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Benefit Review Conference (BRC) Information for Subclaimants - Appeal of a Medical Fee Dispute Decision - Appeal of a Medical Fee Dispute Decision

A party to a medical fee dispute may appeal a medical fee dispute decision by requesting a BRC no later than 20 days from the date the medical fee dispute decision is received by the party. At a BRC, the parties may not resolve the dispute by negotiating fees that are inconsistent with any applicable fee guidelines adopted by the Commissioner of Workers' Compensation. A first responder's request for a benefit review conference must be accelerated by the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) and given priority.

TDI-DWC Forms

DWC Form-045M, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (BRC-MFD)

Additional Information

For a medical fee dispute a subclaimant should include:

  • a copy of the medical fee dispute decision must be included in the request to schedule a BRC (DWC Form-045M) to satisfy the documentation requirements in 28 Texas Administrative Code (TAC) §141.1(d); and
  • provide a copy of any applicable section of the fee guidelines adopted by the Commissioner of Workers' Compensation.

Exchange of Information

Pertinent information must be exchanged in accordance with 28 TAC §141.4.

  • Disputing party must exchange all documents in their possession with the other party before requesting a BRC.
  • Opposing party must exchange documents within 10 working days after receiving the request to schedule a BRC (DWC Form-045M).
  • Any additional documents that come into a party's possession after the initial time frames must be exchanged no later than 14 days before the BRC (5 days if the BRC is expedited).
  • All documents must be submitted to the TDI-DWC no later than 14 days before the BRC (5 days if the BRC is expedited).
  • Any documents obtained after the exchange deadline should be brought to the BRC with sufficient copies for both the other party and the TDI-DWC.

Definition of Terms

  • "Benefit" means a medical benefit, an income benefit, a death benefit, or a burial benefit based on a compensable injury. See Texas Labor Code §401.011(5).
  • "Agreement" means the resolution by the parties to a dispute under this subtitle of one or more issues regarding an injury, death, coverage, compensability, or compensation. The term does not include a settlement. See Texas Labor Code §401.011(3).
  • "Health care facility" means a hospital, emergency clinic, outpatient clinic, or other facility providing health care. See Texas Labor Code §401.011(20).
  • "Health care practitioner" means:
    • (A) an individual who is licensed to provide or render and provides or renders health care; or
    • (B) a nonlicensed individual who provides or renders health care under the direction or supervision of a doctor. See Texas Labor Code §401.011(21).
  • "Health care provider" means a health care facility or health care practitioner. See Texas Labor Code §401.011(22).


Last updated: 04/04/2016

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