The dwc-ad 100 is California’s Employee’s Permanent Disability Questionnaire, also called the DEU 100. The injured worker fills it out so the Disability Evaluation Unit can rate a permanent disability. If your injury has left you with lasting limits, this form lets you describe your job and daily life in your own words. That matters, because your rating can affect how much money you receive. This guide explains what the form does, when to use it, and how to avoid common mistakes.
What the Dwc-Ad 100 Is For
When a workplace injury doesn’t fully heal, a doctor writes a report on your lasting limits. However, a medical report alone does not turn into a dollar figure. The DEU has to convert those findings into a percentage rating. To do that fairly, it needs facts about your job, your age at injury, and the physical demands of your work. The dwc-ad 100 collects those facts straight from you.
Your occupation matters a great deal. For example, a knee injury may affect a warehouse worker very differently than an office worker. In most cases, the rater uses your job description to place you in an occupational group. As a result, clear and accurate answers on the dwc-ad 100 help the rating reflect your real work. Here are the key facts about the form:
| Item | Details |
|---|---|
| Form number | DWC-AD 100 |
| Form title | Employee’s Permanent Disability Questionnaire (DEU 100) |
| Who files | The injured worker, for a Disability Evaluation Unit rating |
| Where filed | The DEU office listed in the form instructions, under the California Division of Workers’ Compensation (DWC) |
| Fee | No filing fee is listed on the form. Confirm with the DWC. |
| Official PDF | DWC-AD 100 official PDF |
Who Files the Dwc-Ad 100 and When
The injured worker files the dwc-ad 100. In most cases, it is used by workers who do not have a lawyer. If you have an attorney, they typically handle rating requests for you. Either way, the answers should come from you, because you know your job best.
Typically, the form comes into play after your doctor finds you have reached maximum medical improvement. That means your condition has leveled off. At that point, a doctor issues a report on permanent impairment. The dwc-ad 100 usually goes to the DEU along with a request to rate that report. Sometimes the DEU or the claims administrator will send you the form and ask you to complete it.
If you are unsure where your claim stands, start with the basics. Our guide on how to file a California workers comp claim walks through the early steps. You can also review California workers comp requirements to check that your claim is on track.
How to Fill It Out and Where to Send It
The dwc-ad 100 asks for several kinds of information. Expect questions about your personal details, your claim, and your employer. It also asks about your job title and duties, and how much you lift, stand, walk, or reach. Finally, it asks about your education, past jobs, and whether you are working now. Take your time. Answer in plain words, and describe a normal workday in detail.
Common mistakes can slow down your rating. Watch for these:
- Leaving sections blank, especially the job duties section.
- Using only a job title, like “laborer,” without listing real tasks.
- Missing claim numbers or a wrong date of injury.
- Forgetting to sign and date the form.
- Downplaying pain or limits because you don’t want to complain.
Be honest and specific. However, don’t exaggerate either. Raters compare your answers to the medical records. Download the free official dwc-ad 100 PDF directly from the state. You can also find it on the DWC official forms page. Most unrepresented workers send the completed form by mail or in person to the DEU office named in the instructions. Electronic filing is generally used by attorneys and claims administrators. Keep a copy of everything you send.
What Happens After You File
After the DEU gets your dwc-ad 100 and the medical report, a rater reviews them. The rater then issues a summary rating. This is a percentage that reflects your permanent disability. Typically, the rating is sent to you and to the claims administrator. The insurer then uses it to figure out the permanent disability benefits it owes. Any dollar estimate you hear is illustrative only. Every case is different.
📨 Get Free Workers Comp Guides Alerts
Free · No spam · Unsubscribe anytime
If you disagree with the rating or the medical report behind it, you may have options to object. Those options have their own deadlines. For questions, contact the DWC directly. You can also learn how the California workers comp board fits into the process. In addition, the DWC offers Information and Assistance officers who help unrepresented workers for free. Confirm your next steps with the DWC and a licensed attorney.
Frequently Asked Questions
Do I have to pay to file the dwc-ad 100?
The official form does not list a filing fee. You can download it for free from the DWC website. Confirm with the DWC if anyone asks you to pay to file it.
Can I fill out the dwc-ad 100 if I have a lawyer?
The form is mostly used by workers without a lawyer. If you have an attorney, ask them before you file anything on your own. They typically handle rating requests and know your claim’s deadlines.
What if I make a mistake on the dwc-ad 100?
Contact the DEU office that received your form as soon as you notice the error. In most cases, you can send corrected information. Keep copies of both versions so you have a clear record.
Dwc-ad 100: Quick Recap
If you remember one thing about dwc-ad 100, make it this: the rule is set by the state (or the federal program), not by the insurer, and the official source is linked above. Every figure on this page about dwc-ad 100 should be confirmed with the agency before you act on it.
Questions about dwc-ad 100 that this page does not answer are usually answered for free by the state workers’ comp agency’s information line — and, for a disputed claim, by a licensed attorney in a first consultation.
See your state’s exact numbers
What you are owed depends on your state’s benefit caps and deadlines. Start with your state’s settlement and claim guides for the exact figures.
Sources & How to Verify
The figures on this page come from official government and industry sources. Workers’ comp benefit caps, deadlines, and rules change, so always confirm the exact figure with your state’s workers’ comp board or a licensed attorney before acting. Settlement estimates are illustrative, and every case is different.
- Your state workers’ comp board, division, or commission: the official source for your state’s exact caps, deadlines, and forms — search “[your state] workers compensation board”
- U.S. Department of Labor (OWCP): dol.gov — federal workers’ compensation overview
- NCCI: ncci.com — workers’ comp rating and benefit data
- Social Security Administration: ssa.gov — benefit-cap and SSDI offset data
- Insurance Information Institute: iii.org — neutral workers’ comp background
Content last reviewed October 2026. If you notice an outdated figure, please contact us.
Related Guides
- California Workers Comp Board
- How to File a California Workers Comp Claim
- California Workers Comp Requirements
- Workers Comp Settlements by State (All 50)
- Workers Comp Claims by State (All 50)
- More in This Category
- Settlements by Injury
- Benefits Explained
- Workers Comp Glossary
Informational only — not legal, medical, or financial advice. Workers Comp Explained is an independent educational resource, not a law firm, insurer, or medical or financial advisor, and this page does not provide legal, medical, or financial advice. Workers’ compensation benefits, deadlines, and rules vary by state and change over time, and settlement estimates are illustrative only. Always confirm the exact figure and any deadline with your state’s workers’ compensation board and a licensed attorney before you act.