Texas Department of Insurance, Division of Workers Compensation TDIDWC

1

• Texas Department of Insurance, Division of
  Workers Compensation (TDI-DWC)
• REVISED RULES FOR SUPPLEMENTAL INCOME BENEFITS
  (SIBs)
• Labor Code 408.1415, 408.142, 408.143
• Revised Rules 130.101 through 130.109

2
Agenda

• Whats New
• Work Search Requirements
• Texas Labor Code
• Amended Rules
• Vocational Rehabilitation Program

3
Agenda

• continued
• Work Search Efforts
• Effective Date for the Amended SIBS Rules
• Key Definition Changes
• Other Changes

4
Whats New

• Work Search Requirements Changes
• SIBs and the Effective Date for the Revised
  Rules.
• Key Definition Changes

5
Work Search Requirements
6
Work Search Requirements ChangeTexas Labor
Code

• Labor Code 408.1415 requires the Commissioner
  to
• establish the level of activity a recipient
  should have with TWC and DARS
• define the number of job applications required to
  be submitted and
• consider factors affecting the availability of
  employment.

7
Work Search Requirements ChangeAmended Rules

• Amended SIBs rules will require an injured
  employee to make
• active work search efforts.
• This replaces the requirement for the injured
  employee to make a good faith effort to search
  for work.

8
Work Search Requirements Rule 130.102(d)

• (New)
• To demonstrate an active effort to obtain
  employment, an injured employee must meet at
  least one or any combination of the five
  following work search requirements each week
  during the entire qualifying period
• 1. Actively participate in a vocational
  rehabilitation program
• 2. Actively participate in work search efforts
  conducted through the TWC
• 3. Perform active work search efforts
  documented by job applications

9
Work Search Requirements Rule 130.102(d)

• continued
• 4. Return to work in a position which is
  commensurate with the employees ability to work,
  or
• (Unchanged)
• 5. Be unable to perform any work in any capacity

10
Work Search RequirementsRule 130.102(d)(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.

11
Active Participation in a Vocational
Rehabilitation Program Rule 130.102(e)

• An injured employee must provide documentation
  sufficient to establish that he or she has
  actively participated in a vocational
  rehabilitation program during the qualifying
  period.

12
Work Search Efforts
13
Work Search Efforts Rule 130.102(f)

• An injured employee must 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 required for unemployment
  compensation in the employees county of residence

14
Work Search Efforts Rule 130.102(f)

• continued
• The documentation produced as proof of work
  search may include
• The date of the work search
• Employer name and who was contacted
• Job applied for
• The result of the contact
• Was a job application or resume filed

15
Work Search Requirements
16
Number of Weekly Work Search Contacts Required
during the Qualifying Period

• The minimum number of work search contacts will
  vary depending on the injured employees county
  of residence
• Number required weekly is established by the
  local TWC Workforce Development Board
• The number has ranged from one to seven per week

17
Number of Weekly Work Search Contacts Required
during the Qualifying Period

• continued -
• Only rural counties are permitted to set a work
  search contact requirement lower than three per
  week.
• 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.

18
Effective date for the Amended SIBs Rules
19
Qualifying Period and the Effective Date for the
Revised Rules

• Qualifying Period
• A period of time for which the employee's
  activities and wages are reviewed to determine
  eligibility for supplemental income benefits.
• Effective date - A qualifying period that begins
  on or after July 1, 2009, will fall under the
  requirements of the newly adopted SIBs rules, and
  a qualifying period that begins prior to July 1,
  2009, will still fall under the requirements of
  the existing SIBs rules.

20
Example of the Effective Date of the Rule

• An injured employee whose qualifying period
  begins on April 14, 2009, and ends on July 13,
  2009, will fall under the requirements of the
• existing rules and not the newly adopted rule as
  the qualifying period began prior to July 1, 2009.

21
Key Definition Changes
22
Key Definition Changes130.101

• Application for SIBs
• Employee must show compliance with Labor Code
  408.1415 and the work search requirements of the
  amended rules
• Eliminates good faith standard
• Self-employed individuals must establish the
  amount of income earned during the qualifying
  period

23
Key Definition Changes 130.101

• Vocational Rehabilitation Program
• Any program provided by DARS,
• A comparable federally-funded rehabilitation
  program in another state, or
• A private provider that is included in the
  Registry of Private Providers of Vocational
  Rehabilitation Services.

24
Key Definition Changes130.101

• continued
• Vocational Rehabilitation Program
• The program must be for
• The provision of vocational rehabilitation
  services designed to assist the injured employee
  to return to work, and
• Include a vocational rehabilitation plan.

25
Key Definition Changes 130.101

• continued
• A Vocational Rehabilitation Plan or Individual
  Plan for Employment (IPE) includes, at a minimum
• An employment goal and any intermediate goals
• A description of the services to be provided or
  arranged
• The start and end dates of the described
  services, and
• The injured employees responsibilities for
  successful completion of the plan.

26
Other Changes
27
1st Quarter of SIBs Determination(Changes) -
Rule 130.103

• The notice of determination shall be sent by DWC
  to the injured employee and the insurance carrier
  by first class mail, electronic transmission,
  or personal delivery.
• Subsection (d) - regarding referral to the
  Texas Rehabilitation Commission has been deleted
  from the amended rules.

28
Determination for Subsequent Quarters(Changes) -
Rule 130.104

• Injured employee will file the SIBs application
  and any documentation with the insurance carrier
  by first class mail, personal delivery or
  electronic transmission
• Insurance carrier will issue the notice of
  determination by first class mail, personal
  delivery or electronic transmission
• Notice of determination of non-entitlement shall
  contain sufficient claim specific information to
  enable the employee to understand the reason for
  the insurance carrier's determination

29
Determination for Subsequent Quarters(Changes) -
Rule 130.104

• continued
• The insurance carrier will send the injured
  employee a copy of the Application for
  Supplemental Income Benefits and include
• the minimum number of work search efforts
  required during the next qualifying period.

30
Loss of Entitlement to SIBsRule 130.106

• Refusal of Vocational Services
• An injured employee, in a vocational
  rehabilitation program, who refuses vocational
  services or refuses to cooperate with services
  provided at any time during the qualifying period
  is not entitled to SIBs for the related quarter.

31
Review

• Amended SIBs Rules are scheduled to be applicable
  to a qualifying period that begins on or after
  July 1, 2009
• Active work search efforts will replace the good
  faith effort standard
• An injured employee must demonstrate an active
  effort to obtain employment pursuant to Rule
  130.102(d) to meet the requirements

32
Review

• continued -
• TWC establishes the number of job contacts
  required by county
• The number has ranged from one to seven per week
• The required number of work search contacts will
  be available through a web link or by contacting
  TDI-DWC
• The definition of a Vocational Rehabilitation
  Program has changed pursuant to Rule 130.101

33
Review

• The SIBs application and entitlement notices may
  be sent by first class mail, electronic
  transmission, or personal delivery
• Insurance carriers must include the minimum
  number of work search efforts required for the
  next qualifying period on the DWC Form-052
• Rule sections 130.100, 130.105, 130.107 130.109
  have not changed

34
Resources

• Web link to obtain the required number of work
  search contacts
• http//www.tdi.state.tx.us/wc/employee/benefits.h
  tmlsibs
• Local Field Office
• Toll Free Phone Number 800-252-7031
• Web link to the Amended rules
  http//www.tdi.state.tx.us/wc/rules/adopted/index.
  html

35
Resources

• Internet Link for information on SIBs- Fast Facts
  
• http//www.tdi.state.tx.us/wc/publications.htmlf
  actsheets
• Internet link for DWC Form-052
• http//www.tdi.state.tx.us/forms/dwc/dwc52.pdf
• Division of Workers Compensation Website
• http//www.tdi.state.tx.us/wc/indexwc.html

36
Questions ?