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Ca claim 2026

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  1. Click ‘Get Form’ to open the ca claim in the editor.
  2. Begin by entering the full name of the person claiming damage or injury. If a business is involved, use its name.
  3. Provide a daytime telephone number and an optional email address for communication.
  4. Fill in your complete mailing address, ensuring accuracy for correspondence.
  5. If applicable, include your identification number if you are an inmate or patient at a state hospital.
  6. For claims on behalf of a minor, enter their birth date. If you're an insurance company, provide your insured’s name.
  7. State the exact date of the incident that caused the damage or injury. Include both start and end dates if necessary.
  8. Describe the specific damage or injury and explain why you believe the state agency is responsible.
  9. Attach any supporting documentation and ensure to include the $25 filing fee before submitting your claim.

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Related links

20 CFR 10.102 - How and when is a claim for wage loss

The form should be completed as soon as possible, but no more than 14 calendar days after the date pay stops due to the injury or disease.Read more

Learn more
Claim Search Page

To begin your search, enter your last name, or the name of your business. To better refine your results, you may also enter your first name.Read more

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