Get Dwc Ad Form104

The Dwc Ad Form104 is an essential document for requesting a consultative rating through the California Division of Workers' Compensation. This guide will walk you through the process of completing the form online, ensuring clarity and ease throughout each section.

Follow the steps to accurately complete the Dwc Ad Form104 online.

1. Click the ‘Get Form’ button to access the form digitally and open it in your preferred editor.
2. Indicate the type of request by selecting either 'Mail-in' or 'Walk-in'. Make sure to review the instructions pertaining to your choice carefully.
3. If you selected 'Mail-in', be prepared to attach a photocopy of the medical report(s), ensuring they have not been previously submitted. Avoid sending original reports.
4. If you selected 'Walk-in', attach the completed request form to copies of the medical reports you want rated. List the names of the doctors and the corresponding dates of the reports.
5. For depositions, identify and note the specific pages to be reviewed by the rater.
6. Fill in personal information including the date of birth, social security number, and all relevant dates of injury along with case numbers.
7. Provide your name, occupation, and any additional descriptions if necessary.
8. Input the insurance claim number, the doctor’s name, and the date of report(s) to be rated.
9. Complete the hearing type by checking the appropriate box: 'Rating MSC', 'Trial', or 'Conference'. Include the date set for the hearing.
10. Indicate the name of the firm representing you and ensure a copy of the request has been served on the appropriate party. Fill in the firm's address accurately.
11. Review all fields for accuracy and completeness before finalizing.
12. Once all information is filled out, you can save your changes, download, print, or share the completed form as needed.

Take the next step in your process by completing the Dwc Ad Form104 online today.