1. (a) Reinstated entitlement criteria. Except as provided by §130.106 of this title (relating to Permanent Loss of Entitlement to Supplemental Income Benefits), an injured employee initially determined by the commission to be entitled to supplemental income benefits, but who thereafter loses entitlement, will regain entitlement if the employee, for one filing period:

   1. (1) is 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) Delayed entitlement criteria. Except as provided by §130.106 of this title (relating to Permanent Loss of Entitlement to Supplemental Income Benefits), an injured employee initially determined by the commission not to be entitled to supplemental income benefits will become entitled if the employee, for one filing period:

   1. (1) is 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.
3. (c) Statement of Employment Status. An injured employee seeking reinstated or delayed entitlement to supplemental income benefits must send the carrier a Statement of Employment Status by first class mail or personal delivery.
4. (d) Procedure for determining reinstated or delayed entitlement and amount. Not later than 10 days after receiving the statement, the carrier shall determine reinstated or delayed entitlement to supplemental income benefits, and send written notice of determination to the injured employee and the commission.

5. (e) Determination of entitlement and amount. If the carrier determines that the employee is entitled to reinstated or delayed supplemental income benefits, the notice shall:

   1. (1) state the beginning and end dates of the compensable quarter;
   2. (2) specify the amount of the monthly payment;
   3. (3) specify the wages used to calculate the monthly payment;
   4. (4) advise the employee of the procedures for contesting the carrier's calculation of amount, as provided by §130.108 of this title (relating to Contesting Entitlement or Amount of Supplemental Income Benefits); and
   5. (5) enclose instructions for filing the Statement of Employment Status, a filing schedule, and a description of the consequences of late filing and failing to file.

6. (f) Determination of non-entitlement. If the carrier determines that the employee is not entitled to reinstated or delayed supplemental income benefits, the notice shall:

   1. (1) state the grounds for this determination;
   2. (2) advise the employee of the procedures for contesting the carrier's determination, as provided by §130.108 of this title (relating to Contesting Entitlement or Amount of Supplemental Income Benefits); and
   3. (3) enclose a Statement of Employment Status and filing instructions for claiming reinstated or delayed entitlement to supplemental income benefits, as provided by §130.105 of this title (relating to Reinstated or Delayed Entitlement to 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 date the statement is filed with the carrier.

Source Note:The provisions of this §130.105 adopted to be effective April 17, 1992, 17 TexReg 2400.