March 3, 2025 | Oakland, CA — MedLegalNews.com — The California Division of Workers’ Compensation (DWC) has launched a 15-day public comment period to review proposed modifications to utilization review regulations. After holding a public hearing on July 25, 2024, the agency incorporated stakeholder feedback to enhance efficiency and clarity in the workers’ compensation system.
Key Changes in the Proposed Regulations
Utilization Review Regulations: These updates impact multiple sections of Title 8, California Code of Regulations and introduce several notable improvements. Instead of requiring the PR-1 Treating Physician’s Report, the revised proposal allows physicians to use it as an option. The updated PR-1 form and instructions aim to improve usability and accuracy.
Furthermore, the changes simplify the UR plan application process, making submissions more straightforward. The revised Form UR-01 now applies to both initial applications and modifications, reducing unnecessary paperwork. Additionally, the new rules establish a process for handling requests for authorization (RFAs) submitted to non-designated addresses or numbers.
Another critical modification prevents UR deferrals when the “Resubmission – Change in Material Fact” checkbox is marked on an RFA or PR-1 form. The revised regulations also refine written UR approval requirements under the 30-day exemption rule. To keep the regulations relevant, DWC removed outdated dates and clarified non-substantive text.
How to Submit Public Comments
The DWC encourages stakeholders to provide input before the deadline. The final date for written feedback is 11:59 PM on Friday, March 14, 2025.
Submit Comments Via Mail
Maureen Gray, Regulations Coordinator
Department of Industrial Relations
Division of Workers’ Compensation
1515 Clay Street, 18th Floor
Oakland, CA 94612
Submit Comments Via Fax
(510) 286-0687
Submit Comments Via Email
For a detailed list of modifications and related forms, visit the DWC Rulemaking Page.
Why This Matters for Medical & Legal Professionals
These updates will significantly impact medical providers, attorneys, and insurers involved in workers’ compensation claims. By refining UR processes, DWC aims to reduce administrative burdens while ensuring injured workers receive faster medical decisions.
For official rulemaking details, forms, and submission guidelines, visit the California Department of Industrial Relations page to access the full text of the proposed utilization review regulations.
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FAQs: California DWC Utilization Review Regulations Update
What are the proposed changes to utilization review regulations?
The DWC’s proposed utilization review regulations simplify the UR process, allowing optional use of the PR-1 form and streamlining the UR-01 application for efficiency.
How will the updated utilization review regulations affect medical providers?
Medical providers may see faster review times and fewer administrative delays as the new utilization review regulations clarify authorization and submission rules.
When is the deadline to submit comments on the utilization review regulations?
Stakeholders must submit written comments on the utilization review regulations by 11:59 PM on Friday, March 14, 2025, via mail, fax, or email.
Why are utilization review regulations important for workers’ compensation cases?
Updated utilization review regulations help ensure timely medical care decisions, reduce disputes, and promote transparency between providers and insurers.