City of Riverside, California

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:: Workers' Compensation

Forms

Medical Authorization - Blue Cross/Other
Medical Authorization - Kaiser
Medical mileage expense form
Medical Provider Network
Pre-Designation of Personal Medical Physician
Request to Withdraw Claim

If You Have Questions...
Ask your supervisor or call the Workers' Compensation office at (951) 826-5559.

WORKERS' COMPENSATION FRAUD IS A FELONY

Anyone who knowingly files or assists in the filing of a false workers' compensation claim may be fined up to $50,000 and sent to prison for up to five years (Insurance Code section 1871.4).