Simi Valley California Request for Summary Rating Determination for Workers' Compensation

State:
California
City:
Simi Valley
Control #:
CA-DEU-101-WC
Format:
PDF
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Description

This form is an official California Worker's Compensation form which complies with all applicable state codes and statutes. USLF updates all state forms as is required by state statutes and law. This form is available in fillable PDF format.

How to fill out California Request For Summary Rating Determination For Workers' Compensation?

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FAQ

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

(b) Consultative rating determinations may be requested for the purpose of determining the ratable significance of factors, reviewing proposed compromise and release agreements for adequacy, determining commuted values, resolving occupational questions or any other matters within the expertise of the disability

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.

If your workers' compensation adjuster disagrees with the doctor's report on your permanent disability, he or she may request that you be examined by a qualified medical examiner (QME). However, you should be aware that the adjuster may try to manipulate this process to deny you the benefits you deserve.

A summary rating is a document issued by the Disability Evaluation Unit that turns a doctor's report about your injury into a permanent disability rating. Summary ratings are given out after all qualified medical evaluator (QME) exams and after treating doctor exams, when requested.

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.

Leave Buy Back. Compensation for Leave without Pay. The CA-7 must be filed electronically through the Employees' Compensation Operations & Management Portal (ECOMP).

A QME must be a physician licensed to practice in California. QMEs can be medical doctors, doctors of osteopathy, chiropractors, psychologists or acupuncturists. Who makes the decision about going to a QME? Either you or your attorney (if you have one) or the claims administrator can request a QME exam.

After your injury and at the request of the insurance claims adjuster, the DWC will send you a list of three qualified medical evaluators based on the specialty you select and your location. You then have 10 days to select a QME, make an appointment, and notify your employer.

A panel request is considered premature if it is made before 15 days (10 days plus 5 days for mailing) have elapsed after the objection communication or delay/denial letter is sent to the opposing party. In other words, an eligible request can be made on the 16th day.

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Simi Valley California Request for Summary Rating Determination for Workers' Compensation