Pre-Designation
Predesignation of Personal Physician
Medical Mileage Expense
Medical Mileage Expense Form 2021
Medical Mileage Expense Form 2020
Medical Mileage Expense Form 2019
Medical Mileage Expense Form 2018
Reimbursement
Out of pocket Reimbursement Form
Physician’s Return to Work
Physician’s Return to Work Form
California Department
California Department of Industrial Relations Division of Workers’ Compensation
Division of Workers’ Compensation (DWC)
Injured Worker Fact Sheets from the Department of Industrial Relations:
- DWC Basic Facts on Workers’ Compensation for Injured Workers
- DWC Fact Sheet A: Utilization Review
- DWC Fact Sheet B: Glossary of Workers’ Compensation Terms for Injured Workers
- DWC Fact Sheet C: Answers to Your Questions About Temporary Disability Benefits
- DWC Fact Sheet D: Answers to Your Questions About Permanent Disability Benefits
- DWC Fact Sheet E: Answers to Your Questions About Qualified Medical Evaluators and Agreed Medical Evaluators
CA Department of Industrial Relations Guidebook for Injured Workers
CA Department of Industrial Relations Guidebook for Injured Workers
CA Department of Industrial Relations QME Competency Examination Study Guide
CA Department of Industrial Relations QME Competency Examination Study Guide
Permanent Disability Rating Schedule (2005)
Permanent Disability Rating Schedule (2005)
LACERA Disability Retirement Application
LACERA Disability Retirement Application
Request for Panel Qualified Medical Examiner- Unrepresented
Request for Panel Qualified Medical Examiner- Unrepresented
Sample Request for Authorization Form
Sample Request for Authorization Form
Sample PR-2 Form
Permanent Disability Indemnity Chart
Permanent Disability Indemnity Chart
City of LA Medical Provider Network Link
City of LA Medical Provider Network Link
County of Los Angeles Sworn Medical Provider Network: Login is COLA
County of Los Angeles Sworn Medical Provider Network: Login is COLA
