Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (DWC) recently noted that it has revised four forms: DWC Form-022, Request for a required medical examination (RME); DWC Form-31, Request to change payment period or purchase an annuity; DWC Form-051, Request for a lump sum payment of impairment income benefits (IIBs); and DWC Form057, Request to extend the date of maximum medical improvement for an approved spinal surgery.
TDI posted the draft forms online for a 30-day period from March 03, 2023, to April 3, 2023.
The DWC Form-022 is necessary for workers’ compensation insurance carriers to request a RME to evaluate the appropriateness of health care received or issues previously addressed by a designated doctor. This form cannot be used for appropriateness of health care if the claim is in a health care network or political subdivision.
The DWC Form-031 is necessary for 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 necessary for 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 necessary for 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 revised forms are not formal rule proposals under the Administrative Procedures Act.
The forms are on the TDI website and can be used immediately.
The previous versions will be accepted until July 31, 2023.