medical Examiner or Agreed Medical
Examiner) who finds the that the disability from all conditions has become
permanent and stationary and finds that the injury caused partial permanent
disability on the revised EAMS form:
http://www.dir.ca.gov/dwc/FORMS/SJDB/10133.36.pdf
Additional links that explain the Electronic Adjudication Management System or "EAMS” process:
· EAMS (Electronic Adjudication Management System) Forms
· Supplemental Job Displacement Benefit (SJDB) EAMS Forms - Effective Date 1/1/14
· EAMS (Electronic Adjudication Management System) Handbook and instructions manual
· EAMS (Electronic Adjudication Management System) Guide on how to prepare and use fillable forms
· EAMS (Electronic Adjudication Management System) Answers to frequently asked questions