The California Labor Code as it relates to Workers’ Compensation states that the employer, i.e., Workers’ Compensation, is responsible for the medical care of employees’ work-related injuries. So what’s the difficulty? You, Group Health Carriers are not responsible, right? You have recovery rights! California Workers’ Compensation law is unique. Who’s representing your interest?
Submission Process
- Complete an Assignment Request Form (click here for document)
- Complete the Summary Sheet (click here for document)
- Provider Name
- Dates of Service
- Amount of Bill
- Amount of Bills Paid by your company
- If immediately available, a copy of all bills paid relating to the injury/illness. If not immediately available, we will need this supportive documentation as soon as possible. In addition, if applicable – we will need the following info:
- Copy of Paid Claims
- UB-82/92 – Diagnosis
- Itemization of hospital charges
- Patient admittance form
- Pertinent medical info (e.g., Operative Report)
- If this case was discovered by your company, we need to know why you believe the injury is work-related. Please include:
- WCAB# or Employees Claim for Workers’ Compensation Benefits (DWC-1) Form
- Relative notes or completed questionnaire
- Names and address of the Employer
- Any attorney correspondence including Workers’ Compensation subpoenas.