Medical issues and resources

An important announcement for employers, physicians and insurers concerning first aid treament for workers' compensation injuries

Employer and physician responsibilities for lead-exposed workers requiring medical removal protection** PLEASE DESCRIBE THIS IMAGE **.pdf


Medical Fee Schedules

Official Medical Fee Schedule (OMFS)

This fee schedule is promulgated by the DWC administrative director under Labor Code 5307.1 and Section 9790 et seq. of Title 8, California Code of Regulations. It is used for payment of medical services required to treat work related injuries and illnesses. Ordering instructions for the most recent (1999) edition of the OMFS plus links to download all of the updates for services provided from 1999 to present can be found here. Please note that in addition to physician services, the OMFS now also covers: inpatient and outpatient hospital services; pharmaceuticals; durable medical equipment and prosthetics; pathology and labrabory; and ambulance services.

Medical Legal Fee Schedule

The medical-legal fee schedule is contained in Section 9795 of Title 8, California Code of Regulations. It is used to reimburse physicians for preparing medical evaluation reports that are used in workers' compensation cases.

Interpreters Fee Schedule

The fee schedule for interpreter services when required during a medical examination is contained in Section 9795.3 of Title 8, California Code of Regulations.

Frequently asked questions

Answers to many of the questions DWC receives regarding the new fee schedules can be found here. Another information resource available for download is the Power Point presentation (.zip, 117k) used at training sessions conducted by DWC.

Managed Care Program - HCOs

The Managed Care Program reviews applications from health care organizations and certifies them for the delivery of managed care services under California workers' compensation law. Further information, including application requirements for certification and a list of certified HCOs, can be found on the managed care/HCO page.

Physician reporting requirements

California's workers' compensation system has a number of requirements for reports from physicians to claims administrators. These include Doctor's First Report (DLSR Form 5021), the initial report and progress reports of an employee-selected physician, permanent and stationary reports from all physicians, and a variety of forms and reports from employer-selected physicians. Section 9785 of Title 8, California Code of Regulations, covers these reporting requirements, which are essential to communications between claims administrators and medical providers. These regulations were amended effective Jan. 1, 1999 to require all physicians, however selected, to make the same reports and require detailed treatment plans in all reports (DWC Newsline). The amended regulations also provide for two new forms, PR-2 Primary Treating Physican's Progress Report, and PR-3 Primary Treating Physican's Permanent and Stationary Report.

Utilization review

DWC Medical Unit

Reports studies

Quality of care September 2007