1. (a) Continuing entitlement criteria. An injured employee initially determined by the commission to be entitled to supplemental income benefits will continue to be entitled to supplemental income benefits for subsequent compensable quarters if the employee, during each filing period:

   1. (1) has been unemployed, or underemployed as defined in §130.101 of this title (relating to Definitions), as a direct result of the impairment from the compensable injury; and
   2. (2) has made good faith efforts to obtain employment commensurate with the employee's ability to work.
2. (b) Statement of Employment Status. Unless this requirement has been expressly modified by the commission, an employee claiming continuing entitlement to supplemental income benefits must send the carrier a Statement of Employment Status. The carrier shall enclose a copy of the statement with the supplemental income benefit payment for the third month of the compensable quarter, accompanied by filing instructions and a description of the consequences of late filing and failing to file.
3. (c) Filing the statement. The employee shall file the statement with the carrier by first class mail or personal delivery. To ensure no lapse in benefits, the statement should be filed no later than the 15th day after receipt of the statement.
4. (d) Procedure for determining continuing entitlement and amount. Not later than 10 days after receiving the statement, the carrier shall determine continuing entitlement to supplemental income benefits, and send written notice of determination to the injured employee and the commission.

5. (e) Determination of continuing entitlement and amount. If the carrier determines that the employee continues to be entitled to supplemental income benefits at an amount the same or greater than that paid during the prior compensable quarter, the notice shall:

   1. (1) state the beginning and end dates of the next compensable quarter;
   2. (2) specify the amount of the monthly payment; and
   3. (3) specify the wages used to calculate the monthly payment.

6. (f) Determination of non-entitlement or reduced amount. If the carrier determines that the employee has lost entitlement to supplemental income benefits, or continues to be entitled at an amount less than that paid during the prior compensable quarter, the notice shall:

   1. (1) state the grounds for this determination; and
   2. (2) request the commission to set a benefit review conference, as provided by §130.108 of this title (relating to Contesting Entitlement or Amount of Supplemental Income Benefits).

7. (g) Accrual date. If the employee is entitled to supplemental income benefits under this section, the benefits begin to accrue on the later of:

   1. (1) the day after the last day of the prior compensable quarter; or
   2. (2) the date the statement is filed with the carrier.

Source Note:The provisions of this §130.104 adopted to be effective April 17, 1992, 17 TexReg 2400.