--- title: ARS, LLC description: ARS, LLC --- # DWC legacy forms ## Access To Public Records - [ Request For Authorization Number Form_DWC-AD3.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20Authorization%20Number%20Form_DWC-AD3.pdf?hsLang=en) - [ Request For Public Records.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20Public%20Records.pdf?hsLang=en) ## Administrative Forms - [Arbitrator Application.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Arbitrator%20Application.pdf?hsLang=en) - [ Arbitrator Submittal Form_DWC-10297.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Arbitrator%20Submittal%20Form_DWC-10297.pdf?hsLang=en) - [ Doctor's First Report Of Occupational Injury Or Illness_DLSR-5021.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Doctors%20First%20Report%20Of%20Occupational%20Injury%20Or%20Illness_DLSR-5021.pdf?hsLang=en) - [ EDEX Client Acknowledgement.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/EDEX%20Client%20Acknowledgement.pdf?hsLang=en) - [EDEX Client List.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/EDEX%20Client%20List.pdf?hsLang=en) - [ EDEX Subscriber Agreement Application.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/EDEX%20Subscriber%20Agreement%20Application.pdf?hsLang=en) - [ Employer's Report Of Occupational Injury Or Illness_DLSR-5020.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Employers%20Report%20Of%20Occupational%20Injury%20Or%20Illness_DLSR-5020.pdf?hsLang=en) - [ Notice Of Employee Death_DIA-510.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Employee%20Death_DIA-510.pdf?hsLang=en) - [ Notice To Employees Poster_DWC-7.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20To%20Employees%20Poster_DWC-7.pdf?hsLang=en) - [ Official Medical Fee Schedule Order Form.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Official%20Medical%20Fee%20Schedule%20Order%20Form.pdf?hsLang=en) - [ Physician's Guide Order Form.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Physicians%20Guide%20Order%20Form.pdf?hsLang=en) - [ Request For Accommodations By Persons With Disability_DWC-5.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20Accommodations%20By%20Persons%20With%20Disability_DWC-5.pdf?hsLang=en) ## Audit Forms - [ Annual Report Of Adjusting Location For Claims Adminstrators_DWC-852.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Annual%20Report%20Of%20Adjusting%20Location%20For%20Claims%20Adminstrators_DWC-852.pdf?hsLang=en) - [Audit Referral Form_DWC-AU906.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Audit%20Referral%20Form_DWC-AU906.pdf?hsLang=en) - [ Audit Report Of Inventory 2011_DWC-851.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Audit%20Report%20Of%20Inventory%202011_DWC-851.pdf?hsLang=en) - [ How To File A Complaint With The Audit Unit_DWC-AU905.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/How%20To%20File%20A%20Complaint%20With%20The%20Audit%20Unit_DWC-AU905.pdf?hsLang=en) ## Carve Out Agreement Forms - [ Petition For Permission To Negotiate A Section 3201.7 Labor-Management Agreement_DWC-RSG1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20For%20Permission%20To%20Negotiate%20A%20Section%203201.7%20Labor-Management%20Agreement_DWC-RSG1.pdf?hsLang=en) ## Claim And Court Forms - [ Appeal From Determination And Order Of The Rehabilitation Unit.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Appeal%20From%20Determination%20And%20Order%20Of%20The%20Rehabilitation%20Unit.pdf?hsLang=en) - [ Application For Adjudication Of Claim (Death Case)_DIA-2.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Adjudication%20Of%20Claim%20(Death%20Case)_DIA-2.pdf?hsLang=en) - [ Application For Benefits For Serious And Willful Misconduct Of Employer.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Benefits%20For%20Serious%20And%20Willful%20Misconduct%20Of%20Employer.pdf?hsLang=en) - [ Application For Discrimination Benefits Pursuant To Labor Code Section 132(A).pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Discrimination%20Benefits%20Pursuant%20To%20Labor%20Code%20Section%20132(A).pdf?hsLang=en) - [ Declaration Pursuant To Labor Code Section 4906(g).pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Declaration%20Pursuant%20To%20Labor%20Code%20Section%204906(g).pdf?hsLang=en) - [I&A Guide 11.pdf](https://www.arslegalca.com/legacy-files#) - [ Information Guidelines For Submission Of Settlement Documents.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Information%20Guidelines%20For%20Submission%20Of%20Settlement%20Documents.pdf?hsLang=en) - [ Medical Mileage Expense_1-1-07.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_1-1-07.pdf?hsLang=en) - [ Medical Mileage Expense_1-1-08.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_1-1-08.pdf?hsLang=en) - [ Medical Mileage Expense_1-1-09.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_1-1-09.pdf?hsLang=en) - [ Medical Mileage Expense_1-1-10.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_1-1-10.pdf?hsLang=en) - [ Medical Mileage Expense_1-1-11.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_1-1-11.pdf?hsLang=en) - [ Medical Mileage Expense_7-1-06 to 1-1-07.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_7-1-06%20to%201-1-07.pdf?hsLang=en) - [ Medical Mileage Expense_7-1-08.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Medical%20Mileage%20Expense_7-1-08.pdf?hsLang=en) - [ Notice Of Dismissal Of Attorney_DWC-37.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Dismissal%20Of%20Attorney_DWC-37.pdf?hsLang=en) - [ Notice Of Employee Death_DIA-510.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Employee%20Death_DIA-510.pdf?hsLang=en) - [ Objection To Treating Physician's Recommendation For Spinal Surgery_DWC-233.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Objection%20To%20Treating%20Physicians%20Recommendation%20For%20Spinal%20Surgery_DWC-233.pdf?hsLang=en) - [ Petition For Appointment Of Guardian Ad Litem And Trustee_DWC-8.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20For%20Appointment%20Of%20Guardian%20Ad%20Litem%20And%20Trustee_DWC-8.pdf?hsLang=en) - [ Petition For Change Of Primary Treating Physician_DWC-280.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20For%20Change%20Of%20Primary%20Treating%20Physician_DWC-280.pdf?hsLang=en) - [ Petition For Commutation Of Future Payments_DWC-49.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20For%20Commutation%20Of%20Future%20Payments_DWC-49.pdf?hsLang=en) - [ Petition For Reconsideration_DWC-45.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20For%20Reconsideration_DWC-45.pdf?hsLang=en) - [ Petition To Reopen_DWC-42.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Petition%20To%20Reopen_DWC-42.pdf?hsLang=en) - [ Pre-Trial Conference Statement_DWC-10253.1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Pre-Trial%20Conference%20Statement_DWC-10253.1.pdf?hsLang=en) - [ Special Notice Of Lawsuit.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Special%20Notice%20Of%20Lawsuit.pdf?hsLang=en) - [ Substitution Of Attorneys_WCAB-36.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Substitution%20Of%20Attorneys_WCAB-36.pdf?hsLang=en) - [ Workers' Compensation Claim Form_DWC-1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Workers%20Compensation%20Claim%20Form_DWC-1.pdf?hsLang=en) ## Complaint Forms - [ How To File A Complaint With The Audit Unit_DWC-AU905.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/How%20To%20File%20A%20Complaint%20With%20The%20Audit%20Unit_DWC-AU905.pdf?hsLang=en) - [ Qualified Medical Evaluator Complaint Form.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Qualified%20Medical%20Evaluator%20Complaint%20Form.pdf?hsLang=en) - [ Utilization Review Complaint Form_DWC-UR1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Utilization%20Review%20Complaint%20Form_DWC-UR1.pdf?hsLang=en) ## Disability Evaluation Forms - [ Apportionment_DEU-105.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Apportionment_DEU-105.pdf?hsLang=en) - [ Employee's Request For Informal Permanent Disability Rating_DEU-200.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Employees%20Request%20For%20Informal%20Permanent%20Disability%20Rating_DEU-200.pdf?hsLang=en) - [ Notice Of Options Following Disability Rating (Spanish)_DEU-110.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Options%20Following%20Disability%20Rating%20(Spanish)_DEU-110.pdf?hsLang=en) - [ Notice Of Options Following Disability Rating_DEU-110.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Options%20Following%20Disability%20Rating_DEU-110.pdf?hsLang=en) - [ Request For Informal Rating (By Insurance Carrier Or Self-Insurer)_DEU-201.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20Informal%20Rating%20(By%20Insurance%20Carrier%20Or%20Self-Insurer)_DEU-201.pdf?hsLang=en) ## Fraud Reporting Forms - [ Report Of Suspected Medical Care Provider Fraud_DWC-SMBFR1115.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Report%20Of%20Suspected%20Medical%20Care%20Provider%20Fraud_DWC-SMBFR1115.pdf?hsLang=en) ## Judicial Ethics Forms - [ Complaint Form And Information.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Complaint%20Form%20And%20Information.pdf?hsLang=en) ## MPN Forms - [ Cover Page For Medical Provider Network Application_DWC-9767.4.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Cover%20Page%20For%20Medical%20Provider%20Network%20Application_DWC-9767.4.pdf?hsLang=en) - [ Independent Medical Review Application (Spanish)_DWC-9768.10.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Independent%20Medical%20Review%20Application%20(Spanish)_DWC-9768.10.pdf?hsLang=en) - [ Independent Medical Review Application_DWC-9768.10.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Independent%20Medical%20Review%20Application_DWC-9768.10.pdf?hsLang=en) - [ Notice Of Medical Provider Network Plan Modification Labor Code 9767.8_DWC-9767.8.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Medical%20Provider%20Network%20Plan%20Modification%20Labor%20Code%209767.8_DWC-9767.8.pdf?hsLang=en) - [ Physician Contract Application_DWC-9768.5.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Physician%20Contract%20Application_DWC-9768.5.pdf?hsLang=en) - [ Sample Initial Written Employee Notification Re. Medical Provider Network (Spanish).pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Sample%20Initial%20Written%20Employee%20Notification%20Re.%20Medical%20Provider%20Network%20(Spanish).pdf?hsLang=en) - [ Sample Initial Written Employee Notification Re. Medical Provider Network.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Sample%20Initial%20Written%20Employee%20Notification%20Re.%20Medical%20Provider%20Network.pdf?hsLang=en) ## Pre-Designation Of Personal Physician_Change Of Physician Forms - [ Notice Of Personal Chiropractor Or Personal Acupuncturist (Spanish)_DWC-9783.1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Personal%20Chiropractor%20Or%20Personal%20Acupuncturist%20(Spanish)_DWC-9783.1.pdf?hsLang=en) - [ Notice Of Personal Chiropractor Or Personal Acupuncturist_DWC-9783.1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Personal%20Chiropractor%20Or%20Personal%20Acupuncturist_DWC-9783.1.pdf?hsLang=en) - [ Notice Of Pre-Desgination Of Personal Physician_DWC-9783.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Pre-Desgination%20Of%20Personal%20Physician_DWC-9783.pdf?hsLang=en) - [ Notice Of Pre-Designation Of Personal Physician (Spanish)_DWC-9783.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Notice%20Of%20Pre-Designation%20Of%20Personal%20Physician%20(Spanish)_DWC-9783.pdf?hsLang=en) ## Primary Treating Physician Forms - [ Primary Treating Phsycian's Permanent And Stationary Report_DWC-PR3.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Primary%20Treating%20Phsycians%20Permanent%20And%20Stationary%20Report_DWC-PR3.pdf?hsLang=en) - [ Primary Treating Physician's Permanent And Stationary Report_DWC-PR4.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Primary%20Treating%20Physicians%20Permanent%20And%20Stationary%20Report_DWC-PR4.pdf?hsLang=en) - [ Primary Treating Physician's Progress Report_DWC-PR2.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Primary%20Treating%20Physicians%20Progress%20Report_DWC-PR2.pdf?hsLang=en) ## QME And AME Forms - [ Additional Panel Request_QME-31.7.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Additional%20Panel%20Request_QME-31.7.pdf?hsLang=en) - [ AME Or QME Declaration Of Service Of Medical - Legal Report_QME-122.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/AME%20Or%20QME%20Declaration%20Of%20Service%20Of%20Medical%20-%20Legal%20Report_QME-122.pdf?hsLang=en) - [ Application For Accreditation Or Re-Accreditation As Educaiton Provider_QME-118.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Accreditation%20Or%20Re-Accreditation%20As%20Educaiton%20Provider_QME-118.pdf?hsLang=en) - [ Application For Accreditation Or Re-Accreditation As Education Provider Instructions.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Accreditation%20Or%20Re-Accreditation%20As%20Education%20Provider%20Instructions.pdf?hsLang=en) - [ Application For Appointment As Qualified Medical Evaluator_QME-100.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Appointment%20As%20Qualified%20Medical%20Evaluator_QME-100.pdf?hsLang=en) - [ Declaration Regarding Protection Of Mental Health Records_QME-121.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Declaration%20Regarding%20Protection%20Of%20Mental%20Health%20Records_QME-121.pdf?hsLang=en) - [ Faculty Disclosure Of Commercial Interest_QME-119.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Faculty%20Disclosure%20Of%20Commercial%20Interest_QME-119.pdf?hsLang=en) - [ QME Appointment Notification Form_QME-110.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME%20Appointment%20Notification%20Form_QME-110.pdf?hsLang=en) - [ QME Disclosure Of Specified Financial Interests_QME-124.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME%20Disclosure%20Of%20Specified%20Financial%20Interests_QME-124.pdf?hsLang=en) - [ QME Notice Of Unavailability_QME-109.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME%20Notice%20Of%20Unavailability_QME-109.pdf?hsLang=en) - [ QME Or AME Conflict Of Interest Disclosure Form And Objection Or Waiver Instructions.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME%20Or%20AME%20Conflict%20Of%20Interest%20Disclosure%20Form%20And%20Objection%20Or%20Waiver%20Instructions.pdf?hsLang=en) - [ QME Or AME Conflict Of Interest Disclosure Form And Objection Or Waiver_QME-123.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME%20Or%20AME%20Conflict%20Of%20Interest%20Disclosure%20Form%20And%20Objection%20Or%20Waiver_QME-123.pdf?hsLang=en) - [ QME_AME Report Time Fram Extension Request_QME-112.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/QME_AME%20Report%20Time%20Fram%20Extension%20Request_QME-112.pdf?hsLang=en) - [ Qualified Medical Evaluator's Findings Summary Form (Unrepresented Cases Only)_QME-111.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Qualified%20Medical%20Evaluators%20Findings%20Summary%20Form%20(Unrepresented%20Cases%20Only)_QME-111.pdf?hsLang=en) - [ Reappointment Application As Qualified Medical Evaluator_QME-104.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Reappointment%20Application%20As%20Qualified%20Medical%20Evaluator_QME-104.pdf?hsLang=en) - [ Registration For QME Competency Examination_QME-102.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Registration%20For%20QME%20Competency%20Examination_QME-102.pdf?hsLang=en) - [ Replacement Panel Request_QME-31.5.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Replacement%20Panel%20Request_QME-31.5.pdf?hsLang=en) - [ Request For QME Panel Under Labor Code Section 4062.1 - Unrepresented (Spanish)_QME-105.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20QME%20Panel%20Under%20Labor%20Code%20Section%204062.1%20-%20Unrepresented%20(Spanish)_QME-105.pdf?hsLang=en) - [ Request For QME Panel Under Labor Code Section 4062.1 - Unrepresented Attachment.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20QME%20Panel%20Under%20Labor%20Code%20Section%204062.1%20-%20Unrepresented%20Attachment.pdf?hsLang=en) - [ Request For QME Panel Under Labor Code Section 4062.1 - Unrepresented_QME-105.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20QME%20Panel%20Under%20Labor%20Code%20Section%204062.1%20-%20Unrepresented_QME-105.pdf?hsLang=en) - [ Request For QME Panel Under Labor Code Section 4062.2 - Represented Attachment.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20QME%20Panel%20Under%20Labor%20Code%20Section%204062.2%20-%20Represented%20Attachment.pdf?hsLang=en) - [ Request For QME Panel Under Labor Code Section 4062.2 - Represented_QME-106.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Request%20For%20QME%20Panel%20Under%20Labor%20Code%20Section%204062.2%20-%20Represented_QME-106.pdf?hsLang=en) - [ Voluntary Directive For Alternate Service Of Medical-Legal Evaluation Report On Disputed Injury To Psyche_QME-120.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/VoluntaryDirectiveForAlternateServicePsyche_QME-120.pdf?hsLang=en) ## Spinal Surgery Second Opinion Forms - [ Application For Spinal Surgery Second Opinion Physician List_DWC-232.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Application%20For%20Spinal%20Surgery%20Second%20Opinion%20Physician%20List_DWC-232.pdf?hsLang=en) - [ Objection To Treating Physician's Recommendation For Spinal Surgery_DWC-233.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Objection%20To%20Treating%20Physicians%20Recommendation%20For%20Spinal%20Surgery_DWC-233.pdf?hsLang=en) ## Utilization Review Forms - [ Utilization Review Complaint Form_DWC-UR1.pdf](https://www.arslegalca.com/hubfs/Arslegalca_March2023/pdf/Utilization%20Review%20Complaint%20Form_DWC-UR1.pdf?hsLang=en)