(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.
(c) The carrier shall calculate the AWW in accordance
with Chapter 128 of this title (relating to Calculation of Average
Weekly Wage) and shall calculate the Post-Injury Earnings (PIE) in
accordance with §129.2 of this title (relating to Entitlement
to Temporary Income Benefits). In determining the PIE, the carrier
shall base its calculations on specific wage information reported
by the employer and/or the employee. A generic statement by the employer
indicating the employer is "continuing full salary" or "the employee
is earning full salary" is not adequate documentation to be considered
PIE.
(d) The carrier shall calculate the employee's lost
wages by subtracting the PIE from the AWW (or AWW - PIE).
(e) The amount of TIBs an employee is entitled to is
based on the lost wages. If the employee's PIE equals or exceeds the
employee's AWW, the employee has no lost wages and the carrier shall
not pay TIBs.
(f) Subject to the minimum and maximum TIBs rates as
provided in subsection (g) of this section, an employee is entitled
to TIBs as follows:
(1) for a workers' compensation claim with a date of
injury before September 1, 2015,
(A) an employee who earns $8.50 or more per hour is
entitled to TIBs in the amount of 70% of the lost wages; or
(B) an employee who earns less than $8.50 per hour
is entitled to TIBs as follows:
(i) 75% of the lost wages for the first 26 weeks of
TIBs due; and
(ii) 70% of the lost wages for all TIBs payments thereafter;
and
(2) for a workers' compensation claim with a date of
injury on or after September 1, 2015,
(A) an employee who earns $10 or more per hour is entitled
to TIBs in the amount of 70% of the lost wages; or
(B) an employee who earns less than $10 per hour is
entitled to TIBs as follows:
(i) 75% of the lost wages for the first 26 weeks of
TIBs due; and
(ii) 70% of the lost wages for all TIBs payments thereafter.
(g) The carrier shall pay the TIBs in the amount calculated
in subsection (f) of this section, unless:
(1) this amount is greater than the maximum weekly
TIBs rate computed in accordance with Texas Labor Code, §408.061,
in which case the carrier shall pay the maximum weekly TIBs rate;
or
(2) this amount, when added to the employee's PIE,
is less than the minimum weekly TIBs rate computed in accordance with
Texas Labor Code, §408.062, in which case the carrier shall pay
the minimum weekly TIBs rate.
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