DWC Finally Lifts SIBs, DDR and RME Restrictions Imposed during Pandemic
More than fifteen months after restricting carriers from fully adjusting Texas claims, the Commissioner of Workers’ Compensation has announced the resumption of work search compliance standards for supplemental income benefit qualification as well as the Division’s intent to resume processing requests for designated doctor examinations and RME examinations for all issues, including return to work or disability as a direct result of the compensable injury. In Commissioner’s Bulletin No. B-0018-21, the agency announced that restrictions in both areas will be lifted August 2, 2021.
Background
On March 27, 2020, Governor Abbott approved DWC’s request to suspend work search compliance standards for supplemental income benefits under Labor Code Section 408.1415(a) and 28 Texas Administrative Code Section 130.102(d). Commissioner’s Bulletin No. B-0012-20.
On March 25, 2020, the Division of Workers’ Compensation ceased ordering DD exams and began holding requests for such as exams. Commissioner’s Bulletin No. B-0010-20. The agency also suspended RME, DD, and referral exams that had already been ordered. Any RME, DD, or referral exams ordered and scheduled on or before March 25, 2020, were suspended and the Division advised that those exams should not occur until further notice from DWC. Commissioner’s Bulletin No. B-0010-20.
On June 4, 2020, Commissioner’s Bulletin No. B-0030-20 announced that doctors with DD or maximum medical improvement and impairment rating certifications and referral doctors could resume scheduling and conducting DD examinations and RMEs that DWC previously ordered. DWC ordered removing return to work or disability as a direct result of the compensable injury from exams previously ordered but not yet completed.
So, for more than 15 months, claimants have been permitted to qualify for SIBs without having to meet statutory work-search requirements. Carriers have been unable to secure examinations from division-ordered doctors on the issues of return to work or disability as a direct result of the compensable injury to confirm or rebut the opinions of treating doctors on those issues.
The newest bulletin will end those practices.
Procedures to Resume Statutory Practices
The new Commissioner’s bulletin states that, for each full week of a qualifying period on or after Monday, August 2, 2021, injured employees must meet at least one of the work search requirements to be able to get SIBs.
On Monday, August 2, 2021, DWC will resume processing requests for DD examinations and RMEs for all issues, including return to work or disability as a direct result of the compensable injury. DWC will contact DD requesters about pending requests to determine if the exam is still needed. DWC will not process pending RME requests. Insurance carriers should submit new requests for RMEs as needed.
DWC Publishes FAQ Answers
The Division has created an FAQ page to assist system stakeholders with procedures for resuming statutory processes. Among several answers, the FAQs state:
Supplemental Income Benefits (SIBs) Work Search Requirements
Q: What happens if I do not meet one of these requirements each week in the qualifying period beginning on or after Monday, August 2, 2021?
A: If you have not met at least one of these requirements each week after this date, you will not be able to get SIBs unless you can show that you had a good reason not to.
Designated Doctor (DD) Exams
Q: I sent a DD exam request on the issue of return to work. Do I need to send a new request?
A: DWC will contact each requester to see if the exam is still needed. The requester may need to submit a new request if the information on the old request has changed.
Required Medical Exams (RMEs)
Q: I sent an RME request on the issue of return to work. Do I need to send a new request?
A: Yes. The requester must send a new request with an updated date and time for the examination.
If you need to request a new RME or DD exam in connection with this change, contact ddr@fol.com or go to the FOL website and select Designated Doctor Review or Required Medical Exam Request. If you have questions concerning these changes in general, please contact gqs@fol.com.
FOLIO
