Which PLN Forms Do I File with DWC?

Contrary to popular belief, not every PLN form is filed with the Division of Workers’ Compensation.

These PLN forms ARE to be filed with DWC:

PLN-1 Notice of Denial of Compensability/Liability and Refusal to Pay Benefits
PLN-4 Notice of LIBs Eligibility (but ONLY if the Carrier is disputing eligibility for LIBs)
PLN-11 Notice of Disputed Issue(s) and Refusal to Pay Benefits
PLN-14 Notice of Continuing Investigation

These PLN forms are NOT to be filed with DWC:

PLN-2 Notice of First TIBS Payment
PLN-3 Notice of MMI/IR
PLN-4 Notice of LIBs Eligibility (if the Carrier is accepting and initiating LIBs)
PLN-5 Notice of First Death Benefit Payment
PLN-6 Notice of Employer Full Salary Payment
PLN-7 Notice of Change of Indemnity Benefit Type
PLN-8 Notice of Change in Amount of Indemnity Benefit Payment
PLN-9 Notice of Suspension of Indemnity Benefits
PLN-10 Notice of Reinstatement of Indemnity Benefits
PLN-12 Notice of Potential Entitlement to Death Benefits

These forms are not filed with DWC because the equivalent information is filed with DWC via Electronic Data Interchange (EDI).  For example, the EDI equivalent of a PLN-1 is the EDI-04.

Note: all PLN forms must be sent by the Carrier to Claimant and to their attorney, if represented.

Please do not send PLN Forms 2, 3, 4 (if you are accepting LIBs), 5, 6, 7, 8, 9, 10 or 12 to FOL for filing with DWC.

Let us know if you have any questions about this at all: gqs@fol.com.