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Medical Providers
Information for Medical Providers

Requesting Authorization for Treatment

As a medical provider, we know caring for patients is your first priority. Here’s what you need to know to make the process as simple as possible.

Parts of the California Code of Regulations (CCR) dictate how you request authorization for treatment. Simply put, you must:

  • Make your request in writing for a specific course of proposed medical treatment (CCR 9792.6.1 (t)).
  • Use DWC Form RFA “Request for Authorization” (CCR 9792.6.1 (t)(1) and CCR 9785.5).
  • Identify both the employee and yourself (the provider); identify with specificity the recommended treatment or treatments; provide documentation substantiating the need for the requested treatment (i.e. DLSR 5021, PR-2, or narrative report per instruction on the form CCR 9792.6.1(t)(2)).
  • Sign your request (as the treating physician) and submit it via mail or fax it to the number below. 

Additional information about the required forms and access to them is available at the California’s Department of Industrial Relations’ website, Division of Workers’ Compensation page.

To request treatment authorization via fax, please send your request for authorization (RFA) to the dedicated UR fax number of the Regional Office handling the claim.

State Fund Regional Office

Dedicated UR Fax #


(707) 646-6801

Bay Area Claims Services - Pleasanton

(707) 646-6291

Eureka State Contracts

(707) 646-2682


(707) 646-6592

Inland Empire Claims Services - Riverside

(707) 646-6020

L&H – Longshore & Harbor

(707) 646-8363

Los Angeles Claims Services - Monterey Park

(707) 646-2649

Major Case Operations

(707) 646-2683

Major Case Operations State Contracts

(707) 646-2690

Orange County Claims  - Santa Ana

(707) 646-2462


(707) 646-6939

Riverside State Contracts

(707) 646-0738

Rohnert Park State Contracts

(707) 646-0584

Sacramento State Contracts

(707) 646-0438

Santa Ana State Contracts

(707) 646-0826


(707) 646-8125

Vacaville State Contracts

(707) 646-2681


UR Connected—Submit Your Request For Authorization Online
We have implemented UR Connected to expedite the provision of medical benefits to injured employees. UR Connected lets medical providers input treatment requests and receive immediate decisions at the point of care via a web portal or Electronic Medical Record (EMR) integration.

If you’re a medical provider who has established UR Connected capability with us through Conexia (our vendor partner), submit your RFA via the web-based portal or EMR integration.  When using the web portal or EMR integration, you may sign your request electronically.

If you’re interested in learning about UR Connected and becoming a user, please email Conexia at

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