Form DWC045M Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (Brc-Mfd) - Texas

What Is Form DWC045M?

This is a legal form that was released by the Texas Department of Insurance - Division of Workers' Compensation - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form DWC045M?
A: Form DWC045M is a request form used in Texas to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision.

Q: What is a Benefit Review Conference?
A: A Benefit Review Conference is a meeting held between the parties involved in a medical fee dispute to try to reach a resolution.

Q: How can I use Form DWC045M?
A: You can use Form DWC045M to request, reschedule, or cancel a Benefit Review Conference by filling out the necessary information and submitting it to the appropriate entity.

Q: Is there a fee to submit Form DWC045M?
A: No, there is no fee to submit Form DWC045M.

Q: Can I appeal a medical fee dispute decision in Texas?
A: Yes, you can appeal a medical fee dispute decision in Texas by requesting a Benefit Review Conference using Form DWC045M.

Q: What should I do if I need to reschedule or cancel a Benefit Review Conference?
A: You should use Form DWC045M to request the rescheduling or cancellation of the conference.

Q: Are there any specific requirements for filling out Form DWC045M?
A: Yes, you need to provide accurate and complete information on the form, including details about the medical fee dispute decision and the desired outcome of the conference.