Identify the denial and the completed review stage
TDI’s non-network guidance describes an adverse determination followed by reconsideration before an IRO request, with exceptions such as a life-threatening condition. Ask the carrier or TDI which process applies to your notice and act promptly on its instructions.
Collect the original denial, your reconsideration request and the response. Mark the service being disputed and the dates the notices were received. Confirm that the issue is medical necessity under a non-network workers’ compensation claim. A payment dispute, a network claim or a denial under ordinary health insurance may need different instructions.
Sources: TDI: Independent review FAQ for non-network claims; TDI: Request for review by an IRO
Use the injured-worker form and the correct fields
TDI directs injured employees to LHL009; its online IRO request system is for payers, utilization review agents and their representatives. The form asks who is requesting review, the denied service, the DWC claim reference and relevant provider or representative details.
Use the notice to identify the denied service accurately. Ask the provider’s office for an unknown administrative detail instead of guessing. Follow the instructions for your role and leave the company/URA section to the company. The form distinguishes health-plan release requirements from workers’ compensation cases, for which it says the release signature is not required.
Sources: TDI: Request for review by an IRO; TDI LHL009: Request for a review by an IRO
Return the request to the denying company
LHL009 directs you to return the form to the denying carrier or URA, not to TDI. TDI’s non-network FAQ gives a limit of 45 calendar days after receiving the adverse reconsideration decision. Confirm the applicable date promptly with the responsible contact; this guide does not calculate your deadline.
Use the recipient information in the denial notice or the completed company section. Save the exact packet and delivery evidence. If instructions conflict, ask the named contact to resolve the destination before sending. Record a submission as submitted, then obtain confirmation that the intended office received it.
Sources: TDI LHL009: Request for a review by an IRO; TDI: Independent review FAQ for non-network claims
Use the assignment notice for the records handoff
The carrier or URA forwards the request for IRO assignment. TDI then provides the reviewer information. The non-network FAQ directs additional records or related information to the assigned IRO using the notice’s contact details.
Keep the assignment letter with a list of requested documents, their source and who will send them. Ask the treating office about the relevant records or statement and any authorization it needs. If a clinical opinion is requested, leave that opinion to the clinician. Track the actual review decision separately from the appointment you hope to arrange.
Sources: TDI: Independent review FAQ for non-network claims; TDI LHL009: Request for a review by an IRO
Your next-step checklist
- Confirm non-network status and a medical-necessity denial within this guide’s scope.
- Keep both denial and reconsideration notices.
- Complete the current LHL009 fields for your role.
- Confirm the deadline and send the form to the denying company.
- Use the IRO assignment notice for subsequent records delivery.
Keep personal, insurance and medical information in the appropriate organization’s approved secure channel.
Common questions
Should I send LHL009 directly to TDI?
The form instructs applicants to send it to the company that denied the service. That company forwards the request for assignment.
Can I use this process for an ordinary health-plan denial?
TDI distinguishes workers’ compensation IRO requests from external review under other health plans. Use your plan’s applicable appeal instructions rather than applying this workers’ compensation checklist to it.
Sources: TDI: Request for review by an IRO
Sources and verification
The sources below support the administrative information in this guide. Follow the responsible organization’s current instructions when requirements, forms or contact routes change.
- TDI: Request for review by an IRO — checked .
- TDI: Independent review FAQ for non-network claims — checked .
- TDI LHL009: Request for a review by an IRO — checked .