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You are here: Home . wc . news . advisories . ad2000-08

Advisory 2000-08

Supplement to Advisory 99-04, Notice of New Form TWCC-34, Notice of Intent (REVISED) Use of TWCC-34

Advisory 99-04, issued December 20, 1999, prescribed Form TWCC-34 as the required form and manner for a "Notice of Intent," pursuant to Rule 126.7, Suspension of Temporary Income Benefits Based On the Opinion of a Carrier-Selected Required Medical Examination Doctor. This form has modified information boxes to facilitate proper claims processing in accordance with the Commission's revised procedure:

Part I, General Information, now includes box 5 for documenting the date of the injury.

Part II, Grounds for Suspension, and Part III, Employee/Treating Doctor Response, do not contain any changes.

Part IV, Carrier Notice to the Commission. The most significant additions to the form occur in Boxes 23(a) and (b). Box 23(a) allows the carrier to elect to waive their right to the remedies provided under Texas Labor Code Ann. §408.004(f), and agree to continue the payment of temporary income benefits pending the receipt of the designated doctor's report. This waiver on the carrier's part is contingent on the Commission scheduling a designated doctor's examination no later than 3 weeks from the date the Commission received the carrier's TWCC-34 form. Box 23(b) allows the carrier to agree to pay impairment income benefits based on the carrier doctor's impairment rating. This agreement is contingent upon the concurrence of the injured employee, which will be confirmed by Commission staff, and upon the Commission scheduling a designated doctor's examination no later than 3 weeks from the date the Commission received the carrier's TWCC-34 form. If the Commission is not successful in scheduling the designated doctor's examination no later than 3 weeks from the date the Commission received the TWCC-34, the "Notice of Intent" will be processed in accordance with Rule 126.7. Box 23(c) contains the original carrier's request to suspend temporary income benefits under Rule 126.7. Boxes 24(a) and (b) have been changed to reflect the appropriate weekly income benefit rates.

Attached is a copy of the Notice of Intent form along with instructions for its use. The form is also available in an electronic format on the Commission's web site at http://www.tdi.texas.gov under "Forms." While TWCC encourages the immediate use of this revised form, the use of the form is mandatory effective February 1, 2001.

Signed this 25th day of September 2000

Leonard W. Riley, Jr., Executive Director

Distribution:
TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC Website



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