Overview: The Request for Authorization for Medical Treatment (DWC Form RFA) is required for the employee’s treating physician to initiate the utilization review process required by Labor Code section 4610.

2023年7月30日 · Make your request in writing for a specific course of proposed medical treatment. Use the DWC Request for Authorization form. Identify both the employee and yourself, identify specifically the recommended treatment or treatments, provide documentation substantiating the need for the requested treatment.

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 Buttons on the Modify Appointment screen. See sample of a filled-in RFA form.

The Request for Authorization for Medical Treatment (DWC Form RFA) is required for the employee’s treating physician to initiate the utilization review process required by Labor Code section 4610.

Electronically filed with the Workers' Compensation Board, with PDF copy to employer's insurance carrier or directly to employer or third-party administrator if employer is a Board-approved self-insurer.

You may file this form with the Workers' Compensation Board when you want the Board to take a specific action in your client's case, or if you need to alert the Board to any problem or situation that is affecting your client's case.

2014年12月1日 · To request authorization, you need to submit a Request for Authorization (or RFA). The RFA is a written request for treatment, diagnostic testing or other medical services for the injured worker. Anybody can fill out a form. But it takes a true professional to complete an RFA form with all the information that insurance administrators need.

Routing Information: The DWC Form RFA can either be mailed or faxed to the claims administrator. The treating physician must complete all applicable fields on the form, including all identifying information regarding the employee, the claims administrator, and the physician.