FO&L Designated Doctor Review

Instructions

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has enlarged the information to be filed on the DWC Form-032, Request for Designated Doctor. These changes are a part of an initiative to improve the designated doctor process by:

  • Improving the quality of designated doctor examinations and narrative reports;
  • Decreasing the need for letters of clarification;
  • Reducing the inconvenience and expense of multiple re-examinations;
  • Expediting agreement between parties by bringing facts into focus early in the dispute resolution process.

To assist those claims departments requiring additional support, and upon request from you, Flahive, Ogden & Latson offers
three levels of services (See below).
We require: (1) a complete copy of all medical records in the carrier’s possession; (2) a copy of any investigative materials
if they are pertinent to the issue; and (3) that you complete FOL’s online request form. Requests for this service should be
sent direct to FOL’s DDR Department. Please do not send us your entire file.

Request for electronic Order Form can be made to: ddr@fol.com.If you have questions, please call 512-435-2294 or 512-435-2251.

For those offices preferring to self-complete the DWC-32 and file it through our office, we would be glad to file the request.
If you will provide a separate copy of the face sheet of the DWC-32, we will have it file stamped and returned to you.
We understand that you will monitor for approval by DWC and will be responsible for forwarding the medical and analysis if any.
Should you have general questions about this process a lawyer in our firm will be available to assist you by telephone.
These services are included in the Austin Division Representative services and are available without additional charge.

Platinum Service: $375

  • Prepare the DWC-32 form
  • Complete each mandatory field of information on the form;
  • Complete each discretionary field of information on the form;
  • Respond to Division inquiries related to DD request.
  • Prepare Analysis
  • Review medical records;
  • Summarize history of injury and course of medical care;
  • Analyze all reviewed file materials;
  • Tailor analysis specifically for the disputed issues raised.
  • Tracking Service:
  • File the form;
  • Notify you of date filed by email;
  • Monitor for DWC approval;
  • Follow up with DWC until exam approved;
  • Notify you of the date and time of the exam by email;
  • Forward copy of filed DWC – 32 and OA32A;
  • Forward all medical records to the Designated Doctor;
  • Notify you by email claimant attended, rescheduled, or no-showed at the Designated Doctor appointment.

Gold Service: $300

  • Prepare Analysis
  • Review medical records;
  • Summarize history of injury and course of medical care;
  • Analyze all reviewed file materials;
  • Tailor analysis specifically for the disputed issues raised.
  • Tracking Service:
  • Follow up with DWC until exam approved;
  • Forward copy of filed DWC – 32 and OA32A;
  • Forward all medical records to the Designated Doctor;
  • Notify you by email claimant attended, rescheduled, or no-showed at the Designated Doctor appointment.

Silver Service: $250

  • Prepare the DWC-32 form
  • Complete each mandatory field of information on the form;
  • Complete each discretionary field of information on the form;
  • Respond to Division inquiries related to DD request.
  • Tracking Service:
  • File the form;
  • Notify you of date filed by email;
  • Monitor for DWC approval;
  • Follow up with DWC until exam approved;
  • Notify you of the date and time of the exam by email;
  • Forward copy of filed DWC – 32 and OA32A;
  • Forward all medical records to the Designated Doctor;
  • Notify you by email claimant attended, rescheduled, or no-showed at the Designated Doctor appointment.

  • I will attach:
  • - -
  • - -
  • / /
  • / /
  • - -
  • - -
  • - -
  • Reason For Request - From Carrier's Perspective:
  • A: Determine MMI and IR
    Are you disputing a prior certification?
  • / /
  • / /
  • / /
  • / /
  • E: Has there been a SIBs DD exam within the last 365 days?
  • Return medical records to:
    FOL DDR Dept.
    P.O Box 201329 Austin, TX 78720
    Phone: 512-435-2294 or 512-435-2251
    Fax: 512-241-3349
    Email: ddr@fol.com
  • DFW Metroplex file pick up:
    Contact:
    Paul Railey: 214/704-0066
    Email: pkr@fol.com