DWC Accepting Comments on Two Newly Proposed Forms

The Division of Workers’ Compensation is accepting public comment on two newly created forms. One form is designed to help carriers obtain performance data while the other has been created to facilitate the investigation process in first responder presumption claims.

DWC-29 Request for Standard Detailed Data Reports

Insurance carriers, including certified self-insurers, certified self-insurer groups, and governmental entities, may submit the DWC-29 to ask for claim-level data they have already submitted to DWC. The data will be made available to them or another entity on their behalf. The reports provide the detail related to the insurance carrier performance scorecards for:

• • • timely payment of initial temporary income benefits (TIBs) and EDI reporting;
    • timely processing of medical bills and EDI reporting; and
    • timely processing of reconsideration medical bills and EDI reporting.

The new form will replace the current process for requesting standard detailed data reports through DWC’s open records portal. DWC will establish a secure file transfer protocol (SFTP) box to provide data to the requestor.

Comments must be received by 5 p.m., Central time, Friday, September 6, 2019

PLN-14 Notice of Continuing Investigation

The Division is also accepting public comments on proposed Plain Language Notice 14 (PLN-14) to implement Senate Bill 2551. That bill made substantial changes in the way carriers must process claims that may qualify for a presumption under Texas Government Code, Chapter 607, Subchapter B. The Division has also proposed a number of new or amended rules to implement the legislation.

Proposed Rule 124.2 adds Subsection (f) that describes the three alternative actions that an insurance carrier must take no later than the 15th day from the notice of injury: pay the claim, deny it, or issue a notice of a continuing investigation. The PLN-14 is the form the Division has created for the purpose of notifying the agency and the injured worker of the notice of continuing investigation. Proposed Subsection (h) of the rule describes the elements of a Notice of Continuing Investigation.

Proposed Rule 124.3 (a)(4) provides that an insurance carrier’s failure to file a timely Notice of Continuing Investigation obligates the insurance carrier to pay all accrued and accruing income and medical benefits, subject to contesting compensability on or before the 60th day from written notice of injury.

Proposed Rule 124.3 (d) and (e) respectively provide for a Notice of Continuing Investigation relating to a claim for death benefits and burial benefits.

Proposed Rule 180.26 (f) provides that when an insurance carrier has provided a Notice of Continuing Investigation, the Division must consider a number of factors described in Labor Code §415.021(c-2).

DWC will host a public hearing on the proposed form on November 20, 2019, at 10 a.m. at the DWC central office located at 7551 Metro Center Drive, Suite 100, in Austin. Written comments on the proposed PLN-14 may be submitted at the meeting, by email to RuleComments@tdi.texas.gov, or by mailing or delivering your comments as described below.

To be considered, comments on the proposed PLN-14 must be received by 5 p.m., Central time, on November 25, 2019.

Written Comments for Both Forms

Written comments on either form may be submitted by email to RuleComments@tdi.texas.gov, or by mailing or delivering your comments to:

Cynthia Guillen
Office of General Counsel, MS – 4D
Texas Department of Insurance, Division of Workers’ Compensation 7
551 Metro Center Drive, Suite 100
Austin, Texas 78744-1645

If you have questions about the public hearing or the proposed forms, please contact Bobby Stokes, James Sheffield or Steve Tipton.