eForms RFA-1LC

It will automatically be available on December 13. Users will need to perform a successful case search before the eForm button appears.

No, you must submit electronically starting on December 13, 2024. After this date, the Board will not accept or act on any paper RFA-1LC forms submitted by attorneys/representatives.

Yes. We encourage firms that have an interest in pursuing our XML options to visit the RFA-1LC eForm page. Testing for both the API and the sFTP file-based options will continue to be available after December 13.

Yes, you can download or print a PDF of the completed eForm. Submitted eForms are placed in the case folder and can be viewed from the eForms landing page using the Submission ID hyperlink. The hyperlink will open the PDF.

A copy of the completed RFA-1LC eForm is not automatically sent to the required parties. It is the responsibility of the claimant's legal counsel to download and print the completed eForms and serve all parties the RFA-1LC and any uploaded documents following the same methods currently being used to serve all parties.

No, once the RFA-1LC is submitted, no other changes can be made. However, the form can be saved and edited as a work in progress before submission.

You cannot cancel the RFA once it's been submitted, but you can send attorney correspondence to the Board and parties of interest stating that you withdraw the RFA-1LC that was filed.

No, submit the documentation with attorney correspondence if you need to reference additional documentation in relation to the RFA-1LC.

Use the Required Document Matrix file from the Requirements and examples section above to assist you in determining if supporting documentation will be needed (referenced or uploaded).

There can only be one draft per WCB case number. Only one person can work in a WCB case number at a time. One user can start an eForm, save a draft, and another user can resume that draft and save or submit it.

If an attorney fee is being requested in relation to the issue raised on the RFA-1LC, select the option "Attorney or Licensed Representative fee requested" under the Additional Proposed Findings step and upload/reference your Application for Fee by Claimant's Attorney or Licensed Representative (Form OC-400.1) with the eForm submission.

As a reminder, per our Efficiency Enhancements GovDelivery , do not use eCase Upload to submit your OC-400.1 after the hearing is closed. OC-400.1 form submissions trigger automatic Board action without additional correspondence but will not do so if instantly uploaded after the hearing has closed.

OC-400.1 follow-up may be requested by submitting an online claims inquiry and selecting "Request Board action on case documents."

No, do not file an RFA-1LC. The Section 32 agreement or stipulation creates a work item for the examiner to review. If these actions do not automatically happen within 30 days, you can submit an online claims inquiry.

Yes, under the Medical Category, select "Prior Authorization Request (PAR) was denied or granted in part by the Medical Director's Office (MDO)." You will be required to reference the appropriate PAR(s). PAR(s) eligible for selection have the following Form IDs: MG2-L3D, RX-L3D, DME-L3D, SS-L3D, MG2-L3GP, RX-L3GP, DME-L3GP, SS-L3GP.

If a specific PAR document does not appear, please refer to the "PAR Denial Appeals" section on Board's website for a list of PAR denial types the attorney may request for Adjudication review.

No, you cannot use this reason for medical authorization requests that have been submitted by the claimant's health care provider through the Prior Authorization Request (PAR) process. PARs that are eligible for Adjudication review will appear as a document to select within these two request reasons: "Prior Authorization Request (PAR) was denied or granted in part by the Insurer" and "Prior Authorization Request (PAR) was denied or granted in part by the Medical Director's Office (MDO)." If a specific PAR document does not appear, please refer to the "PAR Denial Appeals" section on the Board's website for a list of PAR denial types the attorney may request for Adjudication review.

To request that the Board act on a permanency report, file an RFA-1LC using the request reason "Claimant is at maximum medical improvement and a medical report on permanency has been filed or the claimant agrees with the insurer's IME permanency report."

To request that the Board act on a permanency report, file an RFA-1LC using the request reason "Claimant is at maximum medical improvement and a medical report on permanency has been filed or the claimant agrees with the insurer's IME permanency report."

Attorney correspondence can be uploaded with the RFA-1LC if an in-person hearing is requested for facial disfigurement.

Do NOT file an RFA-1LC using the request reason "Preclusion of Medical Reports" for this issue.

First, consider if you have already filed an RFA-1LC using the request reason "Claimant is at maximum medical improvement and a medical report on permanency has been filed or the claimant agrees with the insurer's IME permanency report." If not, then you should file one to request Board action on a permanency report.

If an EC-81.7 has been issued for schedule loss of use, then depositions will be directed automatically by Proposed Decision without any further action required by the parties. For permanency reports noting non-schedulable injuries, a hearing will be scheduled when the RFA-1LC is filed. If these actions do not happen within 30 days, you can submit an online claims inquiry.

For other topics where cross-examination is desired, select the appropriate request reason related to the joined issue on the RFA-1LC and indicate in the additional information field that you are requesting depositions/testimony. If the request reason is not on RFA-1LC, submit attorney correspondence.

When the Board receives an RFA-1LC presenting prima facie medical evidence (PFME) for an unestablished injury or condition, the Board will issue a Proposed Decision finding PFME, and will afford the insurer the right to accept the condition, get an independent medical examination (IME), cross-examine the health care provider, or make an argument on the record.

Once the Board issues the PFME Proposed Decision, it will set the case for a hearing approximately 75 days later. At that hearing, the insurer must produce the evidence directed by the Proposed Decision. In addition, the parties will have the opportunity to take brief testimony of the claimant on mechanism of injury. If an IME does not contest the injury or condition, the judge will make a decision on the additional site at this first hearing.

If the IME finds that the injury is not related, and depositions are requested, the judge will grant a continuance for outcome of those depositions. It is expected, absent good cause, that the Board will resolve these issues within one to two hearings.

Note: A Claimant's Notice of Independent Medical Examination (Form IME-5) or proof of a testimony date must be in the file by the date the Proposed Decision becomes final, or the Board may deem the insurer's inaction as a waiver of the right to get an IME or cross-examine claimant's provider. In addition, to be considered timely, any requests for a broader release of medical records should be made well in advance of the scheduled hearing.

In schedule loss of use cases when an EC-81.7 has been issued or where a judge has continued a case for a hearing or Reserved Decision, there should be follow-up action already scheduled by the Board. No RFA-1LC is necessary.

For other topics where the Board has directed the parties to follow-up, do one of the following:

• Submit an online claims inquiry and select "Request Board action on case documents."
• Select the appropriate request reason related to the joined issue on the RFA-1LC and indicate in the additional information field that you are requesting depositions/testimony.
• If the request reason is not on RFA-1LC, then submit attorney correspondence.

First, consider whether the Board needs a request on that topic. For example, any of the following will trigger Claims action without the need for an RFA-1LC or attorney correspondence: Section 32 waiver agreement, Stipulation (Form C-300.5), and Agreed Upon Proposed Decision Findings (Form C-312.5). Sending unnecessary requests will cause delays.

For issues that do not result in an automated Board action, the attorney may submit attorney correspondence. Do NOT file an RFA-1LC using a request reason that does not apply.

The free text option is within the Request Details step (if available for that request reason).

On the RFA-1LC eForm, select the appropriate request reason. Documents can be selected from the case file or uploaded from the user's device within that request reason.

If the claimant alleges they have reattached to the labor market and payments should resume, then select request reason "Claimant is not working and not receiving payments," upload the attachment evidence, and write "Claimant has reattached to the labor market" in the Additional Information Related to This Reason free text field.

If required, status on a previously submitted RFA-1LC may be checked by submitting an online claims inquiry and selecting "Request for Further Action (Form RFA-1LC) status." Please give the Board at least 30 days before submitting an inquiry.

If there is a direction in the WCB Board Panel decision to have a hearing, the case will be scheduled automatically; no RFA-1LC is needed. Follow-up may be requested by submitting an online claims inquiry and selecting "Request Board action on case documents."

If there isn't a direction for further hearings, then select a reason on the RFA-1LC eForm that needs to be addressed or submit attorney correspondence.

Notify the claim administrator of the change and copy the Board. If there isn't a claim administrator on file, send the information to the Board.

If an interpreter is needed for a hearing, ensure an Employee Claim (Form C-3) is filed indicating that an interpreter is required. More information is also available in the Claimant Information Packet.

Submit attorney correspondence raising the issue that the Claim Administrator improperly used Granted Without Prejudice for an accepted or established site/condition and identify the document ID number of the PAR. Do NOT file an RFA-1LC using a request reason that does not apply.