Employees Election For Commuted (Lump Sum) Impairment Income Benefits {DWC-51}

DWC051 - REQUEST FOR A LUMP SUM PAYMENT OF IMPAIRMENT INCOME BENEFITS (IIBs). The injured employee can file the DWC Form-051 to request a lump sum for IIBs when they have returned to work for at least three months and are earning at least 80% of their average weekly wage. Send your DWC Form-051 to the insurance carrier. Contact your insurance carrier adjuster for mailing address, fax number, or email address. The insurance carrier will review the request and approve or deny within 14 days of receiving the DWC Form-051. They will send copies of the approval or denial to the injured employee, their representative, and DWC. If approved, the insurance carrier will include the payment to the employee. If denied, the injured employee can request a benefit review conference to dispute the insurance carrier’s decision. The injured employee can get help by hiring an attorney or by contacting the Office of Injured Employee Counsel. www.FormsWorkflow.com