Summary

Treating physicians are required to submit a complete and compliant Request for Authorization (RFA) for treatment.

Regulation 9792.6.1 defines Request for Authorization as a written request for a specific course of proposed medical treatment. An RFA must meet both of the following criteria:

1. Only for medical treatment and
2. Must be written.

RFA Form: Must Be Correct

Per regulation 9792.6.1(t)(1), providers must use the correct version of the DWC Form RFA, effective February 2014.

The RFA definition designates that the RFA form is “completed by a treating physician.” The regulation does not indicate that the Primary treating physician must complete the form; instead, the regulation simply requires a treating physician to complete the RFA form.

RFA Form: Must Be Complete

Regulation 9792.6.1(t)(2) provides clear instructions on what constitutes a completed DWC Form RFA. A “Completed” RFA must:

1. identify both the employee and the provider,
2. identify with specificity a recommended treatment or treatments, and
3. include documentation substantiating the need for the requested treatment.

RFA Form: Must Be Signed

Per regulation 9792.6.1(t)(3), a completed RFA must include the signature of the treating physician.

California Code of Regulations (CCR)

§ 9792.6.1 Utilization Review Standards - Definitions - On or After January 1, 2013

DaisyBill Resources

Daisy News: Your Request for Authorization (RFA) Questions Answered

For more information about California’s workers’ comp, watch DaisyBill’s free, information-packed webinars.

Webinar Library