Free DWC Form RFA to Request Authorization for Medical Treatment

Why use the DWC Form RFA?

The DWC Form RFA can be used to:

• Request approval: It ensures healthcare providers obtain authorization for treatments that need insurance approval.
• Facilitate communication: The form details the proposed treatment and its medical necessity between the provider and insurance company.
• Streamline authorization: It helps ensure treatments are covered under worker’s compensation and meet legal requirements.

Who use the RFA form?

The DWC Form RFA is primarily used by:

• Doctors and specialists who need prior approval for treatments like expensive medications, procedures, or extended therapy sessions.
• Healthcare providers seeking worker’s compensation authorization for specific treatments.

What information does the RFA form include?

The DWC Form RFA includes:

• Patient details such as the name, date of birth, and other information to identify the person.
• Diagnosis and description of the health condition or injury.
• Proposed treatment plan details such as treatment, medications, or procedure being requested.
• Duration and frequency of treatment.
• Justification on why the treatment is necessary with evidence in documents.

Download the DWC Form RFA

Download this free DWC form RFA template to ensure efficient authorization for medical treatments. This easy-to-use form helps healthcare providers request treatment approval quickly and maintain compliance with California’s compensation requirements.