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State of California Department of Industrial Relations Division of Workers ' Compensation Request fo

State of California Department of Industrial Relations Division of Workers ' Compensation Request fo 2025

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The document outlines the process for requesting factual corrections to an unrepresented Panel Qualified Medical Evaluator (QME) report in California. It provides a form that must be completed by either an injured worker or a claims administrator, detailing required information such as personal details, injury date, and specifics about the QME report. The document explains the procedure for submitting the request, including timelines for responses and actions by the QME after receiving the correction request.

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What is a request for authorization?

Request for authorization means any request by a physician for assurance that appropriate payment will be made for a course of proposed medical treatment, including surgery or hospitalization, or any diagnostic studies beyond plain X-rays.

What is a DWC 7 form?

Form DWC-7 is a notice to provide injured workers with rights, benefits and contact information.

What is a dwc1 form?

If you are hurt at work, it is imperative that you report your work-related injury or illness, regardless of the nature or severity, to your supervisor immediately. Request an Employees Claim for Workers Compensation Benefits form from your supervisor (its also known as a DWC 1 form).

What is the utilization review process in California?

Utilization review (UR) is the process used by employers or claims administrators to review treatment to determine if it is medically necessary. All employers or their workers compensation claims administrators are required by law to have a UR program.

What is an RFA form?

To accompany the Doctors First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating Physicians Progress Report, DWC Form PR-2, or narrative report substantiating the requested treatment.

What forms are required on a California workers comp policy?

California Workers Compensation Insurance Forms CA 130 Workers Compensation Application. California Employer Fact Sheet for Employers. California Application for Exclusion of Officers and Stockholders. CA Affidavit of Exemption for Workers Compensation Insurance. CA First Report of Injury Form.

How long can you be on workers comp in California?

After 104 weeks of receiving temporary disability benefits in California, your benefits will generally cease. However, if your injury or illness falls under specific exceptions like severe burns or chronic lung disease, you may be eligible for temporary disability benefits for up to 240 weeks.

What is an RFA authorization?

An RFA is a form that the doctor is required to use to request treatment, diagnostic tests or other medical services for an injured worker. If the treatment request was first made verbally, it must be confirmed in writing.

State of California Department of Industrial Relations Division of Workers ' Compensation Request fo 2025

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