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

 

 Adobe PDF viewer is required for some of these documents.  Click here to get the latest copy of Adobe Reader.

 

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


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