When it comes to the indemnity side of Workers’ Compensation, no area has had more changes than Supplemental Income Benefits (SIBs). An injured workers is entitled to SIBs when they receive an Impairment Rating (IR) of 15% or greater, their disability is directly resulting from the compensable injury, they are earning less than 80% of their Average Weekly Wage (AWW) and demonstrated an active effort to obtain employment in accordance with Labor Code §408.1415.
When the Texas Law changed in 1991, claimants were found entitled to SIBs with a letter from a doctor stating that they can not work or a list of places where they look for work (seeking employment in good faith).
Presently entitlement to SIBs is determined under Texas Administrative Code §130.102
(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.
Claimants must meet at least one of the criteria of A-E for each week of the qualifying period to be found eligible for the quarter of SIBs. Training programs should be through the Department of Rehabilitative Serves (DARS) or have documentation that the program has been approved by DARS.
The Claimant should register with the Texas Workforce Commission (TWC) and if they are seeking employment, should have job contacts each week equal to or greater than the minimum number required by the TWC for the given county to qualify for unemployment benefits.
Under the new rules, a designated doctor can be requested for ability to work prior to the second anniversary of the initial determination for entitlement. The designated doctor’s findings carry presumptive weight, but may be overcome by a preponderance of the evidence.
SIBs are a difficult area to navigate. The application of the Rules are in constant flux and are evolving as new case law is decided. If your insurance carrier disputes a quarter of SIBs and you prevail on that quarter, the insurance carrier is liable for your attorney’s fees. There is no reason not to have an attorney on your side for SIBs. Call us at our Dallas location, (214)357-1782 or contact us at firstname.lastname@example.org