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RESPONSE OF CARRIER/SELF INSURED EMPLOYER FOR AUTHORIZATION Check appropriate box below and return to requesting Health Care Provider Claimant and Claimant Attorney as provided by rule The requested Treatment or Testing is approved Not in accordance with Medical Treatment Schedule or R*S*23 1203. 1 D Attach summary of reasons The request or a portion thereof is not related to the on-the-job injury The claim is being denied as non-compensable Other Attach brief explanation R Signature of Carrier ...

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a 1010 document?

Form 1010 is an IRS form used to request a refund of the excise tax on heavy trucks, buses, and trailers.

What is a 1010 form in Louisiana?

As anyone who is familiar with the 1010 form can explain, it is to be used by an injured workers treating physician to request authorization for medical treatment or testing.

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