DWC provides clarification on use of Request for Authorization form

NEWSLINE

The Division of Workers' Compensation (DWC) has adopted updated regulations regarding Utilization Review (UR), which became effective April 1, 2026. These regulations, designed to streamline and standardize the medical treatment authorization process, are available on the DWC website.

In light of these updates, the DWC has received several inquiries regarding whether the use of the DWC Form RFA (Request for Authorization) is mandatory for treating physicians.

Pursuant to California Code of Regulations, title 8, section 9792.6.1, a "Request for Authorization" is formally defined as a written request for a specific course of proposed medical treatment. The regulations mandate that this request be set forth on the DWC Form RFA (as found in section 9785.5) and completed by the treating physician.

The standardized use of the DWC Form RFA is a critical regulatory requirement intended to ensure clear, consistent communication between medical providers and claims administrators, thereby reducing delays in the delivery of necessary medical care.

While the DWC Form RFA is the primary standard, a narrative report may serve as a functional equivalent only under specific conditions outlined in CCR section 9792.9.1(b) and 9792.6.1(u):

1. Mutual Acceptance: The claims administrator (CA) must voluntarily agree to accept a narrative report in lieu of the formal DWC Form RFA.
2. Minimum Content Standards: To be deemed "completed," the narrative report must contain all essential data elements required by law, including:
3. • Clear identification of both the employee and the requesting provider.
   • Specific identification of all recommended treatments on the first page of the narrative.
   • Substantiating documentation created no earlier than 30 days prior to the request.
   • Treating Physician's Signature: The report must be signed by the physician (electronic signatures are permitted by agreement of the parties).

DWC reminds all stakeholders that failure to provide a "completed" request (one that lacks specificity or the required substantiating documentation) may impact the timelines for UR decisions and the overall adjudication of treatment requests.