Required Medical Examination Notice Or Request For Order {DWC-22}

DWC022 - REQUEST FOR A REQUIRED MEDICAL EXAMINATION (RME). The insurance carrier may request this examination for: • Issues ordered to be addressed in a designated doctor report: To have a doctor of their choice check the same issues as the designated doctor and provide their opinion for each examination. • Appropriateness of health care: To have a doctor of their choice examine whether the health care the injured employee received is appropriate and provide an opinion. The carrier can’t request an exam for appropriateness of health care if the claim is in a health care network or political subdivision. The employee only needs to sign the form when the purpose of the RME is for appropriateness of health care. DWC will approve or deny the request and send the order to all parties. The employee and RME doctor must contact each other 24 hours or earlier before the examination date to reschedule. If the employee fails to attend the examination, DWC may submit an administrative violation. If the examination is 30 miles or more from where the employee lives, the employee may request reimbursement for travel expenses from the insurance carrier using DWC Form-048, Request for Travel Reimbursement. www.FormsWorkflow.com