28 Tex. Admin. Code § 116.12 - Subsequent Injury Fund Payment/Reimbursement Schedule
(a) Claims against the Subsequent Injury Fund
(SIF) shall be paid in the following priority:
(1) claims by insurance carriers for
reimbursement made pursuant to Labor Code §
403.007 and §
132.10(g) of
this title (relating to Payment of Death Benefits to the Subsequent Injury
Fund);
(2) claims by injured
employees for lifetime benefits, as provided by Labor Code §
408.162;
(3) claims by insurance carriers for
reimbursement, made pursuant to Labor Code §§
408.0041,
410.209, and
413.055 and §
116.11 of this title (relating to
Request for Reimbursement from the Subsequent Injury Fund); and
(4) claims by insurance carriers for
reimbursement made pursuant to Labor Code §
408.042(g)
relating to multiple employment and those in accordance with division rule(s)
adopted pursuant to Labor Code §
413.0141.
(b) The SIF uses the fiscal year
September 1 through August 31.
(c)
Claims described in subsection (a) of this section should be reviewed and, if
appropriate, paid in the fiscal quarter following the quarter in which the
request was submitted and no later than one year following the
submission.
(d) In accordance with
Labor Code §
403.006(d),
if the commissioner determines that partial payments of the claims described in
subsection (a)(4) of this section are necessary, partial payments shall be
calculated in the following manner:
(1) The
total amount of completed eligible requests for reimbursement submitted under
subsection (a)(4) of this section that are received during the previous fiscal
year will be used to establish a baseline amount.
(2) The baseline amount will be divided by
the total amount of SIF funding available as determined in accordance with the
Labor Code.
(3) The resulting
fraction will be equally applied to all claims submitted under subsection
(a)(4) of this section to determine the partial reimbursement amount.
(4) If reimbursement requests are paid with
partial payments, no further future recovery is available from the SIF for the
non-reimbursed portion of that particular request.
(e) If reimbursement requests are paid with
partial payments, the SIF administrator shall, no later than October 30 of the
following fiscal year, enter appropriate orders for claims described in
subsection (a)(4) of this section. The order shall specify the amount the SIF
shall pay to the insurance carrier.
(f) The SIF administrator will refrain from
acting on an insurance carrier's request for reimbursement from the SIF until
final resolution of all disputes affecting the request for
reimbursement.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.