Workers’ Compensation
Injury Care

Trusted by case managers, adjusters, and employers throughout Brevard County.

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Workers’ Compensation
Referral Form

Built to support workers’ compensation case managers, adjusters, and injured workers through compliant care, clear documentation, and coordinated treatment.

Section 1: Contact Information

Please enter your full name.
This field is required.
Role
Select your role in the referral process.
This field is required.
Optional: Enter the name of your company or organization.
This field is required.
Please provide your contact phone number.
This field is required.
Preferred Method of Contact
Optional: Select the preferred method of contact for follow-up.

Section 2: Injured Worker Information (Optional)

Optional: Enter the full name of the injured worker.
This field is required.
Optional: Enter the employee’s phone number.
This field is required.

Section 3: Claim Details (Optional)

Optional: Enter the claim number associated with this referral.
This field is required.
Optional: Enter the Date of the Incident
This field is required.
Optional: Enter the name of the employer.
This field is required.
Optional: Enter the insurance carrier or program name.
This field is required.

Section 4: Injury Overview (Optional)

Injury Type
Optional: Select all applicable injury types.

What happens next

  • Your submission is acknowledged immediately
  • We contact the injured worker (if authorized) to schedule same day or following day appointments
  • We send initial evaluation + treatment plan promptly
  • Ongoing updates available upon request

Need to send documents?

Email: DrDorfman@brevardaccidentandworkinjurycenters.com

Why case managers choose us

We provide organized, process-driven injury care designed to support workers’ compensation cases with consistent communication, clear documentation, and coordinated treatment.

Process-driven care

Structured evaluations and treatment plans designed to support workers’ compensation cases from initial assessment through recovery.

Clear Documentation

Timely, objective reporting to support treatment decisions, case tracking, and continuity of care.

Coordinated Communication

Responsive coordination with injured workers and involved parties.

Local Brevard Coverage

Convenient access to care throughout Brevard County, helping reduce delays and improve compliance with treatment plans.

Frequently Asked Questions

Here are answers to common questions patients and case managers ask about injury care, workers’ compensation coverage, and treatment at Brevard Accident & Work Injury Centers.

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