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How to use or fill out DWC Form-022, Request for a required medical examination (RME) with our platform
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Click ‘Get Form’ to open DWC Form-022 in the editor.
Begin with Section 1: Claim Information. Fill in the employee's name, Social Security number (last four digits), phone number, and address. Ensure you also include the date of injury and any representative's details if applicable.
Proceed to Part 2: Insurance Carrier Information. Enter the insurance carrier's name, address, adjuster's details, and confirm if medical benefits are from a certified health care network.
In Section 2: Examination Information, provide the doctor's name, license number, contact information, and appointment details. Specify if the examination location is over 75 miles from the employee’s address.
Complete Section 3: Purpose of Examination by checking relevant issues previously addressed or appropriateness of health care. Ensure to document any previous examination dates and agreements regarding attendance.
Finally, certify your request in Section 4 by signing and dating the form. Make sure all information is accurate before submitting.
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Submit the DWC-1 to your employer Your Supervisor/HR Representative is then required to complete the Employer section of the form and return a signed copy to you within one working day.
What is DWC 1 form?
A designated doctor (DD) is a doctor or health care provider selected and trained by DWC to resolve questions about an injured employees medical condition; or a dispute about a work-related injury or illness. The injured employee, the employees representative, or insurance carrier, or DWC can request a DD exam.
What is RME in Texas workers compensation?
REQUIRED MEDICAL EXAMINATION: A Required Medical Examination (RME) may be requested by the Texas Department of Insurance Division of Workers Compensation (TDI-DWC) or the insurance carrier. An RME is a medical examination to resolve questions about the workers compensation claim.
What does DWC claim mean?
The Division of Workers Compensation (DWC) monitors the administration of workers compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers compensation benefits.
What not to say to a workers comp doctor?
What You Shouldnt Tell Your Workers Comp Doctor Never lie about prior injuries, pre-existing conditions, or medical history. Never lie about the extent of your workplace injury or how it happened. Do not exaggerate your symptoms, including pain or functionality.
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The document is a Report of Medical Evaluation (DWC Form-069) used by the Texas Department of Insurance, Division of Workers Compensation. It outlines the process for certifying an injured employees Maximum Medical Improvement (MMI) and any permanent impairment resulting from a work-related injury.
What is the purpose of the DWC 1 form?
Form DWC 1 is the official form that California businesses and employees use to file a workers compensation claim. The employee fills out a portion of the form, and the employer fills out the remainder. The employer then sends the completed form to their workers comp insurance company in order to file a claim.
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DWC Form-022, Request for a required medical examination
What if the employee must travel to the RME? If the examination is 30 miles or more from where the employee lives, the employee may request reimbursement for.
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