CA DWC Form 10232.2 2014 free printable template

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How to fill out CA DWC Form 102322

How to fill out CA DWC Form 10232.2

1. Start by downloading the CA DWC Form 10232.2 from the official California Department of Workers' Compensation website.
2. Fill in the employee's information in the designated fields, including name, address, and contact number.
3. Provide details about the employer, including the company's name and contact information.
4. Indicate the date of injury and describe the nature of the injury or illness in the appropriate section.
5. If applicable, include information about any medical treatment the employee has received.
6. Sign and date the form to certify that the information provided is accurate.
7. Submit the completed form to the appropriate workers' compensation claims administrator.

Who needs CA DWC Form 10232.2?

1. Workers who have sustained a work-related injury or illness that requires claims for benefits.
2. Employers who are required to provide documentation regarding employee injuries to workers' compensation insurance providers.

Instructions and Help about CA DWC Form 102322

Welcome to the training video for the online forum 1:06 panel request system my name is Katherine and I will be walking you through the process of submitting a represented initial panel request you can access the online panel request system by going to the DW see medical unit web page once you've accessed the online panel request system from the medical unit homepage you'll be taken to the beginning of the forum before we start let's look at some general features if you look to the right this says step one of eight this lets the user know what step of the forum they are in similarly the top row has page buttons this also lets the user know what section of the forum they are in you cannot proceed to the next stage until you finish the current page any field that has an asterisk next to it means that it is mandatory for the user to complete anything that has a question mark next to it is what we call a tooltip it gives the user instruction or information about the field that it is next to let's begin filling out the form for the date of injury you can either manually type in the date or use the calendar widget that's provided for you for requesting party the available choices are applicant attorney defense attorney or Claims Administrator for name of treating physician there's another tool tip it lets you know that if you do not know the name of the treating physician you may enter unknown for the first name and unknown for the last name for specialty of treating physician there's a drop-down list it lists the specialties in alphabetical order other is at the very bottom you can use the drop-down list, or you can type a letter of the alphabet, and it will take you to that section of the list the same logic goes for me specialty requested and for opposing parties me specialty preferred the only difference is that at the very bottom it says unknown when you get to the Labor Code section depending on what dispute your request is for the following information may change if you choose a 4060 dispute your dispute type is compensability it asks for the date of report being objected to and the date of request for comprehensive exam if you have a forty sixty-one dispute your available choices are permanent disability and future medical treatment and here it asks you for the date of objection communication if you choose forty sixty-two your dispute type choices are temporary disability permanent and stationary status work restriction ability to return to work apportionment diagnosis and causation it also asks you for the date of obstruction communication but note there's another question it says was written objection communicated within 20 days of your receipt of the report for which objections are being made if yes that satisfies the question but if no it'll ask you another question it'll tell you to tell them the reason why it was made more than 20 days from objected report receipt date if you choose mutual agreement that satisfies the question but if you...

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What is CA DWC Form 10232.2?

CA DWC Form 10232.2 is a form used in California for reporting an employee's wage loss due to a work-related injury or illness.

Who is required to file CA DWC Form 10232.2?

Employers who have workers' compensation claims or self-insured employers are required to file CA DWC Form 10232.2.

How to fill out CA DWC Form 10232.2?

To fill out CA DWC Form 10232.2, employers need to provide specific information about the employee, the injury, and the lost wages. The form must be filled out accurately and completely, following the provided instructions.

What is the purpose of CA DWC Form 10232.2?

The purpose of CA DWC Form 10232.2 is to document wage loss related to a work-related injury for the purposes of workers' compensation claims.

What information must be reported on CA DWC Form 10232.2?

The information that must be reported on CA DWC Form 10232.2 includes the employee's personal details, information about the injury, dates of disability, and the wages lost due to the injury.