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You are here: Home . wc . news . advisories . ad99-04

Advisory 99-04

NEW RULE 126.7 AND TWCC-34 FORM

At the December 2, 1999 Public Meeting, the Commissioners adopted new Rule 126.7 relating to Suspension of Temporary Income Benefits Based Upon the Opinion of a Carrier-Selected Required Medical Examination Doctor. This rule was adopted to implement changes in Texas Labor Code '408.004 which allow carriers to file what the rule refers to as a Notice of Intent to set into motion a process that will either allow suspension of temporary income benefits (TIBs) based upon the opinion of the carrier's required medical examination (RME) doctor or result in the issuance of an interlocutory order to require the continuation of TIBs. The new rule and the statute are effective January 1, 2000.

Rule 126.7 sets forth the requirements for filing this notice. System participants, and insurance carriers in particular, are encouraged to review the new rule and how it affects the carrier's ability to file such a notice as well as the effect that such a notice will have. Copies of the new rule may be obtained from the Commission's Publications Section or viewed on the Commission's web site at http://www.tdi.texas.gov.

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. This notice will have several parts. The first main part is notice to the treating doctor and injured employee/representative which must be sent along with a copy of the RME doctor's report. The second main part is for the employee/treating doctor to fill out and send back to the carrier. The third main part is then completed based on the response or lack thereof by the treating doctor and employee and the Notice of Intent is filed with the Commission Field Office handling the claim. When the notice is filed with the Commission, the carrier shall include a copy of the RME doctor's report upon which it is basing its intent to suspend TIBs and a copy of any response received by the treating doctor or employee/representative. This will help to ensure that a benefit review conference (BRC) is not delayed pending receipt of necessary documentation that the carrier had in its possession at the time the carrier filed the notice.

Failure to comply with Rule 126.7 and properly send and file the Notice of Intent with attachments as required will be considered a non-filing of the notice and will not result in the Commission holding a BRC or the automatic issuance of an interlocutory order. Therefore, carriers are encouraged to carefully review new Rule 126.7 to ensure that they are able to navigate this new process.

Signed this 20th day of December, 1999.

Leonard W. Riley, Jr., Executive Director

Distribution: TWCC Staff Medical Professional Associations,Carrier Representatives,Forms Notification List,Public Information List,TWCC Web Site



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