Filing a complaint

The California Division of Workers’ Compensation (DWC) takes complaints about entities it regulates. Complaints can be filed about the doctors who examine injured workers to help determine benefits (qualified medical evaluators), the process used to determine whether treatment given to injured workers is medically necessary (utilization review) or the way in which benefits are provided by the claims administrator in a workers’ compensation claim.

  • Qualified medical evaluator (QME) complaints: The Investigations Unit of the DWC Medical Unit investigates complaints about physicians in the workers' compensation system. Use the QME complaint form to file a complaint about a QME.
  • Utilization review (UR) complaints: Medical providers, injured workers or others who find that UR is not being done according to the regulations can file a complaint with the DWC. Use the UR complaint form to file a complaint about improper UR. Use the UR information page to learn more about UR and find the results of UR investigations.
  • Benefit delivery complaints: The DWC Audit Unit does not resolve disputes about benefits—that is done by the Claims Adjudication Unit or Workers’ Compensation Appeals Board—but it tracks complaints against all workers’ compensation claims administrators (insurance companies, self-insured employers and third party administrators) and takes action to make sure laws that lay out how benefits should be delivered are followed. Use the audit referral form to file a complaint against a claims administrator.

August 2016