DWC045A - Request for a Medical Contested Case or SOAH Hearing

What this form is

The DWC045A, Request for a Medical Contested Case or SOAH Hearing, is the appeal step after a medical dispute has already been decided once. It requests one of two proceedings: a medical contested case hearing, called an MCCH, held before a DWC administrative law judge, or a hearing at the State Office of Administrative Hearings, called SOAH, a separate state agency that holds its hearings in Travis County. Which one you get depends on what kind of medical dispute you have and, for fee disputes, how much money is involved.

Two earlier processes feed into this form. Medical fee disputes, arguments about what a bill should pay, come here after a decision from the DWC's medical fee dispute resolution process; Medical Fee Disputes: When Providers and Carriers Fight Over Bills explains that track, which mostly involves providers and carriers rather than workers. Medical necessity disputes, arguments about whether treatment should be approved at all, come here after a decision by an independent review organization, called an IRO; The IRO Review Process explains that step, and Medical Dispute Resolution (MDR) maps the whole system.

The checkboxes route your case

The form makes you sort your own dispute into one of five checkboxes, and the sorting has consequences: checking the wrong box sends your case toward the wrong tribunal and costs time you may not have. The pattern:

| Your dispute | Where it goes | |---|---| | Medical fee dispute, $2,000 or less | Medical contested case hearing at the DWC | | Medical fee dispute, more than $2,000 | SOAH hearing in Travis County | | Appeal of an IRO decision (retrospective, concurrent, or prospective medical necessity) | Per the necessity checkboxes on the form |

The dollar amount in a fee dispute is the amount still in dispute, not the whole bill. If you are unsure which side of the $2,000 line your dispute falls on, or which necessity category fits, get help before filing rather than guessing; an ombudsman from the Office of Injured Employee Counsel can assist at no charge.

The attachment rules pull in opposite directions

The form carries two instructions that confuse everyone. First, in capital letters: do not include medical documents with this form. Second, also in capital letters: a copy of the decision you are appealing must be attached, the medical fee dispute findings and decision (the MR-04) for a fee dispute, or the IRO decision for a necessity dispute. Both are correct. The decision document is required and the request is incomplete without it; the medical records are for the hearing itself, not the request. Send the form and the decision being appealed, and nothing else.

Where it goes, and when

The completed form is filed with the DWC's Chief Clerk of Proceedings, and it counts as filed when the Chief Clerk receives it, not when you mail it. The form itself states no filing deadline, which is a quiet danger: the deadline to request a hearing after an adverse decision lives in the rules, is short, roughly three weeks, and does not pause while you decide. Treat the day the IRO or fee-dispute decision arrives as day one and act inside the window. Important Texas Workers' Compensation Deadlines collects the dispute deadlines in one place.

One more rule surprises people who have moved: an MCCH is set within 75 miles of the claimant's residence at the time of the injury, not the current address, unless good cause supports a different location. A worker who has relocated may face a hearing near the old home. SOAH hearings are in Travis County regardless of where you live.