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The Texas DWC022 form is a document used by insurance carriers to request a Required Medical Examination (RME) for injured employees. This examination helps determine the appropriateness of the medical care received or evaluates the findings of a Designated Doctor. Understanding this form is essential for navigating the workers' compensation process in Texas.

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The Texas DWC022 form plays a crucial role in the workers' compensation process, particularly concerning Required Medical Examinations (RMEs). This form serves multiple purposes, primarily facilitating requests for agreements or orders related to RMEs. When an employee sustains a work-related injury, the insurance carrier may need to evaluate the appropriateness of the medical care received or assess determinations made by designated doctors. The form collects essential information, including the employee's personal details, the employer's information at the time of injury, and specifics about the insurance carrier and adjuster involved in the claim. Sections of the form guide the user through the process of requesting an RME, detailing examination logistics, such as the examining doctor's information and appointment scheduling. Additionally, it addresses whether the claim involves medical benefits through a Certified Health Care Network or a political subdivision, as these factors can influence the examination process. The insurance carrier must certify the accuracy of the request, ensuring compliance with Texas Labor Code requirements, while the injured employee has the right to agree or disagree to attend the examination. By understanding the DWC022 form's components, stakeholders can navigate the complexities of workers' compensation more effectively.

Dos and Don'ts

When filling out the Texas DWC022 form, it is important to follow certain guidelines to ensure accuracy and compliance. Here are four things you should and shouldn't do:

  • Do: Provide complete and accurate information in all sections of the form.
  • Do: Double-check the spelling of names and addresses before submitting.
  • Don't: Leave any required fields blank; this could delay the processing of your request.
  • Don't: Submit the form without reviewing it for errors or omissions.

Get Answers on Texas Dwc022

What is the Texas DWC022 form used for?

The Texas DWC022 form is a request for a Required Medical Examination (RME). It is primarily used by insurance carriers to ask for an examination of an injured employee by a doctor of their choice. This can be for two main purposes: evaluating a determination made by a Designated Doctor or assessing the appropriateness of health care received by the employee.

Who needs to complete the DWC022 form?

The form needs to be completed by the insurance carrier when they are requesting a medical examination. This includes filling out information about the employee, employer, insurance carrier, and the examination details. If the injured employee is represented by an attorney, their information should also be included.

How often can a Required Medical Examination be requested?

An RME to determine the appropriateness of health care can only be performed once every 180 days. However, examinations to evaluate a Designated Doctor's determination can occur more frequently. After receiving Supplemental Income Benefits for eight quarters, an RME regarding the ability to return to work can be performed no more than once a year.

What happens after the insurance carrier submits the DWC022 form?

Once the form is submitted, the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) will review the request. They will approve or deny it within 7 days. If approved, TDI-DWC will issue an order requiring the injured employee to attend the examination. If denied, the employee will receive a copy of the denial order and will not be required to attend.

Can the appointment for the Required Medical Examination be rescheduled?

Yes, if an employee cannot attend the RME, they must contact the doctor’s office to reschedule at least 24 hours in advance. The new appointment should occur no later than 7 days after the original date, unless a different date is mutually agreed upon, which must be within 30 days of the original appointment.

What should an injured employee do if they do not agree to attend the RME?

If an injured employee does not agree to attend the RME, they must complete the section of the form indicating their non-agreement and return it to the insurance carrier. The carrier may then submit a request to TDI-DWC for an order requiring the employee to attend the examination.

What information is required from the injured employee on the DWC022 form?

Injured employees must provide their name, Social Security number, address, contact information, date of injury, and, if applicable, their attorney's details. This information helps ensure that the correct individual is being referred for the examination.

How can an injured employee request travel reimbursement for attending the RME?

To request travel reimbursement, the injured employee must use the DWC-Form 048 Request for Travel Reimbursement. This form can be found on the Texas Department of Insurance website. For any questions regarding travel reimbursement or accommodations under the Americans with Disabilities Act (ADA), employees can contact TDI-DWC at (800) 252-7031.

How to Use Texas Dwc022

Completing the Texas DWC022 form requires careful attention to detail. This form is essential for requesting a Required Medical Examination (RME). Accurate information is crucial to ensure proper processing. Follow these steps to fill out the form correctly.

  1. Begin with Section I: Employee/Employee’s Attorney Information. Fill in the employee's full name, Social Security number, address, and telephone numbers. Include the date of injury and the name and address of the attorney or representative if applicable.
  2. Proceed to Section II: Employer Information. Enter the name and address of the employer at the time of the injury.
  3. Move on to Section III: Insurance Carrier Information. Provide the name and address of the insurance carrier, along with the adjuster's name, email, telephone, fax number, and license number.
  4. In Section IV: Examination Information, list the examining RME doctor’s name, mailing address, license number, and telephone number. Include the examination location and the date and time of the appointment. Indicate if the claim involves a Certified Health Care Network and if the employee's address and examination location are more than 75 miles apart.
  5. Next, fill out Section V: Purpose of Examination. Include the name of the designated doctor, the date of the designated doctor examination, and check all applicable issues in the designated doctor’s report that the RME will address.
  6. In Section VI: Insurance Carrier Certification, certify that the request is complete and accurate. The adjuster or authorized representative must sign and date this section.
  7. If applicable, complete Section VII: Examination Information for the appropriateness of health care received. Include the examining RME doctor's details and the examination location, along with the date and time of the appointment.
  8. In Section VIII: Insurance Carrier Certification, certify that the request is complete and that the injured employee has been notified regarding the examination agreement. The adjuster or authorized representative must sign and date this section.
  9. Finally, if Section VII has been completed, fill out Section IX: Injured Employee Agreement/Non-Agreement. The injured employee or their attorney must indicate whether they agree to attend the examination and sign the form.

After completing the form, ensure all information is accurate and legible. Submit the form to the appropriate parties as directed, and retain a copy for your records. Following these steps will help facilitate the process efficiently.

Common mistakes

Completing the Texas DWC022 form can be a straightforward process, but several common mistakes can lead to complications. One frequent error is providing incomplete or inaccurate personal information. For instance, omitting the employee's Social Security number or providing an incorrect address can delay processing and create confusion. It is essential to ensure that all fields are filled out accurately to avoid these issues.

Another mistake often made is failing to include the correct details about the insurance carrier. This includes the carrier's name and address, as well as the adjuster's contact information. If any of this information is missing or incorrect, it can hinder communication and potentially affect the outcome of the claim.

People also sometimes overlook the importance of the examination information section. Specifically, when listing the examining RME doctor's name and address, accuracy is crucial. If the information is wrong, it could lead to scheduling conflicts or missed appointments, which can complicate the claims process further.

Additionally, individuals may not check the appropriate boxes regarding the nature of the examination. For example, failing to indicate whether the claim involves medical benefits through a Certified Health Care Network can lead to misunderstandings about the requirements for the examination. This oversight can result in unnecessary delays.

Another common error is neglecting to provide an explanation when the employee's address and the examination location are more than 75 miles apart. This requirement is significant, as it helps justify the need for travel and ensures that the examination process adheres to regulatory standards.

People often forget to include the signature of the adjuster or authorized representative. This signature certifies the accuracy of the information provided and is a necessary component of the form. Without it, the submission may be deemed invalid.

Lastly, individuals may not keep a copy of the completed form for their records. Retaining a copy is important for tracking the status of the claim and ensuring that all parties involved have access to the same information. Keeping organized records can greatly facilitate the process and help avoid misunderstandings.

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