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DWC Form 9768.10 Independent Medical Review Application - California
What Is DWC Form 9768.10?
This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DWC Form 9768.10?
A: DWC Form 9768.10 is the Independent Medical Review Application used in California.
Q: What is the purpose of DWC Form 9768.10?
A: The purpose of DWC Form 9768.10 is to request an independent medical review in California.
Q: Who can use DWC Form 9768.10?
A: Anyone in California who disagrees with a decision made by their workers' compensation claims administrator regarding their medical treatment can use this form.
Form Details:
- Released on May 1, 2007;
- The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
- Easy to use and ready to print;
- Available in Spanish;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of DWC Form 9768.10 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.
Download DWC Form 9768.10 Independent Medical Review Application - California
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