DWC Introduces New Form in Conjunction with DWC-32 Changes

In May 2023, the Division of Workers’ Compensation (DWC) introduced new “Requests for Information” forms for both insurance carriers and claimants. These forms were implemented alongside changes to the DWC-32, specifically to address the elimination of the boxes used to identify what the carrier had accepted as compensable and what had been determined compensable by agreement of decision.

The new form is known as the “REQUEST FOR INFORMATION TO THE INSURANCE CARRIER” and is referred to as DWC form OARF-IC. DWC may send this form to the carrier in case of a dispute concerning the certification of MMI (Maximum Medical Improvement) or the impairment rating.

A copy of the form sent to one of our clients is attached. The first page of the form contains four questions that the carrier needs to respond to. The fourth question, however, raises concerns. In this question, DWC specifies certain injuries or conditions and then asks the carrier to indicate whether they accept or dispute each one. We strongly advise against checking either the ACCEPT or DISPUTE box unless you are absolutely certain of your position.

We have several issues with DWC’s attempt to force carriers into a binary choice of accepting or disputing a specific condition. It is possible that the carrier has not yet taken a position on the injury or condition, and DWC cannot require the carrier to prematurely do so. Except as provided in Section 408.0042 of the Labor Code and Rule 126.14, there is no mandate for carriers to identify specific injuries or conditions they have accepted. Furthermore, a carrier is not obligated to decide on disputing an injury or condition unless it is denying a medical bill based on the extent of the injury. In such cases, the carrier must file a PLN-11 concurrently with or before issuing the EOB that denies the medical bill based on the extent of injury.

Thus, regarding the ACCEPT box, we recommend that you refrain from checking it unless you are entirely certain that the evidence supports the injury or condition. If you are unsure, simply state, “We have not taken a position at this time.”

If any of the ACCEPT boxes are checked, DWC will likely request that you sign a DWC-24 Benefit Dispute Agreement. Even where you believe the condition to be related, we strongly advise against doing so unless the carrier has previously disputed that injury or condition using a PLN-11.

It is essential to understand that the DWC-24 is a dispute resolution document; meaning it is meant to resolve an existing dispute. If the carrier signs the DWC-24 without having filed a PLN-11 disputing the injury, DWC’s Compliance group may pursue a violation against the carrier for raising an unreasonable dispute. We are familiar with a situation where the agency did just that when it signed a DWC-24 on the extent of injury despite the carrier never having disputed the injury. Our advice, therefore, is to never sign a DWC-24 on the extent of injury unless the carrier has previously disputed the injury using a PLN-11.

Regarding the DISPUTE box, refrain from checking it unless the carrier has already filed a PLN-11 that raised a dispute regarding the extent of injury. If the carrier has not filed a PLN-11 disputing the injury or condition, then no dispute has been raised. If the carrier checks the DISPUTE box, DWC’s Compliance group may argue that the carrier did not properly raise a dispute because it did not file a PLN-11. DWC cannot compel the carrier to prematurely raise a dispute. The timing of a dispute depends on whether the carrier is going to pay or deny a medical bill. If the carrier is denying a medical bill based on the extent of injury, then it must file a PLN-11 raising the extent of injury dispute either concurrently with or prior to the issuance of an EOB that denies the bill based on the extent of injury (see Rule 124.3(f)).

Thus, the safest response to DWC’s request to check either the ACCEPT or DISPUTE box is to state, “We have not taken a position at this time.”

On the second page of the OARFI-IC, question number five asks the carrier to list any additional injuries they believe should be considered when assessing MMI/impairment rating. The carrier is then told to check the ACCEPT or DISPUTE box. Our concerns with question number five are the same as those with question number four. We recommend following the same process for this question as well.

In this context, we are suggesting that carriers consider the Section 408.0042/Rule 126.14 process. There are a number of advantages to doing so and, if done correctly, very little downside.

Over the past few weeks, we have been assisting clients with the DWC OARFI-IC. If you need any assistance, please do not hesitate to reach out to either James Sheffield or Roy Leatherberry.