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Request to Schedule a Medical Contested Case Hearing (MCCH) Request to Schedule a Medical Contested 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the REQUEST SPECIFICATIONS section. Check the appropriate box for the type of hearing you are requesting, and attach any necessary documents, such as the IRO decision if applicable.
- In the INJURED EMPLOYEE CLAIM INFORMATION section, provide details about the injured employee including their name, date of injury, and physical address. Ensure all fields are completed accurately.
- Proceed to the REQUESTER INFORMATION section. Indicate your role (e.g., Injured Employee, Health Care Provider) and provide your contact information including mailing address and phone number.
- Finally, review all entered information for accuracy before signing and dating the form. Once complete, submit it via fax or mail as instructed.
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Related links
Nov 18, 2011 Hearings conducts Medical Contested Case Hearings (MCCH) as an appeal process for resolving medical necessity disputes, i.e., appeal of an
Operational or Users Manual. The manual should include instruction, installation, operator, or technical manuals with required information to the users.Read more
a party to a medical fee dispute or less than $2,000.00 may request a medical contested case hearing (MCCH) conducted by a DWC hearing officer.