reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.3 - Amount of Temporary Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) The insurance carrier (carrier) shall pay
				an injured employee (employee) the temporary income benefits (TIBs) the
				employee is entitled to in accordance with this chapter.
(b) The carrier shall determine whether the
				employee earns less than $8.50 per hour for a workers' compensation claim with
				a date of injury before September 1, 2015, or less than $10 per hour for a
				workers' compensation claim with a date of injury on or after September 1,
				2015, as follows:
(1) Once the carrier has
				received the Wage Statement required by this title, the carrier shall divide
				the average weekly wage (AWW) calculated from the Wage Statement by the average
				number of hours worked. The average hours worked is the total gross hours
				reported worked on the Wage Statement divided by the period in which the hours
				were worked;
(2) If the carrier has
				not received the Wage Statement, but has received the Employer's First Report
				of Injury, the carrier shall use the wage information provided by the employer
				through the first report; or
(3) If
				the carrier has not received the information necessary to perform the
				calculations required by subsection (b)(1) or (2) of this section, the carrier
				shall use wage information provided by the employee until the necessary
				information is obtained from the employer.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.4 - Adjustment of Temporary Income Benefit Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) The insurance carrier shall adjust the
				weekly amount of temporary income benefits paid to the injured employee as
				necessary to match the fluctuations in the employee's weekly earnings after the
				injury.
(b) If a seasonal
				employee's average weekly wage is adjusted, as described in §
									128.5
				of this title (relating to Average Weekly Wage Calculations for Seasonal
				Employees), the carrier shall adjust the temporary income benefits paid to the
				seasonal employee.
(c) If the
				injured employee is still employed by the employer at the time of injury, the
				employer is responsible for informing the carrier of changes in the employee's
				weekly earnings after an injury, on Form TWCC 6, Supplemental Report of Injury,
				within 10 days after the end of each pay period, as provided by §
									120.3
				of this title (relating to Employer's Supplemental Report of Injury).
(d) If the employee is no longer employed by
				the employer, the employee is responsible to provide information to the
				insurance carrier about the existence or amount of any earnings, or any offers
				of employment. The employee may use Form TWCC 6, Supplemental Report of Injury,
				for this purpose.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.5 - Work Status Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) As used in
				this section:
(1) the term "doctor" means
				either the treating doctor or a referral doctor, as defined by §
										180.22(c)
				and (e) of this title (relating to Health
				Care Provider Roles and Responsibilities);
(2) "substantial change in activity
				restrictions" means a change in activity restrictions caused by a change in the
				injured employee's medical condition which either prevents the injured employee
				from working under the previous restrictions or which allows the injured
				employee to work in an expanded and more strenuous capacity than the prior
				restrictions permitted (approaching the injured employee's normal
				job);
(3) "change in work status"
				means a change in the injured employee's work status from one of the three
				choices listed in subsection (a)(4) of this section to another of the choices
				in that subsection; and
(4) the
				term "work status" refers to whether the injured employee's medical condition:
(A) allows the injured employee to return to
				work without restrictions (which is not equivalent to maximum medical
				improvement);
(B) allows the
				injured employee to a return to work with restrictions; or
(C) prevents the injured employee from
				returning to work.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.6 - Bona Fide Offers of Employment

Current through Reg. 49, No. 28; July 12, 2024
(a) An employer
				or insurance carrier (carrier) may request the treating doctor provide a Work
				Status Report by providing the treating doctor a set of functional job
				descriptions which list modified duty positions which the employer has
				available for the injured employee (employee) to work. The functional job
				descriptions must include descriptions of the physical and time requirements of
				the positions.
(b) An employer may
				offer an employee a modified duty position which has restricted duties which
				are within the employee's work abilities as determined by the employee's
				treating doctor. In the absence of a Work Status Report by the treating doctor
				an offer of employment may be made based on another doctor's assessment of the
				employee's work status provided that the doctor made the assessment based on an
				actual physical examination of the employee performed by that doctor and
				provided that the treating doctor has not indicated disagreement with the
				restrictions identified by the other doctor.
(c) An employer's offer of modified duty
				shall be made to the employee in writing and in the form and manner prescribed
				by the Commission. A copy of the Work Status Report on which the offer is being
				based shall be included with the offer as well as the following information:
(1) the location at which the employee will
				be working;
(2) the schedule the
				employee will be working;
(3) the
				wages that the employee will be paid;
(4) a description of the physical and time
				requirements that the position will entail; and
(5) a statement that the employer will only
				assign tasks consistent with the employee's physical abilities, knowledge, and
				skills and will provide training if necessary.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.7 - Non-Reimbursable Employer Payments

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				employer who pays an injured employee (employee) salary continuation is not
				entitled to and shall not seek reimbursement from the employee or the insurance
				carrier (carrier).
(b) An employer
				who pays an employee salary supplementation to supplement income benefits paid
				by the carrier is not entitled to and shall not seek reimbursement from the
				employee or the carrier.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 129 - INCOME BENEFITS-TEMPORARY INCOME BENEFITS › Section 129.11 - Agreement for Monthly Payment of Temporary Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon the request of an injured employee,
				the insurance carrier and an injured employee entitled to temporary income
				benefits (TIBs) may agree to change the frequency of TIBs payments from the
				standard weekly period to a monthly period. The agreement to change the payment
				frequency must be in writing and is only required to be filed with the division
				if the division requests a copy. To relieve the insurance carrier of the
				responsibility to pay TIBs weekly, a valid written agreement must include the
				following terms and conditions:
(1) the
				agreement for the monthly payment of TIBs shall be effective the first calendar
				day of the month following the month in which the written agreement was entered
				into by the insurance carrier and the injured employee;
(2) monthly TIBs payment shall be issued on
				or before the seventh day of the month following the month for which benefits
				are due;
(3) weekly TIBs payments
				shall continue through the end of the month in which the agreement was
				signed;
(4) payment of the last
				week of TIBs to transition from weekly payment of TIBs to monthly payments
				shall be prorated to the end of the month to ensure the injured employee
				receives TIBs through the last day of the month; and
(5) if less than the maximum weekly
				compensation rate in effect on the date of the compensable injury is being
				paid, a completed Employer's Wage Statement must be included with the injured
				employee's copy of the written agreement.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.1 - Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment

Current through Reg. 49, No. 28; July 12, 2024
(a) Authorized
				  Doctor.
(1) Only an authorized doctor may
				  certify maximum medical improvement (MMI), determine whether there is permanent
				  impairment, and assign an impairment rating if there is permanent impairment.
(A) Doctors serving in the following roles
				  may be authorized as provided in subsection (a)(1)(B) of this section.
(i) the treating doctor (or a doctor to whom
				  the treating doctor has referred the injured employee for evaluation of MMI
				  and/or permanent whole body impairment in the place of the treating doctor, in
				  which case the treating doctor is not authorized);
(ii) a designated doctor; or
(iii) a required medical examination (RME)
				  doctor selected by the insurance carrier and approved by the division to
				  evaluate MMI and/or permanent whole body impairment after a designated doctor
				  has performed such an evaluation.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.3 - Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by aDoctor other than the Treating Doctor

Current through Reg. 49, No. 28; July 12, 2024
(a) A doctor, other than a treating doctor,
				  who is authorized to certify that an employee has reached maximum medical
				  improvement (MMI), must do so in accordance with §
										130.1
				  of this title (relating to Certification of Maximum Medical Improvement and
				  Evaluation of Permanent Impairment). In addition to complying with the filing
				  requirements of §130.1, the certifying doctor shall file a copy of the
				  Report of Medical Evaluation and the narrative with the treating doctor within
				  the same timeframes for filing with the other persons that §130.1
				  requires.
(b) Upon receipt of the
				  report identified in subsection (a) of this section, the treating doctor shall:
(1) indicate on the report either agreement
				  or disagreement with the certification of maximum medical improvement and with
				  the impairment rating assigned by the certifying doctor, and, in the case of a
				  disagreement, explain the reasons for this disagreement; and
(2) within seven days of receipt, send a
				  signed copy of the report indicating agreement or disagreement and including
				  any required explanation to the commission, the employee and the employee's
				  representative (if any), and the carrier.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.4 - Presumption that Maximum Medical Improvement (MMI) has been Reached and Resolution when MMI has not been Certified

Current through Reg. 49, No. 28; July 12, 2024
(a) This
				  section does not apply if statutory maximum medical improvement (MMI) has been
				  reached. Statutory MMI is the later of:
(1)
				  the end of the 104th week after the date that temporary income benefits (TIBs)
				  began to accrue; or
(2) the date to
				  which MMI was extended by the commission through operation of Texas Labor Code
				  §
											408.104.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.7 - Acceleration of Impairment Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) An employee seeking an acceleration of
				  impairment income benefits shall submit a request in writing to commission, on
				  a form prescribed by the commission, and send a copy to the insurance carrier.
				  The form shall explain subsection (d) of this section.
(b) The commission shall approve the request
				  for acceleration of impairment benefits pursuant to the Texas Workers'
				  Compensation Act, §4.321. The commission shall notify the insurance
				  carrier when a request for acceleration is approved, and of the amount and
				  number of accelerated payments which shall be made.
(c) The insurance carrier shall initiate the
				  accelerated payment schedule no later than seven days after receiving notice of
				  the commission's approval.
(d)
				  Acceleration of payment of impairment income benefits does not reduce the
				  impairment period for purposes of the date that entitlement to supplemental
				  income benefits begins.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.8 - Initiating Payment of Impairment Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Impairment income benefits accrue on the
				  day after the injured employee reaches maximum medical improvement, regardless
				  of whether the employee has suffered seven or more days of
				  disability.
(b) When the date of
				  maximum medical improvement is not disputed, the carrier shall initiate payment
				  of impairment income benefits on or before the fifth day after:
(1) the date of receipt of the employee's
				  treating doctor's medical evaluation report, as described in §
											130.1
				  of this title (relating to Reports of Medical Evaluation: Maximum Medical
				  Improvement and Permanent Impairment); or
(2) the last day of the 104th week after the
				  employee's accrual date, as defined in §
											124.7
				  of this title (relating to Initial Payment of Temporary Income
				  Benefits).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.11 - Agreement for Monthly Payment of Impairment Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon the request of the injured employee,
				  the insurance carrier and an employee entitled to impairment income benefits
				  (IIBs) may agree to change the frequency of IIBs payments from the standard
				  weekly period to a monthly period. The agreement to change the payment
				  frequency must be in writing and is only required to be filed with the
				  Commission if the Commission requests a copy. To relieve the insurance carrier
				  of the responsibility to pay IIBs weekly, a valid written agreement must
				  include the following terms and conditions:
(1) the agreement for the monthly payment of
				  IIBs payments shall be effective the first calendar day of the month following
				  the month in which the written agreement was entered into by the insurance
				  carrier and the injured employee;
(2) monthly IIBs payment shall be issued on
				  or before the seventh day of the month for which benefits are due;
(3) weekly IIBs payments shall continue
				  through the end of the month in which the agreement was signed.;
(4) payment of the last week of IIBs to
				  transition from weekly payment of IIBs to monthly payments shall be prorated to
				  the end of the month to ensure the injured employee receives IIBs through the
				  last day of the month;
(5) if less
				  than the maximum weekly compensation rate in effect on the date of the
				  compensable injury is being paid, a completed Employer's Wage Statement must be
				  included with the injured employee's copy of the written agreement;
(6) the monthly benefit amount shall be equal
				  to the weekly compensation rate for IIBs that the injured employee is entitled
				  to multiplied by 4.34821; and
(7)
				  the impairment rating and source of the impairment rating upon which payment of
				  IIBs is being based.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter A - IMPAIRMENT INCOME BENEFITS › Section 130.12 - Finality of the First Certification of Maximum Medical Improvement and/or First Assignment of Impairment Rating

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  certifications and assignments that may become final are:
(1) The first valid certification of MMI
				  and/or IR assigned or determination of no impairment;
(2) The first valid assignment of IR after
				  the expiration of 104 weeks from the date income benefits begin to accrue or
				  the expiration date of any extension under Section 408.104, if the employee has
				  not been certified as having reached MMI; or
(3) The first valid subsequent certification
				  of MMI and/or assignment of an IR or determination of no impairment received
				  after the date a certification of MMI and/or assignment of an IR or
				  determination of no impairment is overturned, modified or withdrawn by
				  agreement of the parties or by a final decision of the commission or a
				  court.
(4) A designated doctor may
				  provide multiple IRs if there is a dispute over extent of injury. Whichever
				  rating from the designated doctor applies to the compensable injury once an
				  extent of injury (EOI) dispute has been resolved may become final if not
				  disputed. An EOI dispute does not constitute a dispute of the MMI/IR for
				  purposes of finality under this subsection.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.100 - Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) Effectiveness. Entitlement or
				  non-entitlement to supplemental income benefits shall be determined in
				  accordance with the rules in effect on the date a qualifying period
				  begins.
(b) Claims Service.
				  Sections
				  130.101-
				  130.109
				  of this chapter (relating to Impairment and Supplemental Income Benefits)
				  define certain aspects of claims service under the provisions of Texas Labor
				  Code, §
										406.010.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.101 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 shall have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Application for
				  Supplemental Income Benefits--The Division form required pursuant to Labor Code
				  §
										408.143(b)
				  containing the following information:
(A) a
				  statement, with supporting payroll documentation, that the employee has earned
				  less than 80% of the employee's average weekly wage as a direct result of the
				  impairment from the compensable injury;
(B) the amount of the employee's wages during
				  the qualifying period;
(C) a
				  statement, with supporting documentation, that the employee has complied with
				  Labor Code §
											408.1415
				  and this subchapter; and
(D) for
				  self-employed individuals, copies of all supporting documentation to establish
				  the amount of self-employment income earned during the qualifying period and
				  any other pertinent documentation of efforts to establish or maintain a
				  self-employed enterprise during the qualifying period.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.102 - Eligibility for Supplemental Income Benefits; Amount

Current through Reg. 49, No. 28; July 12, 2024
(a) General. An injured employee is not
				  entitled to supplemental income benefits until the expiration of the impairment
				  income benefit period.
(b)
				  Eligibility Criteria. An injured employee who has an impairment rating of 15%
				  or greater, who has not commuted any impairment income benefits, who has not
				  permanently lost entitlement to supplemental income benefits and who has
				  completed and filed an Application for Supplemental Income Benefits in
				  accordance with this subchapter is eligible to receive supplemental income
				  benefits if, during the qualifying period, the injured employee:
(1) has earned less than 80% of the injured
				  employee's average weekly wage as a direct result of the impairment from the
				  compensable injury; and
(2) has
				  demonstrated an active effort to obtain employment in accordance with Labor
				  Code §
											408.1415
				  and this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.103 - Determination of Entitlement or Non-Entitlement for the First Quarter

Current through Reg. 49, No. 28; July 12, 2024
(a) Division Determination. For each injured
				  employee with an impairment rating of 15% or greater, and who has not commuted
				  any impairment income benefits, the Division will make the determination of
				  entitlement or non-entitlement for the first quarter of supplemental income
				  benefits. This determination shall be made not later than the last day of the
				  impairment income benefit period and the notice of determination shall be sent
				  to the injured employee and the insurance carrier by first class mail,
				  electronic transmission, or personal delivery.
(b) Determination of Entitlement. If the
				  Division determines that the injured employee is entitled to supplemental
				  income benefits for the first quarter, the notice of determination shall
				  include:
(1) the beginning and end dates of
				  the first quarter;
(2) the amount
				  of the monthly payments;
(3) the
				  amount of the wages used to calculate the monthly payment;
(4) instructions for the parties of the
				  procedures for contesting the Division's determination as provided by §
											130.108
				  of this title (relating to Contesting Entitlement or Amount of Supplemental
				  Income Benefits; Attorney Fees); and
(5) an Application for Supplemental Income
				  Benefits, filing instructions, a filing schedule, and a description of the
				  consequences of failing to timely file.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.104 - Determination of Entitlement or Non-Entitlement for Subsequent Quarters

Current through Reg. 49, No. 28; July 12, 2024
(a) Subsequent Quarter Determination. After
				  the Division has made a determination of entitlement or non-entitlement for
				  supplemental income benefits for the first quarter, the insurance carrier shall
				  make determinations for subsequent quarters consistent with the provisions
				  contained in §
										130.102
				  of this title (relating to Eligibility for Supplemental Income Benefits;
				  Amount). The insurance carrier shall issue a determination of entitlement or
				  non-entitlement within 10 days after receipt of the Application for
				  Supplemental Income Benefits for a subsequent quarter.
(b) Application for Supplemental Income
				  Benefits. An injured employee claiming entitlement to supplemental income
				  benefits for a subsequent quarter must send the insurance carrier an
				  Application for Supplemental Income Benefits as required under this section.
				  With the first monthly payment of supplemental income benefits for any eligible
				  quarter and with any insurance carrier determination of non-entitlement, the
				  insurance carrier shall send the injured employee a copy of the Application for
				  Supplemental Income Benefits and the proper address to file the subsequent
				  application. On the Application for Supplemental Income Benefits sent by the
				  insurance carrier, the insurance carrier shall include:
(1) the number of the applicable
				  quarter;
(2) the dates of the
				  qualifying period;
(3) the dates of
				  the quarter;
(4) the deadline for
				  filing the application with the insurance carrier; and
(5) the minimum number of work search efforts
				  required by §
											130.102(d)(1)
				  and (f) of this title (relating to
				  Eligibility for Supplemental Income Benefits; Amount) during the next
				  qualifying period.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.105 - Failure to Timely File Application for Supplemental Income Benefits; Subsequent Quarters

Current through Reg. 49, No. 28; July 12, 2024
(a) Failure to
				  timely file. An injured employee who does not timely file an Application for
				  Supplemental Income Benefits with the insurance carrier shall not receive
				  supplemental income benefits for the period of time between the beginning date
				  of the quarter and the date on which the form was received by the insurance
				  carrier, unless the following apply:
(1) the
				  failure of the insurance carrier to timely mail the form to the injured
				  employee as provided by §
											130.104
				  of this title (relating to Determination of Entitlement or Non-entitlement for
				  Subsequent Quarters);
(2) the
				  failure of the Division to issue a determination of entitlement or
				  non-entitlement for the first quarter and the quarter applied for immediately
				  follows the first quarter; or
(3) a
				  finding of an impairment rating of 15% or greater in an administrative or
				  judicial proceeding when the previous impairment rating was less than
				  15%.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.106 - Loss of Entitlement to Supplemental Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) 12-Month Provision. Except as provided in
				  §
										130.109
				  of this title (relating to Reinstatement of Entitlement if Discharged with
				  Intent to Deprive of Supplemental Income Benefits), an injured employee who is
				  not entitled to supplemental income benefits for a period of four consecutive
				  quarters permanently loses entitlement to such benefits.
(b) 401-Week Provision. An injured employee
				  permanently loses entitlement to supplemental income benefits upon the
				  expiration of the 401-week period calculated pursuant to Labor Code §
										408.083.
				  Except for situations where the injured employee has previously permanently
				  lost entitlement to supplemental income benefits, the insurance carrier shall
				  send two notices to the injured employee prior to the expiration of the
				  401-week period if the injured employee has submitted an Application for
				  Supplemental Income Benefits during the 12 months immediately preceding the
				  expiration of the 401-week period. This notification shall be in the form and
				  manner prescribed by the Division and shall be sent:
(1) no later than four months prior to the
				  expiration of the 401-week period; and
(2) one month prior to the expiration of the
				  401-week period.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.107 - Payment of Supplemental Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) First Quarter. After the Division's
				  initial determination of entitlement, the insurance carrier shall pay
				  supplemental income benefits as follows:
(1)
				  the first payment shall be made on or before the tenth day after the day on
				  which the insurance carrier received the Division determination of entitlement
				  or the seventh day of the quarter, whichever is later;
(2) the second payment shall be made on or
				  before the 37th day of the first quarter; and
(3) the last payment shall be made on or
				  before the 67th day of the first quarter.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 130 - IMPAIRMENT AND SUPPLEMENTAL INCOME BENEFITS › Subchapter B - SUPPLEMENTAL INCOME BENEFITS › Section 130.109 - Reinstatement of Entitlement if Discharged with Intent to Deprive of Supplemental Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) An injured
				  employee who has lost entitlement to supplemental income benefits under §
										130.106(a)
				  of this title (relating to Loss of Entitlement to Supplemental Income
				  Benefits), and is discharged from employment within 12 months of losing
				  entitlement, will become re-entitled if the employer discharged the injured
				  employee with intent to deprive the injured employee of supplemental income
				  benefits.
(b) An injured employee
				  seeking reinstated supplemental income benefits under this section shall
				  request a benefit contested case hearing, as provided by Chapter 142 of this
				  title (relating to Dispute Resolution--Benefit Contested Case
				  Hearing).
(c) The injured employee
				  bears the burden of proof of discharge with intent to deprive.
(d) Supplemental income benefits reinstated
				  under this section begin to accrue on the day after the injured employee's
				  discharge.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 131 - BENEFITS-LIFETIME INCOME BENEFITS › Section 131.2 - Calculation of Lifetime Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Lifetime income benefits shall be calculated by multiplying the employee's
				average weekly wage by .75. The lifetime income benefit payable each week under
				this formula shall not exceed the weekly maximum benefit under the Workers'
				Compensation Act, §4.11, for the first year of benefits.
(b) Each year on the anniversary date of the
				day lifetime income benefits began to accrue, the amount of those benefits
				being paid shall be increased by 3.0%. The employee is entitled to the annual
				increase without regard to the limits imposed by the maximum weekly benefit.
				The increase shall be paid without further action by the commission.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 131 - BENEFITS-LIFETIME INCOME BENEFITS › Section 131.3 - Carrier's Petition for Payment of Benefits by the Subsequent Injury Fund

Current through Reg. 49, No. 28; July 12, 2024
(a) When an insurance carrier reasonably
				believes that an injured employee may be eligible for lifetime benefits from
				the subsequent injury fund, the insurance carrier shall petition the commission
				for payment of lifetime income benefits from the subsequent injury fund. The
				petition shall be in writing and contain the following:
(1) the employee's name and social security
				number;
(2) the date of each
				injury;
(3) the workers'
				compensation number assigned to the claim (if any) for each injury;
(4) the name and address of the employer for
				whom the employee was working at the time of each injury; and
(5) any information upon which the carrier
				bases its request.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 131 - BENEFITS-LIFETIME INCOME BENEFITS › Section 131.4 - Change in Payment Period; Purchase of Annuity for Lifetime Income Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) Upon the
				request of an injured employee entitled to lifetime income benefits (LIBs) as
				defined in the Act, the insurance carrier and an injured employee may agree to
				change the frequency of LIBs payments from the standard weekly period to a
				monthly period. The agreement to change the payment frequency must be in
				writing and is only required to be filed with the Commission if the Commission
				requests a copy. To relieve the insurance carrier of the responsibility to pay
				LIBs weekly a valid written agreement must include the following terms and
				conditions:
(1) the agreement for the monthly
				payment of LIBs shall be effective the first calendar day of the month
				following the month in which the written agreement was entered into by the
				insurance carrier and the injured employee;
(2) monthly LIBs shall be issued on or before
				the seventh day of the month for which benefits are due;
(3) weekly LIBs payments shall continue
				through the end of the month in which the agreement was signed;
(4) payment of the last week of LIBs to
				transition from weekly payment of LIBs to monthly payments shall be prorated to
				the end of the month to ensure the injured employee receives LIBs through the
				last day of the month;
(5) the
				monthly compensation rate shall be calculated by multiplying the weekly
				compensation rate by 4.34821;
(6)
				if less than the maximum weekly compensation rate in effect on the date of the
				compensable injury is being paid, a completed Employer's Wage Statement must be
				included with the injured employee's copy of the written agreement;
				and
(7) A clear statement regarding
				the due date of the annual three percent increase in LIBs must be
				included.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.1 - Calculation of Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
Death benefits shall be computed by multiplying the
				  employee's average weekly wage by .75. The amount paid shall not exceed 100% of
				  the state average weekly wage as determined by the Texas Workers' Compensation
				  Commission and in effect on the date of injury. A claim for death benefits
				  shall be filed as required by §
									122.100
				  of this title (relating to Claim for Death Benefits).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.2 - Determination of Facts of Dependent Status

Current through Reg. 49, No. 28; July 12, 2024
(a)
				This section applies to a person who claims death benefits as a dependent of
				the deceased employee.
(b) A
				benefit which flowed from a deceased employee, at the time of death, on an
				established basis in at least monthly intervals to the person claiming to be
				dependent, is presumed to be a regular or recurring economic benefit. This
				presumption may be overcome by credible evidence. The burden is on the claimant
				to prove that benefits, which flowed less frequently than once a month, were
				regular or recurring at the time of the employee's death.
(c) It shall be presumed that an economic
				benefit, whose value was equal to or greater than 20% of the person's net
				resources in the period (see subsection (d) of this section) for which the
				benefit was paid, is an economic benefit which contributed substantially to the
				person's welfare and livelihood. This presumption may be overcome by credible
				evidence. The burden is on the claimant to prove that benefits whose value was
				less than 20% of the person's net resources contributed significantly to the
				person's welfare and livelihood.
(d) Net resources for the purpose of
				subsection (b) of this section are 100% of all wage and salary income and all
				other income including nonpecuniary income and all income of the individual's
				spouse, less 100% of social security taxes and federal income tax
				withholding.
(e) The person
				claiming to be a dependent shall furnish sufficient information to enable the
				commission to accurately identify the net resources and to establish the
				existence of the economic benefit claimed. This information may include, but is
				not limited to, tax returns, a financial statement of the individual, and check
				stubs.
(f) If an economic benefit
				was provided in the form of goods and services, the value shall be the market
				value of the same or similar goods and services in the same vicinity.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.3 - Eligibility of Spouse To Receive Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) The surviving spouse is entitled to
				receive death benefits, unless subsection (b) of this section applies. The
				surviving spouse shall submit a certified copy of the marriage license, or
				satisfactory evidence of common-law marriage to the deceased employee, to the
				insurance carrier.
(b) A surviving
				spouse who abandoned the employee, without good cause for more than one year
				immediately preceding the death, shall be ineligible to receive death benefits.
				The surviving spouse shall be deemed to have abandoned the employee if the
				surviving spouse and the employee had not been living in the same household for
				more than one year preceding the employee's death unless the spouse is:
(1) hospitalized;
(2) in a nursing home; or
(3) living apart due to career choices,
				military duty, or other reasons where it is established their separation is not
				due to the pending breakup of the marriage. The burden is on a person who
				opposes the claim of a surviving spouse to prove the spouse abandoned the
				deceased employee.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.4 - Eligibility of a Child To Receive Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) A child eligible for death benefits is
				the son or daughter of a deceased employee, including an adoptive child, and
				including a dependent stepchild, who meets any of the conditions set out in the
				Texas Workers' Compensation Act (the Act), §4.42(g)(2).
(b) A person claiming benefits as the
				biological or adoptive son or daughter of a deceased employee shall submit
				proof of relationship to the deceased employee to the carrier or along with the
				claim for death benefits. The claimant shall submit a certified copy of the
				claimant's birth certificate or decree of adoption. If these documents do not
				exist, the claimant shall submit other proof of relationship, such as baptismal
				records, court orders establishing paternity, voluntary admissions of
				paternity, or affidavits of persons who have personal knowledge of the
				relationship to the deceased employee.
(c) If there are two parents listed on the
				claimant's birth certificate, but deceased employee is not listed, the claimant
				is presumed to be the child of the parents actually named and is presumed not
				eligible to receive death benefits. The presumption may be rebutted by credible
				evidence.
(d) A person claiming
				benefits as the dependent stepchild of the deceased employee shall prove that
				the employee was married to a parent of the claimant, and must also establish
				dependent status as set out in §
									132.2
				of this title (relating to Determination of Facts of Dependent
				Status).
(e) A child under 18 years
				of age, who is married or has been emancipated from the disabilities of
				minority at the time of the employee's death, shall not be eligible to receive
				benefits as a minor under the Act, §4.42(g)(2)(A).
(f) A child who is a full-time student at the
				time of the employee's death and is less than 25 years old shall submit
				evidence of enrollment at an accredited educational institution. A child shall
				only be considered a full-time student if the child meets the educational
				institution's requirements for a full-time student in the child's course of
				study.
(g) An adult child claiming
				eligibility to receive benefits under the Act, §4.42(g)(2), shall be
				required to establish dependent status as set out in §
									132.2
				of this title (relating to Determination of Facts of Dependent Status). A
				physically or mentally handicapped child also shall submit medical evidence of
				the handicap.
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.5 - Eligibility of a Grandchild To Receive Death Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) A grandchild who was dependent on the
				deceased employee on the day of death shall be entitled to receive death
				benefits, unless the grandchild's own parent is eligible for
				benefits.
(b) A person claiming to
				be an eligible grandchild shall submit proof of the relationship to the
				deceased employee to the carrier or along with the claim for death benefits.
				The claimant shall submit a certified copy of the claimant's birth certificate
				or decree of adoption, and a certified copy of the birth certificate or decree
				of adoption of the parent who was a child of the deceased employee. If these
				documents do not exist, the claimant shall submit other proof of relationship,
				such as baptismal records, court orders establishing paternity, voluntary
				admissions of paternity, or affidavits of persons who have personal knowledge
				of the relationship to the deceased employee. In addition, the claimant must
				present evidence of dependent status on the deceased employee as defined by
				§
									132.2
				of this title (relating to Determination of Facts of Dependent
				Status).
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.7 - Duration of Death Benefits for Eligible Spouse

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as provided in subsection (f) of
				this section, a spouse who is determined eligible for death benefits is
				entitled to receive benefits until the date of the spouse's death or until
				remarriage. The insurance carrier shall notify the eligible spouse of the
				requirements of this section within 60 days of initiating benefits to that
				spouse.
(b) An eligible spouse who
				enters into a ceremonial or informal marriage is entitled to receive a lump-sum
				payment of 104 weeks of death benefits.
(c) An eligible spouse shall notify the
				division and the insurance carrier in writing within 30 days of the date of
				remarriage. The notice shall include the name and social security number of the
				deceased employee, the date of death, the workers' compensation claim file
				number, and the date of remarriage.
(d) The amount of the lump-sum payment shall
				be calculated by multiplying the amount paid to the spouse the week prior to
				the remarriage by 104. If the insurance carrier paid any weekly benefits to the
				eligible spouse after the remarriage, the total amount of such payments shall
				be deducted from the amount of the commuted payment.
(e) An eligible spouse who knowingly accepts
				death benefits after remarriage in excess of the amount allowed by this
				section, and who does not notify the division or the insurance carrier of
				remarriage, may be subject to administrative penalties.
(f) An eligible spouse who remarries is
				eligible for death benefits for life if the employee was a first responder, as
				defined by Labor Code §
									504.055, or an individual
				described by Government Code §
									615.003(1)
				or Labor Code §
									501.001(5)(F),
				who died as a result of an injury in the course and scope of employment or
				while providing services as a volunteer. Subsections (b) - (e) of this section
				do not apply to an eligible spouse under this subsection. This subsection
				applies to:
(1) Eligible spouses of first
				responders, as defined by Labor Code §
										504.055:
(A) who remarry on or after September 1,
				2017; and
(B) who remarried between
				September 1, 2015, and August 31, 2017, if the claim is based on a compensable
				injury that occurred on or after September 1, 2015; and
Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 132 - DEATH BENEFITS-DEATH AND BURIAL BENEFITS › Section 132.8 - Duration of Death Benefits for an Eligible Child

Current through Reg. 49, No. 28; July 12, 2024
(a) A child, who is eligible to receive death
				benefits because the child is a minor on the date of the employee's death, is
				entitled to receive benefits until the date on which the child turns 18.
				However, if the child is enrolled as a full-time student in an accredited
				educational institution on that date, benefits continue as described in
				subsection (b) of this section.
(b)
				A child, who is eligible to receive death benefits as a full-time student in an
				accredited educational institution on the date of the employee's death or on
				the child's 18th birthday, is entitled to receive benefits until the earliest
				of:
(1) the date on which the child ceases,
				for the second consecutive semester (excluding summer semesters), to be
				enrolled as a full-time student;
(2) the date on which the child turns 25;
				or
(3) the date on which the child
				dies.