This version of the form is not currently in use and is provided for reference only. Download this version of Form DWC045M for the current year.
This is a legal form that was released by the Texas Department of Insurance - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is the DWC045M form?
A: The DWC045M form is a request to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision (BRC-MFD) in Texas.
Q: What is the purpose of the DWC045M form?
A: The purpose of the DWC045M form is to request a Benefit Review Conference to appeal a medical fee dispute decision in Texas.
Q: When should I use the DWC045M form?
A: You should use the DWC045M form when you want to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision in Texas.
Q: Do I need to fill out the DWC045M form?
A: Yes, you need to fill out the DWC045M form if you want to schedule, reschedule, or cancel a Benefit Review Conference to appeal a medical fee dispute decision in Texas.
Q: Are there any fees associated with submitting the DWC045M form?
A: No, there are no fees associated with submitting the DWC045M form.
Q: Is the DWC045M form specific to Texas?
A: Yes, the DWC045M form is specific to Texas and is used to appeal medical fee dispute decisions in the state.
Form Details:
Download a fillable version of Form DWC045M by clicking the link below or browse more documents and templates provided by the Texas Department of Insurance.