Red Tape
This form notifies a claimant/beneficiary and the DWC of a dispute pertaining to extent of injury, disability, or eligibility to receive death benefits.
What is a PLN-11?
The date that no further material recovery from an injury can be expected (or 104 weeks after the date of the injury).
What is the date of maximum medical improvement (MMI)?
The carrier must pay these within 15 days after receiving an application from a beneficiary of a fatally injured worker.
What are death income benefits (DIBs)?
A claimant is eligible to apply for these benefits if she receives an impairment rating of 15% or greater.
What are supplemental income benefits (SIBs)?
The only entity that can decide what treatment is reasonable and medically necessary.
What is a Utilization Review Agent?
This form is sent by the carrier to a claimant and his attorney when he is certified to be at MMI by a medical provider.
What is a PLN-3?
An injured worker receives these if he is unable to work for a period of more than one week.
What are temporary income benefits (TIBs)?
This person or entity is required to file a First Report of Injury (DWC-1) with DWC via EDI within 7 days of notice of a claimed injury.
Who is the carrier?
Ten (10) days after the carrier receives a DWC-52.
What is the carrier's deadline to dispute entitlement to SIBs?
An administrative review by a health care provider performed at the insurance company’s request without a physical examination of the employee.
What is a peer review?
This form is sent to the claimant and the DWC when the carrier is denying the claim in its entirety.
What is a PLN-1?
The carrier can stop paying temporary income benefits (TIBs) if the employer provided one of these to the claimant.
What is a bona fide offer of employment (BFOE)?
This must be sent by the employer to the carrier within 30 days of an injury even if no time is lost.
What is an average weekly wage statement (DWC-3)?
The claimant must complete and send this form to the carrier if he believes he is entitled to supplemental income benefits (SIBs).
What is form DWC-52?
Treatments or services that exceed or are not addressed by the commissioner’s adopted treatment guidelines (the ODG).
What requires preauthorization?
This form must be filed when a party wants the DWC to assign a designated doctor to address MMI, impairment, disability, extent of injury, etc.
What is a DWC-32?
This is the carrier's deadline for beginning the payment of indemnity income benefits (IIBs) upon receipt of a designated doctor's report.
What is 5 days?
The inability because of a compensable injury to obtain and retain employment at wages equivalent to the preinjury wage.
What is disability?
The carrier must file this form with the DWC within 10 days of receiving a SIBs application if it wants to dispute the claimant's entitlement to SIBs.
What is a DWC-45 (BRC request)?
The carrier has this many days to dispute or pay a medical bill.
What is 95 days?
The carrier files this form within 10 days of the last benefit payment when a claimant returns to work at full wages or benefits have been fully paid out.
What is a PLN-9?
When the carrier overturns a designated doctor's opinion at a contested case hearing, it is entitled to reimbursement from this.
What is the Subsequent Injury Fund (SIF)?
An examination of a worker by a physician chosen by the insurance carrier.
What is a required medical exam (RME)?
If a claimant who received more than a 15% impairment rating has returned to work for at least 3 months earning at least 80% of his average weekly wage, she can do this.
What is commuting impairment income benefits (filing a DWC-51)?
These cannot be limited or terminated by an agreement or settlement.
What are medical benefits for a compensable injury?