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Legal Resources

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

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

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