What is a Request for Authorization (RFA) in workers' comp?

What is a Request for Authorization (RFA) in workers' comp?

The RFA is the form your treating doctor uses to ask the insurance company to approve a specific treatment for your work injury.

Once you start treatment for a work injury, your doctor sometimes needs the insurance company's approval before giving you certain care. Surgery, an MRI, physical therapy past a basic amount, and durable equipment often need this step first. Your doctor asks for that approval on a form called the Request for Authorization, usually shortened to RFA.

The form itself comes from California Code of Regulations, title 8, section 9785.5, which names and adopts the official DWC Form RFA. A related rule, section 9792.6.1, spells out what makes a request "complete" and how your doctor must send it. The review that follows is called utilization review, or UR, and Labor Code 4610 sets its rules.

This page covers the RFA itself: who sends it, what has to go with it, and the clock it starts. For how the review itself works once the form arrives, read our full guide to utilization review in California workers' comp.

Who fills out the RFA, me or my doctor?

Your treating physician fills out and signs the RFA. You do not complete this form yourself.

Labor Code 4610 has the physician treating you send the request, with supporting records, to the claims administrator handling your claim. Your primary treating physician, often called the PTP, is the doctor who directs your care and decides what to request. Read more in our guide to the primary treating physician in California workers' comp.

If you believe you need a specific test or treatment, say so at your next visit. Ask your doctor to submit the RFA and to flag the request if your condition is urgent. You can still track the request, write down the date you asked, and follow up if the office has not sent it yet.

What does my doctor have to send with the RFA?

A complete RFA names you and your doctor, lists the exact treatment requested, and comes with records from the last 30 days that support the request.

A rule under Labor Code 4610, title 8 section 9792.6.1, spells out when an RFA counts as "complete":

"Completed," for the purpose of this section and for purposes of investigations and penalties, means that the request for authorization identifies both the employee and the requesting provider; identifies with specificity all the recommended treatments in the designated section for requests for authorization if a form is used, or, on the first page if a narrative report is used; and is accompanied by documentation, issued or created no earlier than 30 days before the date of submission of the request for authorization, that substantiates the need for the requested treatment.

In practice, your doctor's office attaches recent exam notes, test results, and a short explanation of why the care is medically needed for your work injury. The same rule requires your doctor's signature on the form, by hand or by an agreed electronic signature, before it goes to the claims administrator.

A request that skips these pieces can be sent back marked "not complete." The claims administrator must do that, with its reasons, within five business days of receiving it, under a related timing rule at title 8 section 9792.9.1. A returned request is not a denial. It simply has not started the review clock yet.

The treatment itself also has to fit California's treatment guidelines. See our guide to the Labor Code 4600 Medical Treatment Utilization Schedule for how a reviewer measures whether care is medically necessary.

How long does the insurance company have to answer an RFA?

Most requests get a decision within five business days, urgent requests within 72 hours, and reviews of care you already received within 30 days.

Labor Code 4610 sets the clock once the claims administrator has what it reasonably needs to decide:

If your doctor marks the request for expedited review because your condition involves an imminent and serious threat to your health, the insurer must use the 72-hour clock instead of the standard one. Once a decision is made, the insurer must tell your doctor within 24 hours. A decision that changes or denies any part of the request must also reach you in writing: within two business days for most requests, or within 24 hours if the review happened while you were already receiving the care (concurrent review).

If the claims administrator does not yet have what it needs to decide, it must tell your doctor and you in writing right away and list exactly what is missing. The clock above then runs from the date that information arrives, not from the original request date.

What happens if the RFA is denied or nobody answers it?

A timely denial can be appealed through Independent Medical Review. A missed deadline is a separate problem worth raising with your attorney.

If the insurer denies or changes your request on time, the decision should explain why and should tell you how to ask for an Independent Medical Review, or IMR, under Labor Code 4610.5. Our guide on appealing a denied utilization review decision covers the IMR steps and deadline.

A missed deadline is different from a denial. The state can fine a claims administrator that misses the timeframes in Labor Code 4610. If your doctor's office sent a complete RFA and weeks pass with no written decision, that delay is worth documenting closely. Our guide on what to do when the insurance company disputes your treatment walks through what to track and when to get help.

When does a lawyer help with an RFA problem?

A lawyer is most useful when the insurer misses its deadline, keeps repeating the same denial without a documented change, or asks for information it never clearly described.

Many RFAs move through review without a fight. A lawyer becomes useful when the clock above is not followed, when a modification or denial seems to ignore your doctor's records, or when the same request keeps getting turned down with no new medical reason. Requesting treatment is the treatment-request stage inside the larger California workers' comp claim process, alongside filing, disability pay, and settlement.

Two related rules are worth knowing. The physician who requests your treatment is defined at Labor Code 3209.3, and your overall right to employer-paid medical care comes from Labor Code 4600. An RFA problem is often really a dispute about one of those two rules.

Eman Yazdchi is a Certified Specialist in workers' compensation law, certified by the California Board of Legal Specialization, State Bar of California. Eman Yazdchi reviews each request individually before recommending next steps. Call (661) 273-1780 or use the contact form for a free consultation about a stalled or denied treatment request.