GQ Corner
Q. I have a file in Texas where the claimant was seen by the treating provider one time, had light duty restrictions, but never went back to work or to be released by the provider. I am unable to contact the claimant. So technically, he still has work restrictions. I did schedule a DDE and he did not show up for the appointment. Can I close this claim for administrative purposes without the DWC-69?
A. Texas law does not provide for any ability to “close” a file. Once an injury is determined to be compensable, the file remains “open” for all time and must be maintained in perpetuity. However, carriers and TPAs will often have internal policies regarding whether to deem a file active or not. That said, the obligations associated with such files remain firmly in place and TDI-DWC does not recognize any mitigating factors for failure to comply with the carrier’s legal responsibilities. That said, the failure to attend the Designated Doctor appointment means that the claimant loses entitlement to TIBs until such time that he attends. That does not, however, affect the right to any other benefits he may be due.
The existence or non-existence of a DWC-69, therefore, is a matter for internal claims processing a does not otherwise have an effect on the legal responsibilities of the carrier. Texas Labor Code §402.081(b) requires TDI-DWC to maintain claim files related to certain workers’ compensation claims, including, but not limited to, employer injury reports, employee wage records, medical reports, and requests for dispute resolution. Prior to September 1, 2005, Labor Code §408.081(b) required the Texas Workers’ Compensation Commission to retain a copy of the claim file for a 50 year period. House Bill 7, 79th Legislature, Regular Session (2005) amended the Labor Code to allow the agency to determine the retention period for claim files. Thus, it would appear that a carrier should consider retaining the file for at least 50 years.
Q. I have an employee that applied for unemployment benefits and I am paying him TIBs. Is he entitled to both?
A. You cannot suspend TIBs based upon the claimant’s receipt of unemployment benefits. However, if the Texas Workforce Commission finds out the claimant has been receiving TIBs, they will request the claimant to pay back what they have been paying the claimant. It does not work in reverse, however.
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