The DWC 500-E is which of the following?

• A. An accident report form
• B. A medical status form
• C. A payroll update form
• D. A denial letter requiring proof of service

Answer: (D)

When a denial must be communicated formally, the DWC-500-E is used to issue a denial letter that requires proof of service. This means the notice not only states that the claim or benefit is denied, but also includes or is accompanied by documentation showing that the recipient was properly served. Proof of service is a record of when, how, and to whom the notice was delivered, ensuring due process and enabling timelines for appeals or reconsiderations. The form is specifically for denials with this service-verification requirement, and it isn’t the form you’d use for an accident report, a medical status update, or payroll updates, which are administrative or medical/HR tasks rather than formal denial communications.