We wish you a very Happy Halloween! We have some very scary stories from the Division’s compliance department and some tricks for dealing with them.
Lunch and Learns – First Come, First Served CEU Credits for All Adjusters
Want Some Credit? Come and Get It!
As the year is ending, you may have realized you still need some Continuing Education Credits. Downs & Stanford is here to help you.
We are offering Lunch and Learns for 1-hour credits. See our series in the list of classes being offered below, and the first 25 adjusters to sign up will be in the course. Once you have registered, you will be emailed the Zoom link for the 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.
November 5, 2021 from 12:00 P.M. to 1:00 P.M.: Fighting Extent by Challenging the Mechanism of Injury Webinar ( 125377 )
November 12, 2021 from 12:00 P.M. to 1:00 P.M.: Subsequent Injury Fund for Adjusters Webinar ( 125362 )
DWC Compliance Issues
Failure to pay pursuant to a Designated Doctor Report: Initially, the Carrier was fined $40,000.00 for failure to timely pay pursuant to a Designated Doctor’s Report. The facts were the Designated Doctor rated more conditions than the conditions the Carrier accepted; therefore, the adjuster did not pay the Impairment Rating per the Designated Doctor’s opinion. Downs & Stanford’s Compliance Department successfully negotiated the fine down to $19,500.00.
TRICK: A Carrier must pay pursuant to a Designated Doctor Report within 5 days. If you have any questions on a Designated Doctor’s report, reach out to any of our attorneys for assistance in properly analyzing the Designated Doctor’s Report.
A Carrier was initially fined $60,000 for failure to secure a proper DWC-3 and accurately pay death benefits for nine years. The Carrier received a DWC-3 in which the non-pecuniary wages section was blank. The Carrier calculated the Average Weekly Wage (AWW) and paid death benefits without trying to obtain a completed DWC-3. On an audit, it was discovered the Claimant had non-pecuniary wages in the form of health insurance which was no longer being paid since the Claimant was deceased. This raised the AWW significantly and the beneficiaries received a $50,000 underpayment. The fine assessed was more than the amount owed to the beneficiaries. Downs & Stanford’s Compliance Department successfully negotiated the fine down to $45,000.00.
TRICK: A Carrier must document the claim file in trying to obtain a DWC-3. The adjuster must work to obtain both the pecuniary and nonpecuniary sections of the DWC-3. If you have any questions regarding a DWC-3 for your claim, reach out to any of our attorneys for assistance with review of the DWC-3.
The Carrier was initially fined $100,000.00 for failure to timely pay SIF on a death claim. The Carrier paid the widow only 231 weeks of death benefits since the widow remarried. Since the Carrier paid less than 364 weeks of death benefits, the remaining 133 weeks of death benefits were owed to SIF per DWC Rule 132.10(b). Payment was owed 7 days after the widow was no longer entitled to benefits. In this case, SIF was not paid until the error was recognized on an audit. Downs & Stanford’s Compliance Department successfully negotiated the fine down to $85,000.00.
TRICK: A Carrier must document their file with respect to the eligibility of beneficiaries. In addition, the adjuster must make sure they can show 364 weeks of Death Income Benefits are paid. If you have any questions regarding death benefits for your claim, reach out to any of our attorneys for assistance with review of your claim.
Need Help with Designated Doctors, Peer Reviews, or Required Medical Examinations? You’ve Come to the Right Place!
Please contact firstname.lastname@example.org, and our office will be happy to assist you.
Downs and Stanford Speakers Around the State
Stuart Colburn and Adrienne Gasser will be presenting Empathy and Texas Workers’ Compensation at Texas’ PRIMA Conference on November 9, 2021, held this year in Galveston, Texas.
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.