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ADVISORY 2004-07

SUBJECT: Plain Language Notices - Rule 124.2

TWCC Rule 124.2 requires the use of Plain Language Notices (PLNs) to provide information to the injured employee about claim administration actions taken on his/her claim, and in certain instances, to provide the Commission with additional information that is not available via electronic data interchange (EDI).

The Commission, with input and assistance from external customers, has finalized the Plain Language Notices and releases them for use through this Advisory. Each PLN has instructions for its use. The PLNs are designed to match the event triggers identified in Rule 124.2 and will replace form TWCC-21, Payment of Compensation or Notice of Refused or Disputed Claim. Several of the notices may be used for multiple events. The applicable rule cites are indicated by each notice below. The new PLNs are:

  • PLN1: Notice of Denial of Compensability/Liability and Refusal to Pay (124.2(d))
  • PLN2: Notification of First Temporary Income Benefit Payment (124.2(e)(1))
  • PLN3: Notification of Maximum Medical Improvement/First Impairment Income Benefit Payment (124.2(e)(1)(4)&(5))
  • PLN4: Notification of First Lifetime Income Benefit Payment (124.2(e)(1))
  • PLN5: Notification of First Death Benefit Payment (124.2(e)(1))
  • PLN6: Notification of Employer Full Salary Payment (124.2(e)(7))
  • PLN7: Notification of Change of Indemnity Benefit Type (124.2(e)(4))
  • PLN8: Notification of Change in Amount of Indemnity Benefit Payment (124.2(e)(2)&(3))
  • PLN9: Notification of Suspension of Indemnity Benefit Payment (124.2(e)(6))
  • PLN10: Notification of Reinstatement of Indemnity Benefit Payment (124.2(e)(5))
  • PLN11: Notice of Disputed Issues(s) and Refusal to Pay Benefits (124.2(h))

In order for insurance carriers to incorporate these notices into their business processes, the notices may be automated and generated electronically or copied and used in paper form. The notices should be on insurance carrier/carrier representative company letterhead and must contain the adjuster's contact information. The language contained on the notices is prescribed by the Commission and may not be altered or modified except by the Commission. As changes to the PLNs are made due to changes in the Workers' Compensation Act or rules, the amended notices will be made available on the Commission website.

Insurance carriers may start using these notices immediately. Use of these notices will be mandatory effective August 1, 2004. The notices are available from the Commission's Publications section, and are also available for downloading from the Commission's website

Signed this 19th day of May, 2004

Richard F. Reynolds, Executive Director


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