Texas Workers’ Comp Division Proposes New Carrier Reimbursement Forms

October 30, 2018

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting comments on five newly proposed forms to help insurance carriers submit requests for reimbursement from the Subsequent Injury Fund (SIF). Use of these forms will be voluntary.

The DWC reported that the forms are designed to help meet filing requirements under 28 Texas Administrative Code §116.11 and are expected to help expedite an insurance carrier’s request for reimbursement by reducing requests from DWC for additional information.

  • DWC Form-095 can be used to file for reimbursement of unrecoupable overpayments due to the decision of a hearing officer, the appeals panel, or an interlocutory order that is reversed or modified by final arbitration, order, or decision.
  • DWC Form-096 can be used to file for reimbursement of death benefits paid to the SIF prior to identifying a legal beneficiary entitled to receive death benefits.
  • DWC Form-097 can be used to file for reimbursement of income benefits paid as a result of an injured employee’s multiple employment.
  • DWC Form-098 can be used to file for reimbursement of unrecoupable overpayments due to a designated doctor opinion that is reversed or modified by a final arbitration award, a final order, or a commissioner or court decision.
  • DWC Form-099 can be used to file for reimbursement of payments resulting from initial pharmaceutical coverage after a determination that the injury is not compensable.

These forms are available for review on the TDI website at www.tdi.texas.gov/wc/rules/drafts.html.

DWC is accepting informal comments on these forms. If you would like to comment, submit your written comments by 5 p.m. Central Time on November 9, 2018. Send written comments by email to Rulecomments@tdi.texas.gov or by mail to:

  • Texas Department of Insurance, Division of Workers’ Compensation
  • Ashley Hyten
  • Workers’ Compensation Counsel MS-40
  • 7551 Metro Center Drive, Suite 100
  • Austin, Texas 78744-1645

Source: TDI-DWC

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