DWC060 - Medical Fee Dispute Resolution Request
Disputing a Medical Fee
Most medical fee disputes are between doctors and insurance carriers. The DWC060 matters to workers for one reason: it is how you get back money you paid out of pocket for care the carrier should have covered.
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What this form is
The DWC060, Medical Fee Dispute Resolution Request, opens a fee dispute with DWC's Medical Fee Dispute Resolution program, which decides payment fights on paper. Doctors and pharmacies use it constantly to fight carriers over reimbursement amounts. For an injured worker, it serves a narrower and more personal purpose: it is the process for getting repaid money you spent yourself on treatment, prescriptions, or services that the workers' comp insurance carrier should have paid for.
Common examples: a pharmacy refused to bill the carrier and you paid cash for your medication; a provider collected payment from you before the claim was accepted; you covered a bill to protect your credit. Few workers know this refund process exists, and unclaimed money simply stays with the carrier.
Before using it, know one thing: in most of these situations you should never have been charged at all. Texas law generally prohibits providers from billing injured workers for treatment of a compensable injury, a protection explained at When Medical Providers Try to Collect From You. The DWC060 is the cleanup tool for money that already left your pocket.
The one-year deadline, and the receipt rule behind it
File the request no later than one year after the dates of service in dispute. The clock runs from when you received the care, not from when you paid or when the carrier refused. Limited exceptions exist in the rules, but do not plan around them.
There is a second rule hiding behind the first: the request is filed when DWC receives it, not when you mail it. A request mailed in the last week of the year can arrive filed too late. If the deadline is close, do not trust the mail to be fast.
What you must send
Providers filling out this form must complete a detailed table of disputed services with billing codes. You do not. An injured employee skips the Table of Disputed Services and instead assembles a four-part package:
- A description of the dispute (what care, what dates, what happened).
- An explanation of why you should be repaid.
- Proof that you paid (receipts, card statements, pharmacy printouts).
- A copy of the carrier's or provider's denial of reimbursement, or convincing evidence that you tried to get reimbursed and got nowhere.
The employee instructions sit on page 3 of the form, below several sections written for providers, which is why so many workers give up on it. Item 4 deserves emphasis: ask the carrier for reimbursement in writing before you file, and keep the request. Your written request and the carrier's silence or refusal are exactly the evidence the form demands.
What this process cannot decide
Fee dispute resolution decides how much should be paid for care. It does not decide whether your injury is covered, whether a body part is included in the claim, or whether treatment was medically necessary. Those questions have their own processes, described at Medical Dispute Resolution (MDR), and a fee dispute generally cannot move forward until they are resolved. If the carrier says the treatment itself was not necessary or not related, that fight comes first.
If the decision goes against you
A written decision you disagree with is not the end. The appeal is a benefit review conference on the fee dispute, requested on form DWC045M, and an unresolved dispute after that conference can go to the State Office of Administrative Hearings on form DWC049. Each step has a short deadline. The whole path, and why workers see it so rarely, is laid out at Medical Fee Disputes: When Providers and Carriers Fight Over Bills.
Workers pay out of pocket during comp claims far more often than the system admits, usually at the pharmacy counter, and most never learn there is a refund process at all. Keep every receipt from the day you are hurt, put every reimbursement request in writing, and remember that the year runs from the date of service, not the date you gave up waiting. If you have paid for care the carrier should have covered, or a provider billed you during an open claim, tell one of our attorneys. Billing you during a claim is often against the law by itself, we take that seriously, and finding out where you stand costs nothing.
4 pages · Rev. 02/21
