Request form: DWC Form-060 Medical Fee Dispute Resolution Request
US Postal Service mail:
Division of Workers’ Compensation
PO Box 12050
Delivery service or in person:
Division of Workers’ Compensation, MC: HS-MFDR
Texas Department of Insurance
1601 Congress Avenue, Suite 6.900
Austin, Texas 78701
An injured employee may file a medical fee dispute if the employee:
- Paid out-of-pocket for medical services for the compensable injury;
- Asked the workers’ compensation carrier for a refund in writing; and
- The insurance carrier either:
- did not respond within 45 days;
- denied your request; or
- did not pay the full amount you asked for.
Request form: DWC Form-060 Medical Fee Dispute Resolution Request
Ways to file:
Division of Workers’ Compensation
PO Box 12050
Austin, Texas 78711
Delivery service or in person:
Division of Workers’ Compensation, MC: HS-MFDR
Texas Department of Insurance
1601 Congress Avenue, Suite 6.900
Austin, Texas 78701
Learn more: Medical fee dispute resolution for injured employees (PDF)
- Pagó de su propio bolsillo por los servicios médicos de la lesión compensable;
- Pidió a la aseguradora de compensación para trabajadores un reembolso por escrito; y
- La aseguradora ya sea:
- no respondió dentro del transcurso de 45 días;
- denegó su solicitud; o
- no pagó la cantidad completa que usted solicitó.
Formulario de solicitud: Formulario DWC-060s, Solicitud para Resolución de Disputas por Honorarios Médicos
Formas en las que puede presentar la solicitud:
Texas Department of Insurance
Division of Workers’ Compensation
PO Box 12050
Austin, Texas 78711
Por servicio de entrega o en persona:
Division of Workers’ Compensation, MC: HS-MFDR
Texas Department of Insurance
1601 Congress Avenue, Suite 6.900
Austin, Texas 78701
Obtenga más información: Resolución de disputas por honorarios médicos para empleados lesionados (PDF)
Use the Medical fee dispute resolution decisions search tool to find MFDR decisions from 2014 to present.
You can search by:
- tracking number,
- the date the dispute was received, or the decision was issued, and
- by the name of the requestor or respondent.
Categories |
Active |
Abated |
---|---|---|
Air ambulance services |
n/a |
1,799 |
Workers’ comp specific services |
157 |
|
Pharmacy services | 116 |
|
Professional services |
139 |
|
Facility services | 72 |
|
Non-MFDR | 38 | |
Other | 84 | |
Totals |
605 |
1,799 |