The Dispute Resolution Process is available to any injured worker, employer, participating provider, or insurance carrier who may have an issue relating to medical care, including a request for a change of physician within the CWMP network. The Dispute Resolution Procedure must be pursued and completed in accordance with Title 85A of the Oklahoma Statutes, Section 56(A).
When a Certified Workplace Medical Plan’s office receives notice of a dispute, a resolution will be offered within ten (10) days. The ten-day time frame may be extended if necessary to gather further medical information relating to the dispute. If an extension is necessary, a written notice will be sent to all parties.
The Dispute Resolution Process consists of up to four (4) possible steps:
- If you have a dispute related to medical care, please complete the CWMP Dispute Resolution Form and fax to CompCHOICE at 405-841-9364.
- Upon receipt of a completed Dispute Form, the Certified Workplace Medical Plan will attempt to resolve the dispute administratively. If the issue can be resolved administratively by CompCHOICE, a letter is sent to all applicable parties.
- If the Certified Workplace Medical Plan is unable to resolve the dispute, it will be referred to the Medical Director for determination. If resolution is achieved, a letter is sent to all applicable parties.
- If the Medical Director feels additional expertise is required to resolve the matter, the Dispute Form and all available medical information pertaining to the issue, will be sent to either a specialist or a panel of healthcare providers at the Medical Director’s discretion. Then, a letter is sent to all applicable parties.