Medical Unit

The Medical Unit performs a variety of services related to delivery of medical benefits in the workers' compensation system. It establishes policy and guidelines for the treatment and evaluation of injured workers. The unit examines and appoints physicians to be qualified medical evaluators (QMEs), who in turn examine injured workers to help determine the level of benefits they receive. It also certifies and oversees groups -- medical provider networks (MPNs) and health care organizations (HCOs) -- that provide care to injured workers. The unit reviews utilization review (UR) plans and handles UR complaints and investigations jointly with the Audit Unit. The unit oversees the independent medical review (IMR) and independent bill review (IBR) programs used to resolve disputes about medical treatment and medical-legal billing. It also assists the DWC administrative director with other issues affecting providers in the workers' compensation system, such as setting medical fee schedules, and undertakes medical care studies.



Office Closure Information

All Division of Workers’ Compensation district offices are open, with the following exception:

  • Eureka office closed until further notice

Judges' Conference Lines Updated  July 2, 2020

Alternative filing during COVID-19

  • In light of the continued state of emergency in response to the novel coronavirus (COVID-19) and to facilitate other methods of filing in line with the newslines issued on April 3 and April 28, and pursuant to the WCAB’s en banc order issued on April 6, documents subject to a statutory time limit may be sent by e-mail directly to the district offices pursuant to AD Rule 10205.7(c) where the filing party could not otherwise e-file, JET file or file the document by mail. Refer to the district office page for e-mail and other contact information.

Interrupted Services

  • Refer to the May 28 newsline for detailed information regarding services starting June 8.
  • Disability Evaluation Unit continues to accept consultative and summary rating requests by mail or efiling. Commutation calculation requests can be requested by mail.
  • Open for essential services only:
    • DWC Medical Unit
    • Return-to-Work Supplement Program
    • Uninsured Employers Benefit Trust Fund
    • Legal Unit
    • Subsequent Injuries Benefit Trust Fund

Updated July 7

Medical Unit Programs:

Online physician education courses
now Available

DWC offers free online education courses providing continuing education credits for physicians, QMEs, chiropractors, and nurses. Current offerings include the use of the Medical Treatment Utilization Schedule (MTUS) and tips for Qualified Medical Evaluators (QME).

Resources:

Database:

Frequently asked questions:

Forms

Medical Unit Office:
Mailing Address:
DWC - Medical Unit
P.O. Box 71010
Oakland, CA 94612
Street Address:
DWC - Medical Unit
1515 Clay Street, 18th floor
Oakland CA 94612
Telephone Number:
510-286-3700 or 800-794-6900
 
PLEASE NOTE:
ALL PACKAGES, CERTIFIED MAIL AND PRIORITY MAIL MUST BE SENT TO THE STREET ADDRESS ONLY

What's New

August 2020