(a) Unless the division prescribed form, format, or manner of a written communication specifies otherwise, all written communications to the division regarding an injured employee or claim for benefits shall include the following information, if known:
(1) the injured employee’s full name, date of injury, address, and social security number. If no social security number has been assigned, insert the numerical digits “999” followed by the claimant’s birth date or if unknown, the claimant’s date of injury, listed by the month, day, and year (MMDDYY); use of “999” shall not be used in place of a valid social security number in order to meet timeliness of reporting requirements.
(2) the name and address of the claimant, if other than the injured employee;
(3) the workers’ compensation number assigned to the claim by the division;
(4) the employer’s name and address;
(5) the employer’s Federal Employer’s Identification Number (FEIN);
(6) the insurance carrier’s name;
(7) the insurance carrier’s policy number; and
(8) the insurance carrier’s claim number.
(b) Written communications filed by Electronic Data Interchange (EDI) pursuant to § 124.2 of this title (relating to Carrier Reporting and Notification Requirements) must include all mandatory data elements and all applicable conditional data elements required by the International Association of Industrial Accident Boards and Commissions (IAIABC) and Texas EDI Implementation Guides.
The provisions of this §102.8 adopted to be effective October 1, 1992, 17 TexReg 6361; amended to be effective March 15, 1995, 20 TexReg 1418; amended to be effective August 29, 1999, 24 TexReg 6488; amended to be effective December 12, 2013, 38 TexReg 8910.