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DWC032 Complete, if known: DWC Claim # Carrier Claim #Request for Designated Doctor Examination Type (or print in black ink) each item on this form. INJURED EMPLOYEE INFORMATION 1. Employee Name (First,
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How to fill out request for designated doctor

01
To fill out a request for a designated doctor, follow these steps:
02
Begin by gathering all necessary information, such as the name and contact details of the injured worker, the employer's information, and the treating doctor's details.
03
Write a clear and concise statement explaining why a designated doctor evaluation is necessary. Include any relevant medical records or test results that support the request.
04
Include any specific questions or concerns you have regarding the injured worker's condition that you would like the designated doctor to address.
05
Provide your own contact information and indicate how you prefer to be contacted with the designated doctor's response.
06
Submit the completed request form to the appropriate authority, such as the workers' compensation board or insurance company.
07
Keep a copy of the request form and all supporting documents for your records.

Who needs request for designated doctor?

01
A request for a designated doctor is typically needed in workers' compensation cases when there is a dispute or uncertainty regarding an injured worker's medical condition and treatment.
02
This request is usually made by the injured worker's attorney, the insurance company, or the workers' compensation board.
03
The designated doctor is responsible for performing an objective evaluation of the injured worker's condition and providing a medical opinion that can help resolve any disputes or guide further medical treatment.
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Request for designated doctor is a form used to request an evaluation by a doctor selected by the Texas Department of Insurance, Division of Workers' Compensation.
The injured worker, insurance carrier, or legal representative is required to file a request for designated doctor.
The request for designated doctor can be filled out online or by submitting a paper form with the necessary information.
The purpose of the request for designated doctor is to obtain an independent medical evaluation to assist in resolving disputes related to the injured worker's medical condition and treatment.
The request for designated doctor must include the injured worker's name, claim number, date of injury, specific medical issues to be evaluated, and any relevant medical records.
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