Skip main navigation

Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.

  2. Forms Repository
  3. WKC-9498-E, Reasonableness of Fee Dispute Resolution Request

Reasonableness of Fee Dispute Resolution Request

Document Number: WKC-9498-E

Description: This form should be used ONLY for fee disputes related to treatment provided on or after July 1, 1992.

Comments: This form is an electronic template that can be filled out on your computer using Microsoft Word or Adobe Acrobat.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-9498-E (Electronic Version - Word/33 KB)

WKC-9498 (Electronic Version - pdf/189 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.

Contact Information

For questions about this form, or if you need this form in an alternate format, please see the Content Contact (listed to the left)

Having trouble finding the correct form? Forms Contacts