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Advisory 95-06

STATUTORY CHANGES AFFECTING CARRIER'S FIRST REPORT OF INJURY

New Statutory Amendment: Amendments to Section 409.005 of the Texas Workers' Compensation Act are effective September 1, 1995. Subsection 409.005(a) has been amended to require the employer to file a report with the employer's insurance carrier if an injury results in the absence of an employee form work of more than one day or if an employee notifies the employer of an occupational disease. An employer must file the report of injury with the carrier no later than the eight day after: (1) the employee's absence from work due to an injury or (2) the day on which the employer receives notice that the employee has an occupational disease. The revised statute removes the employer's requirement to file the written report of injury, the TWCC-1, with the Commission.

New Subsection 409.005(d) requires the insurance carrier, on behalf of the employer, to electronically file the report of the injury with the Commission not later that the seventh day after the date on which the carrier receives the report from the employer. New Subsection 409.005(e) allows the Executive Director to waive the electronic filing requirement.

In accordance with the statutory revision, effective September 1, 1995, the carrier must electronically report each death, each injury with more than one day of lost time, and each occupational disease to the Commission not later than the seventh day after the date on which the carrier receives the report from the employer, regardless of whether compensability is disputed.

The carrier must use the Electronic Data Interchange (EDI) IAIABC flat file records layouts or the ANSI X12 standard to report injury data. The record layouts consist of the First Report of Injury (148) and the Subsequent Report of Injury (A49) which are identified with TWCC Mandatory "M1" Conditional "C1" requirements. (See attached record layouts). To obtain a data dictionary and specifications, and information to implement EDI, please contact the TWCC Records Division, Planning & Analysis, at 512-707-5895.

Mandatory Data Elements: The Commission requires the carrier to provide the mandatory data elements identified as "M1" on the attached record layout for every report of injury. The Commission will not process the electronic report as a properly filed notice of injury with out the mandatory data elements.

Conditional Data Elements: Although the Commission does not initially require this information, this information must be reported as it becomes available. The carrier must obtain the applicable conditional data elements from the employer in order to transmit this data to the Commission as soon as possible, but not later than 90 days from the date of injury.

If the carrier is unable to file data electronically, the carrier must submit the first report of injury on a hard copy TWCC-1 form not later than the seventh day after receiving notice of the injury. Carriers who are unable to file electronically by November 1, 1995, must request a waiver in writing from the Director of Records. Waivers must be requested annually and include justification for the waiver, the volume of claims and premiums, current automation capabilities, EDI programming status, and a specific target date to implement EDI. All waivers require written approval from the Commission.

The Commission will begin monitoring compliance with the electronic filing requirements immediately, but will not impose administrative penalties to their full extent until January 1, 1996, so long as a good faith effort to comply with the electronic filing requirements is demonstrated. This is to allow carriers an interim period to conform to the new procedures. Compliance with the requirements for timely filing of the first report of injury with the Commission is not affected by this provision of an interim period.

The employer's report to the carrier may be telephonic, electronic, or written (using the TWCC-1 or an acceptable alternative form such as the new Acord4). The employer must provide a written copy of the report to the employee at the time the report is made to the insurance carrier along with an explanation of the employee's rights and responsibilities. Telephonic reporting to the carrier does not exempt the employer from providing the employee a written copy of the report at the time of filing.

In addition, the carrier should endeavor to obtain from the employer and report the following data elements to the Commission which are not indicated on the TWCC-1: Self-Insured Indicator, Insured Location Number, Employer's Premises Indicator, Initial Treatment Information, Employment Status, Date Last Day Worked, and Salary Continued Indicator. Commission forms will be modified in the near future to require this data.

This Advisory supplements all earlier Commission correspondence to carriers relating to implementation requirements and grants of waivers. For questions or assistance, please contact Pat Cannon at 512-440-3768 or Marva Moye at 512-707-5895.

Signed August 31, 1995

Todd K. Brown, Executive Director



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