WebDWC Form RFA (Version 12/2012) 1 State of California Division of Workers’ Compensation . Request for Authorization for Medical Treatment (DWC Form RFA) To accompany the Doctor’s First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating Physician’s Progress Report, DWC Form PR-2, or narrative report … [email protected]. Kendra Elmendorf, Manager RFA Implementation Unit Continuum of Care Reform Branch California Department of Social Services 744 P Street, MS 9-14-46 …
DWC Forms - California Department of Industrial Relations
WebDate of “Receipt” of DWC Form RFA: According to California Code of Regulations, section 9792.9.1 and Labor Code section 4610(g)(1), Utilization Review has five (5) business days to issue a decision. The time frame for issuing a decision begins when the DWC Form RFA is “received”. The RFA is considered received five (5) days after it is ... WebNov 9, 2024 · To request authorization for proposed treatment, the DWC essentially requires providers to use the official DWC Form RFA. CCR § 9792.9.1 (c) (2) (B) states that the claims administrator “may accept a request for authorization for medical treatment that does not utilize the DWC Form RFA…” provided it has all the required information. simonmed radiology orlando
Request For Authorization For Medical Treatment {DWC RFA}
WebWhat is an RFA? A. 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 … WebDivision of Workers' Compensation Request for Authorization for Medical Treatment (DWC Form RFA) To accompany the Doctor's First Report of Occupational Injury or Illness, Form DLR 5021, a Treating Physician's Progress Report, DWC Form PR-2, or narrative report substantiating the requested treatment. WebApr 9, 2024 · Providing workers' compensation news, information, research, tools, education and training to the industry, our mission is to improve workers' comp. ... Request for Authorization Form, DWC Form RFA: History: Please purchase a subscription for access. Advertisements. ... Online: 2024 CA Case Law and WCAB Rules Update Online: … simon med record department phone number