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TITLE 28INSURANCE
PART 2TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 126GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS
RULE §126.4Advance of Benefits Based on Financial Hardship

(a) An injured employee seeking an advance of income benefits based on financial hardship shall submit a written application to the Commission in the form and manner prescribed by the Commission that states the basis for the hardship The application must state the employee understands that if an advance is granted the amount of future weekly benefit payments will be reduced as directed by the Commission.

(b) The Commission shall forward a copy of the employee's application to the insurance carrier and shall consider the employee's application and may order an advance if it determines that both a hardship exists for the employee and the employee is likely to be entitled to income benefits sufficient to cover the amount of the advance.

(c) An advance will not be granted to an employee whose combined post-injury earnings, as defined by §129.2 of this title (relating to Entitlement to Temporary Income Benefits), and income benefits under this Act equals or exceeds 90% of the employee's net pre-injury wage. In the absence of specific evidence to the contrary, the net pre-injury wage of an employee shall be presumed to be 80% of the average weekly wage, for this section.

(d) The Commission shall notify the carrier and the employee in writing when an advance is ordered. The notice shall include the amount of the advance to be paid; this amount shall not exceed four times the maximum weekly benefit for temporary income benefits as computed under the Act, §408.061(a). The carrier shall pay an advance ordered by the Commission within seven days of the receipt of notice from the Commission by the carrier's Austin representative.

(e) After the carrier has paid an advance, it shall reduce the amount of the weekly income benefits in an amount set by the Commission, which takes into account the amount advanced and the number of weeks that benefits are likely to be paid in the future. The weekly benefits may be paid in this reduced amount until the carrier has recouped the amount advanced.

(f) The total amount of benefits paid to the employee through weekly payments and advances based on hardship shall not exceed the amount the employee would have received under a normal payment schedule. No more than three advances shall be granted based on the same injury.


Source Note: The provisions of this §126.4 adopted to be effective January 30, 1991, 16 TexReg 313; amended to be effective December 26, 1999, 24 TexReg 11399

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