First Responders Annual Certification For Lifetime Income Benefits (LIBs) {DWC-39} | Pdf Fpdf Docx | Texas

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First Responders Annual Certification For Lifetime Income Benefits (LIBs) {DWC-39} | Pdf Fpdf Docx | Texas

Last updated: 2/27/2025

First Responders Annual Certification For Lifetime Income Benefits (LIBs) {DWC-39}

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Description

FIRST RESPONDER’S ANNUAL CERTIFICATION FOR LIFETIME INCOME BENEFITS (LIBs). First responders who get LIBs because of a serious bodily injury file this form. Learn more about LIBs for first responders Texas Labor Code Section 408.1615 and Texas Penal Code Section 1.07. You must file this form annually with the insurance carrier to certify that you were not employed in any capacity during the preceding year. Send this form to the insurance carrier no later than 30 days after the anniversary of the date your LIBs began to accrue. The insurance carrier must provide you with an annual notice of the anniversary date. www.FormsWorkflow.com

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