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The Division is accepting public comment on planned revisions to the PLN‐11 (Notice of
Disputed Issue(s) and Refusal to Pay Benefits). The proposed new form provides an area for
the insurance carrier to check the appropriate box to indicate which issue (extent of injury,
disability, or entitlement to death benefits) that is being disputed. The form also provides a
definition for “disability” for the injured worker. There are also minor revisions to update and
clarify the instructions, including a “caution” for insurance carriers to “explain the reason(s)
for disputing the issue in plain language without unnecessary use of technical terms,
acronyms, and/or abbreviations.” The instructions also include the following cautionary
statement: “Disputes must be based on the information the carrier has obtained or verified.”
While relatively minor, the above changes exhibit an apparent effort by the Division to
encourage carriers to provide more clear and concise language in its disputes so that the
injured worker understands exactly what is being disputed. We have always discouraged the
use of acronyms in a PLN‐11; best practice is to always use full terms so that a claimant is on
notice of what, exactly, the carrier is disputing. For example, instead of disputing extent of
injury to “CTS” or “lumbar DDD,” the carrier should spell out that it is disputing carpal tunnel
syndrome and lumbar degenerative disc disease. Likewise, instead of disputing disability
based on a “valid BFOE,” the carrier should state it is disputing disability pursuant to a bona
fide offer of employment tendered by the employer. As for the Division’s instructions
requiring that “disputes must be based on the information the carrier has obtained or
verified,” we should take this as a reminder that it is best practice for the carrier to document
its claim file as early as possible with written and verified evidence supporting the basis for
its dispute. In other words, don’t wait until a BRC is set to take and transcribe a recorded
statement, obtain medical records for a pre‐existing injury, or obtain a hard copy of a
toxicology report.
The revised form is currently available on the Texas Department of Insurance website, and the
public comment period closes Wednesday, October 1, 2014 at 5 p.m. Public comments may
be submitted by e‐mail, snail mail, or personal delivery to: Texas Department of Insurance,
Division of Workers’ Compensation, Maria Jimenez, Workers’ Compensation Counsel MS‐4D,
7551 Metro Center Drive, Suite 100, Austin, Texas 78744‐1645; Email:
InformalRuleComments@tdi.texas.gov.