Track where treatment stopped
Early Workers' Comp Treatment Request Tracker
Use this tool now
Use one dated row for each medical request, report, response, UR notice, authorization, scheduling contact, or treatment visit. Preserve the source document for every entry and do not use this tracker to calculate a disputed injury date or legal deadline.
How to use it
- 1.Start with the injury date shown in the claim record without deciding a disputed date yourself.
- 2.Use one row for each request, response, scheduling event, or visit.
- 3.Save the document, message, or contact note supporting every entry.
Tracker
Early Workers' Comp Treatment Request Tracker
| DateDocument or event date | Request or eventRFA, report, response, UR, scheduling, or visit | TreatmentExact service requested | Sender or recipientClinic, adjuster, UR, or provider | StatusSent, received, authorized, delayed, modified, denied, or scheduled | Proof savedFile name, portal message, or contact note |
|---|---|---|---|---|---|
| Date, row 1 | Request or event, row 1 | Treatment, row 1 | Sender or recipient, row 1 | Status, row 1 | Proof saved, row 1 |
| Date, row 2 | Request or event, row 2 | Treatment, row 2 | Sender or recipient, row 2 | Status, row 2 | Proof saved, row 2 |
| Date, row 3 | Request or event, row 3 | Treatment, row 3 | Sender or recipient, row 3 | Status, row 3 | Proof saved, row 3 |
| Date, row 4 | Request or event, row 4 | Treatment, row 4 | Sender or recipient, row 4 | Status, row 4 | Proof saved, row 4 |
| Date, row 5 | Request or event, row 5 | Treatment, row 5 | Sender or recipient, row 5 | Status, row 5 | Proof saved, row 5 |
| Date, row 6 | Request or event, row 6 | Treatment, row 6 | Sender or recipient, row 6 | Status, row 6 | Proof saved, row 6 |
| Date, row 7 | Request or event, row 7 | Treatment, row 7 | Sender or recipient, row 7 | Status, row 7 | Proof saved, row 7 |
| Date, row 8 | Request or event, row 8 | Treatment, row 8 | Sender or recipient, row 8 | Status, row 8 | Proof saved, row 8 |
| Date, row 9 | Request or event, row 9 | Treatment, row 9 | Sender or recipient, row 9 | Status, row 9 | Proof saved, row 9 |
| Date, row 10 | Request or event, row 10 | Treatment, row 10 | Sender or recipient, row 10 | Status, row 10 | Proof saved, row 10 |
| Date, row 11 | Request or event, row 11 | Treatment, row 11 | Sender or recipient, row 11 | Status, row 11 | Proof saved, row 11 |
| Date, row 12 | Request or event, row 12 | Treatment, row 12 | Sender or recipient, row 12 | Status, row 12 | Proof saved, row 12 |
Avoid
- — Do not assume every request is exempt from prospective UR.
- — Do not calculate a disputed injury date or personal deadline here.
- — Do not alter or recreate missing medical records.
Keep with this tool
- — DWC-1 and injury report
- — Claim-status letters
- — Doctor reports
- — RFA and supporting records
- — UR or authorization notices
- — Appointment messages
- — Work-status slips
- — Contact log
Common questions
Does the first 30 days mean every treatment is automatically approved?
No. Labor Code section 4610 includes conditions and categories that may remain subject to prospective utilization review.
What if the clinic says it sent an RFA but the adjuster says it was not received?
Record both statements, ask for written confirmation and transmission details, and preserve every response.
Does this tracker calculate my 30-day period or an IMR deadline?
No. Injury dates, service facts, exceptions, and review deadlines can require advice based on the actual documents.
Read the deeper explanation
First 30 Days of Workers' Comp Treatment: New DWC ReportAuthoritative sources
Check the linked official source for current forms and rules. Updated: .
WCLG
Need help with the actual claim?
Every claim depends on its documents, medical evidence, and procedural history. WCLG offers a free consultation without promising a result.