Instructions to the insurance carrier:

Notice of Change of Indemnity Benefit Type (PLN-7) 28 Texas Administrative Code (TAC) §124.2

This notice must be used to report to the injured employee/representative and the beneficiaries/representatives (if applicable) when the insurance carrier is changing the payment of one income benefit type to another or to death benefits.

Scenarios where this notice must be used (not an exhaustive list):

• Determination of entitlement to supplemental income benefits;
• Entitlement to death benefits after payment of a previous income benefit type (remove statements about medical benefits not changing and about return to work if you are using this PLN to notify beneficiaries about death benefits); or
• Changing from impairment income benefits (IIBs) back to temporary income benefits (TIBs).

The change of benefit type from TIBs to IIBs must be reported using the PLN-3b or PLN-3c.

The change of any benefit type to lifetime income benefits must be reported using the PLN-04.

The insurance carrier must:

• Provide this notice to the injured employee/representative and the beneficiaries/representatives (if applicable).
• Provide a full and complete statement explaining the action taken.

Examples:

• We have been notified by the Texas Department of Insurance, Division of Workers’ Compensation of your entitlement to supplemental income benefits (SIBs). Attached is your first quarterly payment of SIBs.
• We have been notified that the treating doctor’s evaluation of maximum medical improvement (MMI) and impairment rating was disputed. The designated doctor said you have not reached MMI, so we are changing your income benefits from impairment income benefits to temporary income benefits.

Format requirements

• Must use font size of 12-point or larger (28 TAC §124.2(s)).

Format recommendations

Information sent to injured employees must be written in plain language. Along with clear writing, it is helpful to the reader when information is in a clean, easy-to-read format. Using easy-to-understand words and clean formatting might increase the length of your letter, but it also might greatly reduce customer service calls. Here are recommendations for formatting letters to injured employees:

• Print only information that applies to the reader: (1) Remove the section “Instructions to the insurance carrier,” and (2) if this letter has more than one option, remove the option that doesn’t apply to the injured employee.
• Choose a clean font style: Avoid highly stylized fonts. Fonts like Segoe, Verdana, and Times New Roman are known to be the easiest to read.
• Avoid italics and underlines: If you want to emphasize text, it’s often better to use bold or a bigger font size.
• Use sufficient and consistent spacing: DWC suggests using 6 pts between paragraphs and bullets and 12 pts between sections.

File the appropriate electronic data interchange (EDI) transaction with DWC and do not send this notice to DWC.