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On July 2, the DWC
announced a revised DWC Form-052 “Supplemental Income Benefits (SIBs)
Application,” which went into effect on June 20 and became immediately
available on the TDI website.
A great many changes on the new form are immediately noticeable. Gone is
the requirement from the old DWC Form-052 to supply the treating doctor’s name
and phone number, the name of the injured worker’s prior employer, and the
claimant’s county of residence. New items include the adjuster’s fax
number, the claimant’s email address, and a section to specify whether the
application is for the first quarter of SIBs or a subsequent one.
The work status chart has been streamlined, while the grid pertaining to wages
earned during the qualifying period allows for more information (pay period
dates and whether wages were earned weekly, biweekly, or monthly). Also new:
the adjuster may now check a box pertinent to the reason for a quarter’s denial
from a list provided, or include a written explanation otherwise.
Formerly, a written explanation was required.
The certification that accompanies a claimant’s signature has been modified to
attest that the applicant has either been searching for work or is completely
unable to work, but the warning that an administrative or criminal penalty can
follow from intentionally providing false information to obtain benefits has
been excised.
Most notably, the weekly work search log has been modified substantially. The
applicant is no longer asked to supply the method by which a work opportunity
was sought (in person, phone, fax, mail, email/web), nor is he/she asked to
indicate what was submitted to the potential employer (cover letter,
application, or resume). The form now asks only if a job was offered, not
whether it was accepted or if the employer was “not hiring.” The column
for recording the day of the work search now reads “Date you applied” rather
than merely “date,” aligning with the requirement that job applications must be
included with the submission of the DWC Form-052.
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