State News : Texas

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On December 19, 2019 the Division developed the new PLN-14 (“Notice of Continuing Investigation (PLN-14)”).  The form was developed pursuant to Division rule 124.2 and Senate Bill 2551, which involve process changes for claims involving first responders (i.e., peace officers, paramedics, firefighters, or emergency medical attendants and technicians) who may qualify for a presumption of compensability of certain illnesses.  In the case of a first responder, the following diseases are presumed to be work-related under state law if certain conditions are met: smallpox, tuberculosis or other respiratory illnesses, certain cancers associated with firefighting, as well as heart attack or stroke.  

In the case of a first responder, Rule 124.2 provides that a Carrier must make one of three alternative actions no later than the 15th day from the notice of injury: pay the claim, deny it, or issue a Notice of Continuing Investigation.  Subsection (s) requires the Carrier to utilize the form developed by the Division (in this case, the PLN-14) to provide notice that the first responder’s condition may be subject to a presumption of compensability.  

The form is intended to act as a template for Carriers to use when communicating with a first responder whose claim may be subject to a presumption.  According to the form’s instructions, the notice is to be used by the Carrier to notify a Claimant or death benefits beneficiary and the Division that the Carrier still needs to investigate whether the claim qualifies for a “statutory presumption,” and whether the insurance carrier is going to pay income or medical benefits on the claim.  The form was developed because some of that information may be needed from the injured employee or beneficiary to determine if the statutory presumption applies.  

The new PLN-14 form is posted in the “forms” section of the Division’s website.  

-  Copyright 2020, Erin Shanley, Stone Loughlin & Swanson, LLP