File A Claim - California State Compensation Insurance Fund 2025

1. Click ‘Get Form’ to open the File A Claim document in the editor.
2. Begin with Section 1: Demographics. Fill in the Worker’s Name, Provider Name, Claim Number, Date of Injury, Date of Visit, Face to Face Time, and Location/Setting. Ensure all fields are accurately completed for proper identification.
3. Proceed to Section 2: Intake and History. If this is a re-assessment, describe any changes in status from prior assessments and update psychometric measures such as PHQ-4 and GCPS Scores for both Initial and Current Visits.
4. In this section, also indicate which providers or resources you will coordinate with to progress treatment goals. This includes options like Claim Manager or Physical Rehabilitation Provider.
5. Move on to Section 3: Goals. Describe mutually agreed upon treatment goals and strategies. Update any prior treatment goals or interventions as necessary.
6. Finally, ensure that the Therapist’s Name, Phone Number, Signature, and Date Signed are filled out before sending the completed form to the Attending Provider.

Start using our platform today for free to streamline your claims process effortlessly!