1. (a) A carrier may request:

   1. (1) reimbursement from the Subsequent Injury Fund ("SIF") for an overpayment of income, death, or medical benefits when the carrier has made an unrecoupable overpayment pursuant to decision of a hearing officer or the appeals panel or an interlocutory order, and that decision or order is reversed or modified by final arbitration, order, or decision of the Commission, the State Office of Administrative Hearings, or a court of last resort; or
   2. (2) a refund of death benefits paid to the SIF pursuant to §132.10 of this title (relating to Payment of Death Benefits to the Subsequent Injury Fund) prior to a beneficiary being eligible to receive death benefits.
2. (b) The amount of reimbursement that the carrier may be entitled to is equal to the amount of unrecoupable overpayments paid and does not include any amounts the carrier overpaid voluntarily or as a result of its own errors. An unrecoupable overpayment of income benefits for the purpose of reimbursement from the SIF only includes those benefits that were overpaid by the carrier pursuant to an interlocutory order or decision which were finally determined to be not owed and which, in the case of an overpayment of income benefits to the employee, were not recoverable or convertible from other income benefits.

3. (c) The request for reimbursement or refund from the SIF shall be filed with the SIF administrator and shall be in writing and include:

   1. (1) a claim-specific summary of the reason the carrier is seeking reimbursement or refund
   2. (2) a detailed payment record showing the dates of payments, the amounts of the payments, the payees, and the periods of benefits paid, as well as documentation that shows that the overpayment was unrecoupable as described in subsection (b), if applicable;
   3. (3) the name, address, and federal employer identification number of the payee for any reimbursement or refund that may be due;

   4. (4) for requests for reimbursement of an unrecoupable overpayment made pursuant to a modified or overturned decision or interlocutory order pursuant to subsections (a)(1) and (b) of this section:

      1. (A) a copy of the decision or interlocutory order under which the carrier made the unrecoupable overpayment and the final decision of the Commission, State Office of Administrative Hearings, or the judgement of the court of last resort that modified or overturned the decision or interlocutory order;
      2. (B) copies of all reports by the employer including, but not limited to, the Employer's First Report of Injury, the Wage Statement, and all Supplemental Reports of Injury for overpayments of income benefits; and
      3. (C) if an overpayment of medical benefits, copies of all medical bills and preauthorization request forms associated with the overpayment for overpayments of medical benefits;

   5. (5) if the request is for a refund of death benefits paid to the SIF pursuant to §132.10 prior to a beneficiary being eligible to benefits, copies of:

      1. (A) the documentation the beneficiary provided with the claim for death benefits under §122.100 of this title (relating to Claim for Death Benefits); and
      2. (B) the agreement, the final award of the Commission, or the final judgment of a court of competent jurisdiction determining that the beneficiary is entitled to the death benefits, if entitlement to benefits had been disputed; and
   6. (6) any other documentation reasonably required by the SIF administrator to determine entitlement to reimbursement or payment from the SIF and the amount of reimbursement to which the carrier is entitled.

Source Note:The provisions of this §116.11 adopted to be effective February 11, 1992, 17 TexReg 689; amended to be effective March 13, 2000, 25 TexReg 2090.