GQ Corner
Q. Must the carrier complete EDI filing to report reimbursement of payment for prescription services by a claimant? If so, what rule conveys this requirement?
A. Yes. Rule 134.805 was amended effective September 1, 2015 to highlight the existing requirement that the carrier submit medical EDI records to the Division when it reimburses a claimant for health care paid in accordance with Rule 133.270 or when it reimburses an employer for health care paid in accordance with Rule 133.280. This requirement encompasses reimbursement for prescription services.
Q. The carrier has paid death benefits to the non-dependent parents of the decedent (the only identifiable beneficiaries) for 104 weeks pursuant to Rule 132.9 but what further actions need to be taken now that this time period has elapsed?
A. You must now remit a lump sum payment for the remaining amount to the Subsequent Injury Fund in accordance with Rule 132.10. Specifically, your payment should represent the balance left on the 364 weeks of benefits after subtracting the payments to the eligible beneficiaries. It should be mailed to the address provided below. It should be accompanied by the DWC-01, DWC-03, and a detailed payment record showing the dates of payments, the amounts of the payments, the payees, the periods of benefits paid and any other documentation reasonably required by the SIF administrator. Note: the payment that you make can be commuted. If you commute the payment, the amount of the commuted payment should be discounted at the applicable quarterly interest rate established by the Commissioner.
Marisa Lopez Wagley
Associate General Counsel
Subsequent Injury Fund Administrator
Division of Workers’ Compensation
7551 Metro Center Drive, Suite 100
Austin, TX 78744
(512) 804-4739 phone
(512) 804-4759 fax
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