Mad LIBs
The Division of Workers’ Compensation has proposed rules for implementing House Bill 2468, which expanded LIBs entitlement to first responders in Texas Labor Code Section 408.1615 and went into effect on September 1, 2023. Among the more notable changes, Section 127.25(a) permits insurance carriers to suspend LIBs in accordance with Section 408.1615. Reinstatement of LIBs is compulsory under subsection (f) on the date the injured worker attends the designated doctor examination or the date the claimant reschedules the exam. The Carrier has seven days after receiving notice that the injured worker submitted to the exam (or that the DWC finds good cause for his/her not attending) to reinstate LIBs.
New rules include Section 131.12, 131.13, and 131.14 pertaining to the provisions contained in Texas Labor Code 408.1615. Rule 131.12 sets forth the requirement that the injured first responder must certify annually his or her complete non-employment to the insurance carrier. Failure to do so within thirty days of the anniversary of the date LIBs accrued permits the insurance carrier to suspend LIBs.
The Carrier is likewise entitled to suspend LIBs on a showing that the injured first responder has returned to employment in some capacity or failed to submit to a designated doctor examination without good cause, per the proposed Rule 131.13. A Plain Language Notice to the injured worker is a prerequisite for such a suspension. The worker must respond to such a notice within twenty days of its receipt by providing the certification of non-employment, alerting the Carrier to a scheduled DD exam, or by requesting dispute resolution.
Finally, Rule 131.14 compels the insurance carrier disputing the accuracy of the first responder’s annual certification to supply a copy of it to the DWC and the injured worker. The DWC will then determine whether a DD exam for the purpose of establishing continued LIBs entitlement is appropriate. Both the DWC’s and the designated doctor’s determinations are subject to the dispute process if a party so requests.
In accordance with the changes to the Act and Division Rules, the DWC has proposed the new DWC039 form, “First responder’s annual certification for lifetime income benefits.” The PLN-4 “Notice of Eligibility for Lifetime Income Benefits” has been revamped to include a section for first responders to maintain entitlement and instructions to the insurance carrier to provide the annual certification period (if applicable) to the injured employee in that same section.
