DWC049 - Request to Schedule a Medical Contested Case Hearing (MCCH)

What this form is

The DWC049, Request to Schedule a Medical Contested Case Hearing, asks for a formal hearing, called an MCCH, on a medical dispute. One form covers two very different appeals, and knowing which one you are filing matters:

1. Appeal of an Independent Review Organization decision. An IRO is the independent medical reviewer that decides whether denied treatment was medically necessary. If the IRO decides against you, the DWC049 requests a hearing before a DWC administrative law judge.
2. Appeal of a medical fee dispute decision. If a fee dispute was not resolved at the benefit review conference stage (the conference requested on form DWC045M), the DWC049 sends it to the State Office of Administrative Hearings, called SOAH, in Travis County.

For most injured workers, the first route is the one that matters: it is the last chance to win treatment your doctor says you need. Medical Dispute Resolution (MDR) explains how the two tracks fit together.

The 20-day deadlines, and the one that runs early

Both routes give you 20 days, but they start counting from different events.

| Appeal | Deadline | |---|---| | IRO medical necessity decision | No later than the 20th day after the decision is sent to you | | Medical fee dispute decision | No later than the 20th day after the benefit review conference concludes |

Read the first row carefully. The IRO clock runs from the day the decision is sent, not the day you receive it. A decision that sat in the mail for a week has already spent a third of your window. When an IRO decision arrives, check the date on the letter, count 20 days from that date, and act on what remains. The IRO process itself, including this appeal, is covered at The IRO Review Process.

The cost warning that does not apply to you

The form states that the losing party at a SOAH hearing must reimburse the state for hearing costs, and then states, plainly, that these requirements do not apply to the injured employee. Workers skim the first sentence, miss the second, and abandon valid appeals out of fear of a bill. You do not owe the state hearing costs if you lose. Do not let that paragraph make the decision for you.

Getting the request accepted

Attach the IRO decision if you are appealing one. The attachment is mandatory, and an incomplete request means no hearing gets scheduled while your 20 days run out. The form also lets you request an expedited MCCH where the situation justifies speed, and claims involving first responders with serious bodily injury are entitled to expedited handling.

For an IRO appeal, the hearing is set within 75 miles of where you lived at the time of injury. Fee dispute appeals are heard by SOAH in Travis County.

Attend the hearing

Failure to attend an MCCH can result in a penalty or fine, and the hearing can proceed and be decided without you. If the date is impossible, ask for a new setting for good cause before the hearing, not after. These hearings are the medical cousin of the benefit hearings described at Contested Case Hearings; the format is formal, evidence matters, and preparation decides outcomes.