UTILIZATIONREVIEWCOMPLAINTFORMFillable

Complaint form: Utilization review

CA Division of Workers Compensation · Workers Compensation

Verified current as of September 10, 2026

File a complaint challenging improper utilization review decisions that deny or delay necessary medical treatment in workers' compensation cases.

This form has fillable fields — you can complete it directly in the viewer on the right.
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