28 Tex. Admin. Code § 126.4 - Advance 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.
Notes
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