FO&L Required Medical Exam Service Request

 

Instructions

We are happy to offer you our new Post DD RME service.

  • FO&L RME service staff will file the DWC-22. We will secure the RME appointment date.
  • Our Attorneys will prepare a letter to the RME doctor pointing out findings from the claimant’s Treating Doctor, Peer and the Designated Doctor. Our Attorney or staff member will contact you to discuss the issues prior to filing the DWC-22.

We can also assist you in securing an RME on medical necessity issues (i.e., second opinions on medical treatment) for non-network claims.

For these types of examinations, in addition to the above:

  • Client to provide the RME Doctor preferred name.
  • FO&L RME service staff will attempt to secure agreement by the claimant to attend the RME (non post DD RME) prior to submitting the DWC-22 to the DWC.

Fee for Service/Billing: Time & Expense @ $140/hour.

 

  • Requestor Information

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  • Claimant Information

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  • DWC Information

  • Carrier & TPA Information

  • Network Claim

  • Requested Actions and Documentation

  • City in Texas

  • I am transmitting the above support documents via:

  • Questions

    PLEASE NOTE: Questions regarding medical treatment may not be asked of a post-DD RME and may not be asked in cases where the claimant is in a network. Similarly, questions directed to the post-DD RME must be with respect to issues for which the DD was appointed. FOL will review the questions and ensure that only questions allowed by the statute and rules are presented to the RME.

  • Flahive, Ogden & Latson
    Phone No: 512-435-2251
    P.O. Box 201329, Austin, TX 78720
    Fax No: 512-241-3327
    Email: wnb@fol.com

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