Our Attorneys at Downs & Stanford, P.C. are here to help you with your every day questions with Texas Workers’ Compensation. Please see the newest updates below in what is happening with the DWC.
Lunch and Learns – First Come, First Served CEU Credits for All Adjusters
Want Some Credit? Come and Get It!
See the class being offered below; the first 25 adjusters to sign up will be in the course. Once you have registered, you will receive confirmation for the Webinar. The Zoom link will be emailed the Monday before each Webinar.
Please note if you have taken the course listed below in the last two years, you will not be eligible for credit again per Texas Administrative Code §19.1010 (7)(c).
Don’t delay! Email us today at CE@downsstanford.com.
September 13, 2024 from 12:00 P.M. to 1:00 P.M.: Intoxication – From Drugs and Alcohol to Affirmative Defenses. Presented by Pamela Pierce and Adrienne Gasser.
September 27, 2024 from 12:00 P.M. to 1:00 P.M.: Summer AP and Case Law Update 2024. Presented by Stuart Colburn and Wendy Schrock.
DWC HAPPENINGS
YOUR MONTHLY LOOK AT WHAT IS HAPPENING AT THE DIVISION AND HOW IT IMPACTS CARRIERS
The Division has been busy. First, DWC is accepting comment on routine rule review for all sections in the following chapters in Title 28, Texas Administrative Code: Chapter 126 (General Provisions Applicable to All Benefits); Chapter 127 (Designated Doctor Procedures and Requirements); and Chapter 128 (Benefits–Calculation of Average Weekly Wage).
Please join the Division September 5 virtually or in-person at our Austin offices for our insurance carrier and health care provider quarterly meetings to discuss issues in the Texas workers’ compensation system.
DWC is also accepting public comments on a proposed rule that updates and reorganizes 28 Texas Administrative Code Chapter 134, Subchapter F, concerning pharmaceutical benefits. The changes are necessary to remove obsolete provisions and to update references and language to be consistent with other rules.
COMPLIANCE AND INVESTIGATION CORNER
If a compensable death occurs and the deceased employee has no legal beneficiaries, Carrier shall, per Rule 132.10(a), pay the Division of Workers’ Compensation’s Subsequent Injury Fund (“SIF”) an amount equal to 364 weeks of death benefits. Pursuant to Rule 132.10(c) the payment to SIF shall be made not later than seven (7) days after the one-year anniversary of the employee’s death. Failure to timely pay death benefits to SIF is a violation which can result in a monetary penalty. For this reason, it is recommended that at least thirty (30) days before the one-year anniversary Carrier contact the SIF and request an invoice of the amount that will be owed which will be 364 weeks of death benefits paid in a lump sum at the discounted present-day value. Please contact Downs & Stanford, P.C. if you have any questions or need any assistance regarding payment of death benefits to SIF.
Decisions, Decisions, and More Decisions
Current Cases that You Need to Know
• Engel v. Tex. Dep’t of Ins., No. 03-23-00077-CV, 2024 Tex. App. LEXIS 4980 (Tex. App.—Austin July 17, 2024, no pet. h.)
DECISION: Engels challenged the constitutionality of the 90-day finality provision. The court agreed the selection of 90 days was somewhat arbitrary. The court held the added restrictions posed by the finality provisions do not render the Texas workers’ compensation act arbitrary or unreasonable. The statute gives the worker several exceptions if the worker fails to dispute timely. And DWC gives notice to the worker on how to timely dispute the certifications.
WHAT THIS MEANS FOR YOU: The 90-day finality provision survives a constitutional challenge.
• APD 240748
DECISION: Carrier sent the first certification of MMI/IR to the injured worker by verifiable means. The ALJ determined that Carrier failed to prove verifiable delivery on a date certain. The evidence included a yellow sticker placed on the envelope by USPS showing the mail was unclaimed and returned to Carrier on October 30, 2023, a date Carrier argued would be the latest date the worker would have received notice. The APD distinguished 050031-s because the USPS included a date the mail was returned to Carrier as unclaimed and therefore was evidence of a delivery by a date certain.
WHAT THIS MEANS FOR YOU: Carrier should produce evidence of when the USPS attempted service such as a USPS-produced date the mail was returned to Carrier.
• APD 240839
DECISION: The DD’s certification included a right knee contusion and a cervical strain, neither of which had been determined to be part of the compensable injury at the time of the CCH. Therefore, the certification was not adoptable. The treating doctor rated only the compensable injury and therefore that report was adoptable.
WHAT THIS MEANS FOR YOU: Spreadsheets are your friend: make sure the ratings are adoptable.
You’ve got WC questions? We have answers. Send your questions to Q&A.
For Employer’s Liability, General Liability, Subro, and all other areas of law, email questions here.
Want some CE credit? Come and get it! Join us for Lunch and Learns every Friday. For information and registration, email CE Department.
Have questions about Designated Doctors, RMEs, or Peer Reviews or have records for a DD, RME, or Peer? Email our DD Department.
Do you have a hearing and need help or need to send records for an already set hearing? Please send all set notices and records to DWCHearings@Downsstanford.com.