DWC-AD Form 102 Request for Summary Rating Determination of Primary Treating Physician Report - California

DWC-AD Form 102 Request for Summary Rating Determination of Primary Treating Physician Report - California

What Is DWC-AD Form 102?

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-AD Form 102?A: DWC-AD Form 102 is a form used in California to request a summary rating determination of the primary treating physician report.

Q: Who can request a summary rating determination using DWC-AD Form 102?A: Anyone involved in a workers' compensation case in California can request a summary rating determination using DWC-AD Form 102.

Q: What does a summary rating determination of the primary treating physician report involve?A: A summary rating determination involves evaluating the medical report provided by the primary treating physician to determine the level of permanent disability for a workers' compensation case.

Q: Are there any fees for requesting a summary rating determination using DWC-AD Form 102?A: No, there are no fees for requesting a summary rating determination using DWC-AD Form 102.

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Form Details:

  • Released on November 1, 2008;
  • The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DWC-AD Form 102 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-AD Form 102 Request for Summary Rating Determination of Primary Treating Physician Report - California

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