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This version of the form is not currently in use and is provided for reference only. Download this version of
Form I&A19
for the current year.
Form I&A19 Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination - California
What Is Form I&A19?
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 Form I&A19?
A: Form I&A19 is the Information & Assistance Unit Guide for filing a petition to appeal the Administrative Director's Independent Medical Review (IMR) Determination in California.
Q: What is the purpose of Form I&A19?
A: The purpose of Form I&A19 is to provide guidance on how to file a petition to appeal the Administrative Director's IMR Determination in California.
Q: What is the Administrative Director's Independent Medical Review (IMR) Determination?
A: The Administrative Director's IMR Determination is a decision made by the Administrative Director regarding medical treatment disputes in the California workers' compensation system.
Q: How can I file a petition to appeal the Administrative Director's IMR Determination?
A: You can file a petition to appeal the Administrative Director's IMR Determination by following the instructions provided in Form I&A19.
Form Details:
- Released on June 1, 2018;
- 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 printable version of Form I&A19 by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.
Download Form I&A19 Information & Assistance Unit Guide - How to File a Petition Appealing Administrative Director's Independent Medical Review Determination - California
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