Get Dwc Form 280

Filling out the Dwc Form 280 online is a critical step in the process of petitioning for a change of primary treating physician. This guide will walk you through the essential components of the form and provide step-by-step instructions to ensure that your application is completed accurately and effectively.

Follow the steps to fill out the Dwc Form 280 online.

1. Press the ‘Get Form’ button to access the Dwc Form 280 and open it for editing.
2. Begin by entering the WCAB case numbers, if applicable, followed by the employee's name and address. Ensure that all information is entered clearly to avoid any processing issues.
3. Next, include the employee's attorney's name and address. If the employee is not represented, this section can be left blank.
4. Provide the employer's name and address in the designated fields to identify the injured worker's employer.
5. Fill in the claims administrator's details, along with their claim number(s), to direct the petition effectively.
6. In the section for the primary treating physician, enter the physician's name and address. This section is crucial for informing parties involved about the medical provider.
7. List five physicians, including one chiropractor if applicable, in the physician panel section. Include their names, addresses, and medical specialties clearly to assist in identifying alternative providers.
8. In Part A, state the reasons that constitute good cause for the change of physician. Make sure to attach any supportive evidence like medical reports as needed.
9. Complete the verification section by signing and dating the form, ensuring that it is executed correctly to validate your submission.
10. If applicable, attach a proof of service by mail declaration to demonstrate that the petition and all supporting documents have been properly mailed to relevant parties.
11. After reviewing the form for accuracy, you can save your changes, download, print, or share the Dwc Form 280 as necessary.

Complete your Dwc Form 280 online today to ensure a smooth processing of your petition.