WebState of California, Division of Workers' Compensation REQUEST FOR AUTHORIZATION DWC Form RFA Attach the Doctor's First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating Physician's Progress Report, DWC Form PR-2, or equivalent narrative report substantiating the requested treatment. ... DWC Form RFA … WebUnless accepted by a claims administrator under section 9792.9.1 (c) (2), a request for authorization must be set forth on a “Request for Authorization ( DWC Form RFA ),” …

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WebSample DWC Form RFA (02-2014) Periodically, Workers' Comp releases new forms. An updated form for the State of California Division of Workers' Compensation Request for Authorization for Medical Treatment (a.k.a. DWC Form RFA) was released 02-2014. An RFA form can be generated through the Surgery Tab Action Buttonson theModify … WebPrior to March 1, 2014, any version of the DWC Form RFA adopted by the Administrative Director under section 9785.5 may be used by the treating physician to request medical treatment. (2) “Completed” for the purpose of this section and for purposes of investigations and penalties, means citizen 22p watch band replacement

State of California, Division of Workers’ Compensation ...

WebDWC Form RFA (version 01/2014) Page 1 State of California, Division of Workers Compensation REQUEST FOR AUTHORIZATION DWC Form RFA Attach the Doctor s First Report of Occupational Injury or Illness, Form DLSR 5021, a Treating Physician s Progress Report, DWC Form PR-2, or equivalent narrative report substantiating the … http://www.coa.org/docs/2014annualmeeting/presentations/DaisyBill.UR.RFA.IMR.pdf WebNote: It is advised that the claims administrator review and familiarize themselves with the timeframes set forth in Labor Code section 4610 and California Code of Regulations, title 8, sections 9792.9 and 9792.9.1 upon receipt of a completed Form RFA. § 9785.5. Request for Authorization. 1 DWC Form RFA (Version 12/2012) diced tomato chicken