DWC Form-045, Request to Schedule, Reschedule, or Cancel a Benefit Review Conference (BRC), or to Pr 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Part 1, select whether you want to schedule, reschedule, or cancel a BRC by checking the appropriate box. If special accommodations are needed, specify them.
3. Fill out Part 2 with the employee's name, physical address, insurance carrier's name, date of injury, social security number, employer's business name and address.
4. In Part 3, indicate who is making the request and provide their contact information including phone number and email.
5. For Part 4, if requesting a BRC, check all applicable dispute reasons regarding compensability or benefits.
6. If rescheduling or canceling in Part 5, explain your reasons and attach any supporting documents as necessary.
7. Complete Part 6 by describing your communication efforts with other parties regarding the dispute and certify your signature at the end of the form.

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