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Division of Workers' Compensation - Medical issues and resources
Employer and physician responsibilities for lead-exposed workers requiring medical removal protection
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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.
DWC Medical Unit
- The DWC Medical Unit sets standards for Qualified Medical Evaluators (QMEs) and establishes policy and guidelines on treatment and evalution for injured workers. Resources available at the Medical Unit web site include:
- Medical Practice in the California Workers' Compenstion System
(.pdf), a Guide for Physicians, and - Other information of interest to medical providers.
Reports studies
- Pharmaceutical Care in the California Workers' Compenstion Insurance System A report prepared by the University of California, San Francisco, March 24, 2004 (.pdf, 244k)
- Medical Report Reference Materials, a collection of guidelines for the workers' compensation community to help medical providers write complete medical reports for rating purposes (.pdf, 59k)
- Injured Worker Satisfaction with Care in a 24-Hour Pilot Program DWC Report (.pdf, 128k)
- 24 Hour Pilot Programs under Labor Code Section 4612 Interim Report to the Legislature, March 1997. Also available as an Adobe Acrobat file(.pdf, 113k).
- Improving the Quality of Care for Injured Workers in California, Focus Group Discussions, November 2001 (.pdf, 220k)
- What Do Injured Workers Think About Their Medical Care and Outcomes After Work Injury? A research brief, published May, 2001(.pdf, 76k)
- Improving Quality of Care for Injured Workers in California, Workshop Synopsis, May 24-25, 2000 (.pdf, 16k)
- Workers' Compensation Health Care, Ad Hoc Quality Improvement Task Force, September 19, 2000, Minutes (.pdf, 28k)
- What Do Injured Workers Think of Their Medical Care? A report on the development of the patient satisfication survery.(.pdf, 137k)