Notice Of Change Of Indemnity Benefit Type {PLN-7}

NOTICE OF CHANGE OF INDEMNITY BENEFIT TYPE. 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). www.FormsWorkflow.com