DWC-AD Form 103 Request for Reconsideration of Summary Rating by the Administrative Director - California

What Is DWC-AD Form 103?

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 the DWC-AD Form 103?
A: The DWC-AD Form 103 is a form used to request a reconsideration of a summary rating by the Administrative Director in California.

Q: What is the purpose of the DWC-AD Form 103?
A: The purpose of the DWC-AD Form 103 is to request a review and reconsideration of a summary rating assigned by the Administrative Director in California.

Q: Who can use the DWC-AD Form 103?
A: The DWC-AD Form 103 can be used by individuals who wish to challenge or appeal a summary rating assigned by the Administrative Director in California.

Q: How do I submit the DWC-AD Form 103?
A: The DWC-AD Form 103 can be submitted by mail or fax to the appropriate office as indicated on the form.

Q: What should be included in the DWC-AD Form 103?
A: The DWC-AD Form 103 should include the relevant information regarding the summary rating being challenged, along with any supporting documents or evidence.

Q: Is there a deadline to submit the DWC-AD Form 103?
A: Yes, there is a deadline to submit the DWC-AD Form 103. The form must be submitted within 30 days of the date of the summary rating notice.

Q: What happens after submitting the DWC-AD Form 103?
A: After submitting the DWC-AD Form 103, the request for reconsideration will be reviewed by the Administrative Director, who will make a determination based on the information provided.

Q: Can I appeal the decision made by the Administrative Director?
A: Yes, if you disagree with the decision made by the Administrative Director, you have the right to appeal the decision to the Workers' Compensation Appeals Board (WCAB).