The insurance carrier shall enclose with the first payment a notice to the employee. The notice shall be on a form prescribed by the commission. The notice shall state:

1. (1) that the payment is a temporary income benefit;
2. (2) that the employee is required to notify the insurance carrier when the employee returns to work, and report any wages received after the date of injury while benefits are continuing;
3. (3) that the employee is required to notify the insurance carrier of any bona fide offer of employment;
4. (4) the name, address, and phone number of the adjuster handling the claim;
5. (5) that entitlement to temporary income benefits continues only until the employee has reached maximum medical improvement, or until 104 weeks have elapsed from the beginning date of disability, at which time other benefits may be available;
6. (6) that the commission provides an ombudsman at no cost to assist employees who have been notified of a benefit review conference or a benefit contested case hearing and that the ombudsman may be reached by calling 1-800-252-7031 or the local office of the commission. Employees who have questions, other than those about a pending proceeding, should contact the local field office at 1-800-252-7031, and will be assisted by the appropriate commission personnel.

Source Note:The provisions of this §129.3 adopted to be effective January 24, 1991, 16 TexReg 175; amended to be effective December 2, 1997, 22 TexReg 11699.