Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) is accepting public comments on proposed changes to DWC Form-022, Request for a required medical examination (RME); DWC Form-031, Request to change payment period or purchase an annuity for death or lifetime income benefits; DWC Form-051, Request for a lump sum payment of impairment income benefits (IIBs); and DWC Form-057, Request to extend the date of maximum medical improvement for an approved spinal surgery.
The DWC Form-022 is used by workers’ compensation insurance carriers to request a RME to have a doctor of their choice check the same issues as the designated doctor and provide that opinion for each examination. This form is not needed if the claim is in a health care network or political subdivision.
The DWC Form-031 is used by workers’ compensation insurance carriers to request a purchase of annuity for death benefits or lifetime income benefits, or to change the payment period for death benefits.
The DWC Form-051 is used by injured employees to request a lump sum for IIBs when they have returned to work for at least three months and are earning at least 80% of their average weekly wage.
The DWC Form-057 is used by injured employees, the injured employee’s attorney, or the insurance carrier to request to extend the date of maximum medical improvement for an approved spinal surgery.
The proposed revised forms are not formal rule proposals under the Administrative Procedures Act. DWC will not treat comments as formal public comments. However, DWC will consider any substantive comment before the revised forms are adopted. The
proposed forms are on the DWC website at www.tdi.texas.gov/forms/form20.html#drafts.
Submit written comments on the forms to RuleComments@tdi.texas.gov or mail comments to:
Legal Services, MC-LS
Texas Department of Insurance, Division of Workers’ Compensation
PO Box 12050
Austin, Texas 78711-2050
Submit comments by 5 p.m., Central time, on April 3, 2023.