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California Request for Reconsideration of Summary Rating by the Administrative Director for Workers' Compensation
State:
California
Control #:
CA-DEU-103-WC
Format:
PDF
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FAQ
The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid.
What is a P&S report? When you reach a point where your medical condition is not improving and not getting worse, your condition is called permanent and stationary (P&S). This is referred to as the point in time when you have reached maximal medical improvement (MMI).
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.expedited review must be supported by documentation substantiating the employee's condition.
Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.
The LES Form DWC-1, or First Report of Injury or Illness, is the form used to report workers' compensation accidents or work-related illnesses to your insurance carrier or designated claims office. Delays and errors may increase costs related to processing the claim.
The Disability Evaluation Unit (DEU) determines permanent disability ratings by evaluating medical descriptions of physical and mental impairment.
PRIMARY TREATING PHYSICIAN'S PERMANENT AND STATIONARY REPORT (PR-4) This form is required to be used for ratings prepared pursuant to the 2005 Permanent Disability Rating Schedule and the AMA Guides to the Evaluation of Permanent Impairment (5th Ed.).
DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers' compensation benefits and the Medical Provider Network (MPN) in California.Covered Employee Notification of Rights Material (English and Spanish).
