Submission of Required Treatment Plans (DWC-25 Form)
and Medical Reports (s. 44013(4)(A), F.S.)
A provider rendering medical treatment and other physician services
must submit treatment plans to the carrier in a format prescribed by the
Division. The Division adopted the Florida Workers’ Compensation
Uniform Medical Treatment/Status Reporting Form-
the document providers shall use to request authorization for treatment
and to report the medical status of the injured employee. The DWC-25 is
also used to document the physician’s independent or consultative
opinion related to an injured employee’s disability, permanent
impairment or need for continuing medical treatment addressed in an
Independent Medical Examination Report to the carrier.
DWC-25 Forms Submission Time Frames
Physicians, whether treating or
physicians are required to submit the DWC-25 form in accordance with
the time-frames established in the Billing Rule to recommend
services or to request a referral for services, and to report the
injured employee’s medical condition. The time-frames are:
- The initial DWC-25 Form must be
within three (3) business days of the initial
encounter. This initial form is to communicate the
recommended treatment plan, or to request authorization for
subsequent follow-up care, and to report the medical status.
- Subsequent DWC-25 Forms must be submitted by the close
of the business day following the date of the
actionable event or at a maximum of 30 days from the
submission of the prior DWC-25.
- The interim DWC-25 Form also reports
the medical status of the injured employee, updates medical
treatment recommendations and requests authorization for
subsequent follow-up care.
- The final DWC-25 Form addressing the
injured employee’s MMI date and PI rating must be
submitted to the carrier by the close of the business day
following the date of service.
- The DWC-25 Form documenting the
physician’s opinion or finding(s) resulting from an
Independent Medical Examination (IME) must be
submitted to the carrier with the IME report
within ten (10) business days following the date of
- The DWC-25 Form addressing the
injured employee’s MMI date and PI rating
must be submitted to the carrier by the close of
the business day following the date of service.