DWC045M - Request to Schedule, Reschedule, or Cancel a Benefit Review Conference to Appeal a Medical Fee Dispute Decision (BRC-MFD)
Appealing a Medical Fee Dispute Decision
When DWC decides a medical fee dispute against you, the DWC045M is how you appeal. It asks for a special benefit review conference, and it has deadlines and attachments that decide whether you get one.
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What this form is
The DWC045M, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference for a Medical Fee Dispute, is the appeal form for a lost medical fee dispute. When you file a fee dispute on form DWC060 (usually to get repaid money you spent on treatment or prescriptions the insurance carrier should have covered), the dispute is decided on paper by DWC's Medical Fee Dispute Resolution program. If that written decision goes against you, or repays you less than you asked for, the DWC045M is how you take the next step: a benefit review conference on the fee dispute, called a BRC-MFD, where a DWC benefit review officer works the dispute with both sides present.
Most fee disputes are fought between doctors and carriers. But the appeal right belongs to you too, and for a worker who paid bills out of pocket, this form is the second stage of getting that money back.
The deadline comes first
The form itself warns that there are strict deadlines for requesting a BRC-MFD, and then does not state them. Treat the written fee dispute decision the way you would treat any adverse decision on your claim: the appeal window is measured in days, not months, and it starts when the decision issues. Do not set the decision aside to deal with later. If you intend to appeal, prepare this form the week the decision arrives.
What must go with the form
Attach a copy of the decision from DWC's Medical Fee Dispute Resolution program. This is not optional. A request without the attached decision is incomplete, and an incomplete request is denied, which can cost you the deadline entirely. Attach the full decision, not just the first page.
What happens after you file
DWC schedules the conference within 40 days of receiving a complete request, or within 20 days if the request qualifies as expedited. Claims involving first responders are expedited automatically; the form asks you to state that on its face.
Two scheduling rules are worth knowing in advance:
- One nearly free reschedule. A request to reschedule made within 10 days of the setting notice is approved if it is the first request. After that, rescheduling requires agreement or good cause.
- Exchange rules apply. Each side must send the other its pertinent information (the documents that matter to the dispute) within 10 days of a request, and must file its documents with DWC 14 days before the conference. Anything obtained later is exchanged as it arrives.
The cancellation trap
The form allows you to cancel a scheduled conference, and the instructions carry a quiet warning: requesting to cancel a BRC-MFD may be considered a withdrawal of the dispute. A worker who cancels because the date is inconvenient may be treated as having given up the appeal itself. If the date does not work, reschedule. Do not cancel unless you truly intend to drop the dispute.
If the conference does not resolve it
A fee dispute that survives the BRC-MFD moves to the State Office of Administrative Hearings, and the request for that hearing is made on form DWC049, with its own short deadline after the conference ends. The full path, and what workers can realistically expect from it, is explained at Medical Fee Disputes: When Providers and Carriers Fight Over Bills. For help at the conference itself, the Office of Injured Employee Counsel provides free ombudsmen, and Benefit Review Conferences explains how these conferences work generally.
Fee disputes look small next to the rest of a claim, but the money at stake is usually money that came out of your pocket, and the appeal path is unforgiving about attachments and dates. Before you file this form, make sure the real problem is the fee decision and not something larger, because a carrier that wrongly refused a bill once is often refusing other things too. If you paid for care the carrier should have covered and lost the fight to get it back, or a provider is pressing you for money during your claim, talk with one of our attorneys. We will look at the whole claim, not just the bill, and the conversation costs you nothing.
5 pages · Rev. 07/21
