1. (a) Disputes, General. The injured employee, the injured employee's representative, and the insurance carrier shall not pursue a dispute on entitlement or non-entitlement to supplemental income benefits without a factual or legal basis. Further, the insurance carrier shall not dispute entitlement to a subsequent quarter without considering a comparison of the factual situation of the qualifying period for the previous quarter with the factual situation of the current qualifying period.
2. (b) Injured Employee Disputes. An injured employee may contest the determination by the commission or carrier regarding non-entitlement to, or the amount of, supplemental income benefits by requesting a benefit review conference as provided by §141.1 of this title (relating to Requesting and Setting a Benefit Review Conference).
3. (c) Insurance Carrier Dispute; First Quarter. If a carrier disputes a commission finding of entitlement to, or amount of, supplemental income benefits for the first quarter, the insurance carrier shall request a benefit review conference as provided by §141.1 of this title (relating to Requesting and Setting a Benefit Review Conference) within 10 days after receiving the commission determination of entitlement. A carrier waives the right to contest the commission's determination of entitlement to, or amount of, supplemental income benefits for the first quarter if the request is not received by the commission within 10 days after the date the insurance carrier received the determination.
4. (d) Insurance Carrier Dispute; Subsequent Quarter With Prior Payment. If an insurance carrier disputes entitlement to a subsequent quarter and the insurance carrier has paid supplemental income benefits during the quarter immediately preceding the quarter for which the Application for Supplemental Income Benefits is filed, the carrier shall dispute entitlement to the subsequent quarter by requesting a benefit review conference as provided by §141.1 of this title (relating to Requesting and Setting a Benefit Review Conference) within 10 days after receiving the Application for Supplemental Income Benefits. A carrier waives the right to contest the entitlement to supplemental income benefits for the subsequent quarter if the request is not received by the commission within 10 days after the date the insurance carrier received the Application for Supplemental Income Benefits. The insurance carrier does not waive the right to contest entitlement to supplemental income benefits if the carrier has returned the injured employee's Application for Supplemental Income Benefits pursuant to §130.104(c) of this title (relating to Determination of Entitlement or Non-entitlement for Subsequent Quarters).
5. (e) Insurance Carrier Disputes; Subsequent Quarter Without Prior Payment. If an insurance carrier disputes entitlement to a subsequent quarter and the carrier did not pay supplemental income benefits during the quarter immediately preceding the quarter for which the Application for Supplemental Income Benefits is filed, the carrier shall send the determination to the injured employee within 10 days of the date the form was filed with the insurance carrier and include the reasons for the carrier's finding of non-entitlement and instructions about the procedures for contesting the carrier's determination as provided by subsection (b) of this section.

6. (f) Liability. An insurance carrier who unsuccessfully contests a commission determination of entitlement to supplemental income benefits is liable for:

   1. (1) all accrued, unpaid supplemental income benefits, and interest on that amount, and;
   2. (2) reasonable and necessary attorney's fees incurred by the employee as a result of the carrier's dispute which have been ordered by the commission or court.

Source Note:The provisions of this §130.108 adopted to be effective January 31, 1999, 24 TexReg 399.