FOLIO

New Plain Language Notices Become Effective Soon

May 12, 2023 | by FOL

The following list of new and revised Plain Language Notices (PLN) go into effect July 26, 2023, and align with the new Texas Claim EDI R3.1.4 standard:

• • • NEW PLN-02B, Notice of First Payment of Income Benefits on an Acquired Claim
    • Revised PLN-08, Notice of Change in Amount of Indemnity Benefit Payment
    • Renumbered PLN-10A, Notice of Reinstatement of Indemnity Benefits
    • NEW PLN-10B, Notice of Lump Sum Payment of Income or Death Benefits
    • Revised PLN-11, Notice of Disputed Issues and Refusal to Pay Benefits
    • Revised PLN-14, Notice of Continuing Investigation.

The new and revised PLN forms can be accessed via the DWC website: https://www.tdi.texas.gov/wc/index.html.

 

Here is a brief explanation of each of the new and revised forms:

NEW PLN-02B, Notice of First Payment of Income Benefits on an Acquired Claim

• • • Requires any new TPA on a transferred claim to report its first income benefit payment

 

Revised PLN-08, Notice of Change in Amount of Indemnity Benefit Payment

• • • Primarily cosmetic edits from the prior PLN-08
    • The “Instructions to Insurance Carrier” includes two (2) new additions:

1. 1. 1. 1. 1. Minimize abbreviations: Abbreviations create confusion. But if using abbreviations, spell out the full name or phrase the first time you use it and put the abbreviation in parentheses after it.
            2. Letterhead: Use the insurance carrier’s letterhead.

 

Renumbered PLN-10A, Notice of Reinstatement of Indemnity Benefits

• • • Identical to the former PLN-10, with some cosmetic edits only
    • The “Instructions to Insurance Carrier” includes the same two (2) new additions referenced above.

 

NEW PLN-10B, Notice of Lump Sum Payment of Income or Death Benefits

• • • To be used when paying accrued benefits for any reason. Scenarios when you must use this notice (not an exhaustive list):
    • DWC-24 (benefit dispute agreement);
    • DWC order (commissioner’s order, interlocutory order, decision and order, Appeals Panel decision);
    • advance of temporary, impairment, supplemental, or lifetime income benefits;
    • commuted (lump sum) payment of impairment income benefits;
    • payment of accelerated benefits; or
    • payment of underpaid indemnity benefits with interest.

 

Revised PLN-11, Notice of Disputed Issues and Refusal to Pay Benefits

• • • Primarily cosmetic edits from the prior PLN-11
    • Includes a reminder that “If disability is one of the items in dispute, the insurance carrier must also file the appropriate electronic data interchange (EDI) transaction. The notice of disputed issues and refusal to pay benefits is not considered complete until DWC receives a copy of this notice and the electronic filing.”
    • The “Instructions to Insurance Carrier” includes the same two (2) new additions referenced above under PLN-08.

 

Revised PLN-14, Notice of Continuing Investigation

• • • Cosmetic edits from the prior PLN-14 only

 

DWC asks that carriers and claim administrators be ready to use the updated forms when they become effective.  For questions about the new forms, please contact martha.luevano@tdi.texas.gov, or our office at gqs@fol.com.