Alert Concerning Medical Fee Disputes and Possible Violations

At the last carrier quarterly meeting, the manager of DWC’s Medical Review Division identified two issues that he had with carriers, both of which are violations of DWC Rule 133.307.

During medical fee dispute resolution, carriers are required to respond to the DWC-60 (Request for Medical Fee Dispute Resolution) within 14 calendar days and the response must include a production of specific documents.

In the fiscal year 2023, Carriers have been responding in only 84% of the medical fee disputes.  This raises a couple of concerns.  First, the failure to timely respond is an administrative  violation of DWC Rule 133.307(d).  DWC’s Medical Review Division files more internal violations against Carriers than any other single entity in the workers’ comp system.  Do not let this happen to you.  Secondly, if the carrier fails to respond to a two-sided dispute, it is very unlikely for the carrier to prevail in that dispute.

FOL will be happy to automatically respond on the behalf of a carrier to the DWC-60 request for medical fee dispute resolution. We already provide that service for some of our clients.  It is limited to FOL’s Division rep clients because we do not receive the DWC-60 from DWC’s Medical Review on carriers for whom FOL is not the Division rep.

If you would like that automatic service which will protect you from missing the deadline, please reach out to Brian Lam who oversees medical issues at FOL. His e-mail is btl@fol.com. His direct line is 512-435-2260. 

For those who are not our Division rep clients, we are always happy to handle the medical fee disputes for you.  However, you will need to reach out to Brian on each file that you want FOL to handle.

If you have any questions, please reach out to James Sheffield at jrs@fol.com or to Brian Lam.