| (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.
(c) Direct Result. An injured employee has earned less
than 80% of the injured employee's average weekly wage as a direct
result of the impairment from the compensable injury if the impairment
from the compensable injury is a cause of the reduced earnings.
(d) Work Search Requirements.
(1) An injured employee demonstrates an active effort
to obtain employment by meeting at least one or any combination of
the following work search requirements each week during the entire
qualifying period:
(A) has returned to work in a position which is commensurate
with the injured employee's ability to work;
(B) has actively participated in a vocational rehabilitation
program as defined in §130.101 of this title (relating to Definitions);
(C) has actively participated in work search efforts
conducted through the Texas Workforce Commission (TWC);
(D) has performed active work search efforts documented
by job applications; or
(E) has been unable to perform any type of work in
any capacity, has provided a narrative report from a doctor which
specifically explains how the injury causes a total inability to work,
and no other records show that the injured employee is able to return
to work.
(2) An injured employee who has not met at least one
of the work search requirements in any week during the qualifying
period is not entitled to SIBs unless the injured employee can demonstrate
that he or she had reasonable grounds for failing to comply with the
work search requirements under this section.
(e) Vocational Rehabilitation. As provided in subsection
(d)(1)(B) of this section, regarding active participation in a vocational
rehabilitation program, an injured employee shall provide documentation
sufficient to establish that he or she has actively participated in
a vocational rehabilitation program during the qualifying period.
(f) Work Search Efforts. As provided in subsection
(d)(1)(C) and (D) of this section regarding active participation in
work search efforts and active work search efforts, an injured employee
shall provide documentation sufficient to establish that he or she
has, each week during the qualifying period, made the minimum number
of job applications and or work search contacts consistent with the
work search contacts established by TWC which are required for unemployment
compensation in the injured employee's county of residence pursuant
to the TWC Local Workforce Development Board requirements. If the
required number of work search contacts changes during a qualifying
period, the lesser number of work search contacts shall be the required
minimum number of contacts for that period. If residing out of state,
the minimum number of work search contacts required will be the number
required by the public employment service in accordance with applicable
unemployment compensation laws for the injured employee's place of
residence.
(g) Calculation of amount. Subject to any approved
reduction for the effects of contribution, the monthly supplemental
income benefit payment is calculated quarterly as follows:
(1) multiply the injured employee's average weekly
wage by 80% (.80);
(2) add the injured employee's wages for all 13 weeks
of the qualifying period;
(3) divide the total wages by 13;
(4) subtract this figure from the result of paragraph
(1) of this subsection;
(5) multiply the difference by 80% (.80);
(6) if the resulting amount is greater than the maximum
rate under the Act, Labor Code, §408.061, use the maximum rate;
and
(7) multiply the result by 4.34821.
(h) Maximum Medical Improvement and Impairment Rating
Disputes. If there is no pending dispute regarding the date of maximum
medical improvement or the impairment rating prior to the expiration
of the first quarter, the date of maximum medical improvement and
the impairment rating shall be final and binding.
(i) Services Provided by a Carrier Through a Private
Provider of Vocational Rehabilitation Services. The insurance carrier
is responsible for reasonable travel expenses incurred by the injured
employee if the employee is required to travel in excess of 20 miles
one way from the injured employee's residence to obtain vocational
rehabilitation services from a private provider.
|
| Source Note: The provisions of this §130.102 adopted to be effective January 31, 1999, 24 TexReg 399; amended to be effective November 28, 1999, 24 TexReg 10339; amended to be effective July 1, 2009, 34 TexReg 2138; amended to be effective April 15, 2018, 43 TexReg 2153 |
